A recent publication by third-year resident Dr. Amanda Grippen Goddard is her second as lead author to appear this fall. Her first came just a month ago and was written in collaboration with Internal Medicine Chief Resident Dr. Bryan McConomy, Radiology resident Dr. Girish Bathla, and two Internal Medicine faculty members, Dr. Muhammad Furqan and Dr. William Silverman. This article appeared in the Cleveland Clinic Journal of Medicine.
This second publication by Dr. Grippen Goddard has just been published in the Annals of Allergy, Asthma & Immunology and is titled “Work-related asthma secondary to IgE-mediated reactions to rodents successfully treated with immunotherapy.” This case series has one co-author, Dr. Antoine Azar. It demonstrates that after allergen immunotherapy (AIT), also commonly known as allergy shots, four laboratory animal workers who regularly came into contact with mice and rat dander experienced decreased asthma symptoms and allergies at work. After AIT, they required fewer drug interventions such as albuterol inhaler use and they missed fewer days of work.
The Department asked Dr. Goddard for more information about this study and is grateful for her participation in this interview, with questions slightly edited for clarity.
Dr. Azar was a resident at the University of Iowa and a fellow and then faculty in Immunology before taking a position at Johns Hopkins University, correct?
That is correct. Dr. Azar was a resident and then did a dual fellowship in Allergy/Immunology and Infectious Disease. He worked in the Allergy/Immunology department after graduating from his fellowships. I met him during my first year of residency during an elective month in the Allergy/Immunology Clinic. The interesting patient cases and learning opportunities helped me realize a potential direction for my future. He and I started working on this publication before he left UIHC in the spring of my intern year to go to Hopkins.
Were all the patients in this case series seen here?
This is a retrospective study and each of these patients were seen in our Allergy Clinic at UIHC. All of these patients were seen personally by Dr. Azar prior to my residency. There is very little research on the topic of allergen immunotherapy to rodent allergens in patients who have developed allergies and/or asthma to rodent dander. Due to the fact that UIHC alone had four adult patients whose asthma improved with rodent allergen immunotherapy, we wanted to make others aware of this potential treatment strategy. Hopefully, other patients around the world who work with rodents and have similar symptoms can benefit from our data.
This publication cites three other articles from 1980, 2004, and 2013, in which patients with rodent allergies are treated with AIT. Were they not looking at allergies in the context of the workplace? What sparked your interest in this subject?
Several other publications have mentioned one or two patients that had rodent allergies secondary to a workplace setting who were treated with rodent immunotherapy; however, most of these articles didn’t discuss immunotherapy for asthma as was the focus of our paper. Previous publications did not follow patients for years after they returned to the workplace to evaluate for sustained benefits. My research interests are clinical in nature. Knowing that very little literature was published on the topic of rodent allergen immunotherapy for lab animal workers, I was compelled to investigate this topic further since UIHC had a case series of patients. It was also beneficial to have a mentor who was also interested in this topic.
You call for a large-scale, double-blind study. Will you or Dr. Azar expand on this research into a larger study? Would you have interest in doing that?
I think it would be very beneficial and have more impact if this study could be expanded. Currently, neither one of us are researching this topic, but we both have an interest in further researching this topic. As I continue to grow in my career as an allergy/immunologist, I hope to collaborate with other institutions, such as Johns Hopkins, on clinical research projects.
Is allergy and immunology the direction you want to head after finishing your residency? What about it do you find compelling?
As I have alluded to previously in this interview, I plan to complete a fellowship in allergy/immunology. I will be one of the internal medicine chief residents in 2017/2018 and hope to continue researching various topics in allergy/immunology over the course of the next 18 months before starting fellowship. Beginning residency 2 1/2 years ago, I knew little about the field of allergy/immunology. I am grateful to have had the opportunity to rotate through the allergy/immunology department early on in residency and meeting both of my mentors, Dr. Azar and Dr. (Zuhair) Ballas. I find this specialty of internal medicine compelling because you have the opportunity to work with patients of all ages, be at the forefront of advances in immunology and are able to appreciate your patient’s improvement in the quality of their life when allergies are treated appropriately.
I have been very fortunate to have great mentors in residency; they have taught me both the process of publishing in medical journals and to never give up even when your paper has been rejected from several journals.