Immunology & Allergy
- 555 University Avenue, 7th Floor, Black Wing
The Division of Immunology and Allergy provides comprehensive consultative care for patients with inborn errors of immunity and complex allergic diseases. The Division offers six Immunology and Allergy sub-specialty clinics, an immunoglobulin replacement program and inpatient consultative services. We see approximately 1,400 patients annually in our Immunology and Allergy clinics.
The Immunology clinic provides diagnosis and treatment of patients with genetically inherited disorders of the immune system. Patients are referred from across Canada for diagnosis and recommendations for management. The Division works collaboratively with the Bone Marrow Transplant team to provide advanced immunodeficiency management, such as hematopoietic stem cell transplant, to those patients with inborn errors of immunity who may benefit from such therapies.
The Allergy clinic is a referral clinic for the diagnosis and management of children with complex allergic diseases including multiple drug allergies, vaccine allergy, food allergies and patients with complex medical conditions followed by SickKids who require an allergy assessment. The clinic and consultative service provide allergy testing, challenges and desensitizations as needed. Patients with common allergies are referred to designated allergists in the community.
Our Division offers a comprehensive subspecialty residency program that is accredited by the Royal College of Physicians and Surgeons of Canada and a world-renowned fellowship program, enabling trainees to gain in depth experience in a broad range of clinical and theoretical immunology and allergy, including translational and basic research.
What we do
A regional, national and international referral centre
The Primary Immunodeficiency (PID) program at SickKids is the largest centre in Canada. It provides consultation services to over 2,000 outpatients referred from physicians and hospitals across Canada and in-patients with highly complex disorders such as Severe Combined Immune Deficiency Syndrome, receiving highly specialized bone marrow transplant procedures.
This centre will ensure that SickKids' renowned bedside to bench to bedside process continues, allowing the hospital to produce new generations of research and clinical leaders who know why, for example, a common infection causes only a cold in some individuals, while in others it causes devastating meningitis.
At the most extreme end of inherited primary immunodeficiencies are children with Severe Combined Immunodeficiency (SCID). These children have a complete absence of both T and B lymphocyte function, which is essential to lead a normal life. The absence of these types of functional white blood cells puts the very young child at risk for serious life-threatening infections, specifically opportunistic pathogens such as fungus, viruses and pneumocystis jiroveci pneumonia (PJP).
Clinically, these young infants have recurrent severe infections, failure to thrive, diarrhea and sometimes skin rashes. Treatment options for SCID are currently limited to bone marrow transplantation, which involves infusing stem cells from a healthy donor who matches the patient. These transplants are either full-matched sibling transplants or matched unrelated donor transplants.
The BMT Program for primary immunodeficiencies at SickKids is the only one of its kind in Canada. It is a leader in the field of Transplantation for SCID both in Canada and around the world. In the late 1970s the first national transplant for primary immunodeficiencies was performed here, and since that time approximately 50 or more similar transplants have been performed. This is an extremely significant number given the rarity of these conditions.
The first national matched unrelated donor transplant was also executed at SickKids in 1990 in a patient with Omenn’s Syndrome, and since then SickKids holds the highest survival rate for these transplants at 77 per cent compared to 61 per cent in European centres. This transplant program provides care to children all across Canada with a wide variety of immunodeficiencies such as IL-2R deficiency and ADA deficiency, and many types of autosomal recessive and X-linked diseases.
Both before during and after the actual Bone marrow transplant, the SickKids Immunology Team is very involved with each patient and their family in terms of locating a potential donor and devising a plan of care. After the transplant, the Immunology Team follows the patient very closely to provide complex post-transplant care. With a true "bench to bedside" approach to patient care, this program provides genetic diagnoses and outstanding therapeutic practices/clinical care for these patients, while adding to the growing body of knowledge about patients with these inherited disorders.
Chaim Roifman MD
Brenda Reid RN
There are a number of inherited disorders of the immune system that are characterized by patients lacking the ability to produce antibodies. Patients with documented antibody deficiency syndromes are enrolled into the gammaglobulin treatment program at SickKids. Once stable, on therapy patients may receive their treatment in a community hospital that is closer to home and be monitored by a community care physician.
The program team consists of Dr. Roifman and an advanced practice nurse. They monitor the patients’ monthly laboratory results from the community and assess the patients at routine clinic appointments at SickKids. The Immunology Team is always available for consultation to the patients and physicians in the community. This treatment model allows for patients to have the expertise of the SickKids team, while at the same time allowing for care to be delivered in a convenient location for patients and families.
Patients in the program are also monitored for infections by history, pulmonary function tests, and CT scans of their lungs to determine if lung disease develops. As well, liver function tests and viral screening are performed to monitor the safety of gammaglobulin therapy, by screening for possible viral transmission through the blood product. With a long-term follow-up on over 150 patients, the Hypogammaglobulinemia Program at SickKids is one of the largest treatment programs for this patient group in the world. In being viewed as world leaders in the management and treatment of hypogammaglobulinemia, Dr. Roifman and the Clinical Team involved in this program have been invited to participate in National and International Consensus Conferences on patient management of hypogammaglobulinemia and gammaglobulin therapy.
Launched in 2013 by Dr. Eyal Grunebaum, the Food Allergy and Anaphylaxis Program (FAAP) is leading the development of breakthrough research to progress the field of food allergy.
This includes conducting immunological research to understand the mechanisms of food allergy and anaphylaxis for prevention and treatment, performing clinical trials to evaluate treatment options for milk, peanut, and tree nut allergies, and providing educational activities for patients and health care providers. An additional goal of the FAAP team is promoting public awareness of food allergies. The main vision of the SickKids FAAP team continues to be a future without the fear of food.
Chaim Roifman MD
Harjit Dadi PhD
Diagnostic information for patients with primary immunodeficiencies (PIDs) in Ontario and across Canada will be provided via techniques such as protein identification, cloning and sequencing, and a state-of-the-art flow cytometry facility. This strictly pertains to service rendered for already known entities. As new types of PIDs are discovered, the service will adapt quickly and implement accurate and reliable tests. This facility currently includes a modernized immunology service laboratory, located near relevant research activities to their mutual benefit.
Immunology & Allergy Clinics
The Division's team members are involved in various clinical and research activities related to paediatric immunology and allergy.
- Maria Asper
- David Hummel
- Audrey Segal
- Lucy Duan
- Jessica Willett Pachul (Clinical Nurse Specialist)
- Anna Kasprzak (Registered Nurse)
- Sydney Arnold (Registered Nurse)
- Wendy Shama (Social Worker)
- Ori Scott
- Mei Xu
- Jenny Garkaby
- Narges Baluch
- Pinkal Patel
- Laura Abrego Fuentes
The Food Allergy and Anaphylaxis Program actively conducts both clinical trials and basic research to better understand factors influencing the development of tolerance to food allergens, improve approaches to diagnosing allergies, and evaluate novel, safer and more effective treatment options.
Within the Division of Immunology and Allergy there are currently 6 clinical trials in-progress, including:
- Two on-going clinical trials investigating potential low-dose oral immunotherapy (OIT) treatments for children allergic to nuts.
- A phase III clinical trial evaluating the short- and long-term efficacy of epicutaneous immunotherapy in young children. Patients are given patches containing peanut allergen to determine if desensitization to peanut is achieved over time.
- A trial investigating the use of omalizumab (an asthma medication) to facilitate safer and faster OIT for multiple allergens at the same time.
- A clinical trial focusing on the use of platelet activating (PAF) inhibitors to manage allergic symptoms is in planning.
More details about some currently enrolling trials can be found on Research4Kids, or please contact email@example.com for more information.
Translational research projects
- Investigating human models for food allergy which can be used as a platform for drug testing such as human gut tissue model (Eiwegger Lab) and animal models of peanut allergy (Grunebaum Lab).
- Understanding the immunological mechanisms that contribute to the development of food allergies in patients with existing immunodeficiencies or after organ transplantation
- Developing novel methods to diagnose and predict nut allergy with a higher degree of precision than current diagnostic approached
- Identifying unique patterns of food allergen recognition by the immune system
Paediatric Clinical Immunology & Allergy Residency Program
Dr. Vy Kim was appointed the Paediatric Clinical Immunology & Allergy Residency Program Director effective July 2017, while Dr. Chaim Roifman continues to be the Paediatric Clinical Immunology and Allergy Fellowship Program Director.
The goal of this program at SickKids and the University of Toronto, is to generate sub-specialists in Paediatric Immunology and Allergy, who will provide the medical community with expert consultation. This two-year program attracts trainees from around the world and exceeds the essential clinical and laboratory elements that permit outstanding training in Clinical Immunology and Allergy.
The program provides individual training, with flexibility to accommodate trainees’ interests and career goals by presenting opportunities for focusing on immunology, allergy, academia, or community practice. Clinically, the program offers extensive inpatient and outpatient learning experiences through efficiently structured rotations, rounds, and clinics that are embedded with well-organized academic content. There is extensive exposure to diagnosis and management of primary immunodeficiencies with a high level of case diversity, with strong links with the Adult Clinical Immunology and Allergy residency program at St. Michael's Hospital.
The program is committed to the incorporation of research training into the program. The faculty of the Division of Immunology and Allergy at SickKids are committed to guiding residents through all aspects of research. A mandatory research project, along with directions on proposal and grant applications, encourage the participation of residents in tangible publications. The accommodating and experienced staff, diverse patient population, availability of cutting-edge resources and an office with personal working space, all provide the trainees with an excellent learning environment.
Clinic appointments: 416-813-8156
General and education inquiries:
Division of Immunology & Allergy
555 University Avenue
Black Wing, 7th Floor
Clinical immunology was established at the hospital with the appointment of Dr. Robert Orange as Head of the Division of Immunology in 1971. During his tenure at SickKids, Dr. Orange’s work on mediators of inflammation had an significant impact on the emerging field of immunology.
Dr. Erwin Gelfand, who took over the leadership of the Division after Dr. Orange’s premature death, can be credited with the creation of a world-renowned research and clinical centre thanks to his work in complement deficiencies and fetal thymus transplantation. He also enhanced the horizons of the field by hiring a group of clinician-researchers with expertise in rheumatology.
Since Dr. Gelfand's departure in 1987, rheumatology has evolved into an independent division with the Division of Immunology and Allergy being merged into a single division in 1991 under the leadership of Dr. Chaim Roifman. Major achievements since that time include pioneering work in bone marrow transplants for patients who do not have a suitable donor in their family, exploration of the benefits of intravenous immune globulin for patients with immunodeficiency and autoimmunity, and groundbreaking research into the molecular and genetic bases of immune disorders.