Division Focus: Pediatric Allergy, Immunology & Rheumatology

Pediatric AIR combines clinical care with a keen focus on research to deliver the best care possible.

Division Focus: Pediatric Allergy, Immunology & Rheumatology click to enlarge Dr. Ilona Jaspers works in the lab with a colleague.

Allergic diseases are among the most common causes of chronic disease in childhood, with asthma being the most common reason for hospitalization and lost school time in childhood. The pediatric specialists in the UNC Division of Pediatric Allergy, Immunology and Rheumatology treat children with a variety of known or suspected allergic and immunological diseases—and they are also at the forefront of discovery, researching causes and potential treatments.

“Clinically, AIR looks into three things,” explains David Peden, MD, MS, chief of the division. “One, allergic diseases. Two, recurrent infections or immune deficiencies. Three, autoimmune diseases such as lupus.” 

This basic explanation only begins to describe a division that provides a large number of services and performs a wide range of research in conjunction with agencies worldwide. Not bad for a division formed in 2001 as Immunology and Environmental Medicine.

“We had only one allergist on the staff—me,” says Dr. Peden with laugh.

The division continued to grow, adding rheumatologists and other clinicians. In 2004, Peden was named chief of the combined division. Growth of the division's programs and services has been steady since.

Center for Environmental Medicine, Asthma and Lung Biology (CEMALB) 

“Allergy and immunology research has two primary foci: the Food Allergy Initiative with Drs. Wesley Burks and Brian Vickery, and the UNC Center for Environmental Medicine, Asthma and Lung Biology (CEMALB), which researches the impact of environmental agents such as air pollution on human disease,” explains Dr. Peden.

CEMALB is a multidisciplinary lab that works closely with the U.S. Environmental Protection Agency through their Human Studies Division on the UNC campus. The division has worked closely with the EPA on air pollution issues for nearly 30 years.

“We are in the same building, and sometimes we think of ourselves as UNC’s embassy to the EPA,” chuckles Dr. Peden.

Research at CEMALB includes that of Timothy Moran, MD, PhD, who studies how environment influences the development of childhood asthma.

“A key question of my research is whether environmental allergens and irritants found within household dust can promote allergic responses in the respiratory tract,” explains Dr. Moran. “Children in the United States are spending an increasing amount of time indoors, and there is growing concern that this change in lifestyle may be contributing to the rising prevalence of allergic asthma.” 

Using preclinical models, Moran examines the effects of house dust on immune cells within the lungs. He is also investigating the molecular mechanisms responsible for inducing allergic airway inflammation with the aim of identifying new therapeutic targets for childhood asthma.

Research led by Ilona Jaspers, PhD, also focuses on the effects of pollutants on the lungs—more specifically: 1) how cigarette smoke can modify and suppress the immune system in lungs and make them susceptible to viral infections; 2) how other inhaled contaminates, such as diesel exhaust and wood smoke, affect the lungs and viral infections; and 3) how ozone exposure and oxidized lipids can modify host defenses in the lung. 

A rising area of research is how new and emerging tobacco products, such as hookas and e-cigarettes, affect the health of those who use them. 

“We have received funding from the NIH and FDA to find out as much as possible about these products as the agencies begin to decide whether and how to regulate them,” explains Jaspers. 

She notes that one aspect of this research she finds challenging and interesting is how “vaping,” or the use of e-cigarettes, constantly changes. New devices, flavors, and mechanisms of e-cigarettes use change the potential exposure and toxicity of vaping. 

Other Research within the Division

Kevin Kelly, MD, a member of the division who also serves as pediatrician-in-chief of N.C. Children’s Hospital, is an internationally renowned expert in latex allergy. The condition was once an epidemic among healthcare workers and spina bifida patients, with about 17 percent of healthcare workers developing an IgE antibody mediated hypersensitivity to latex and nearly 70 percent of patients with spina bifida developing the problem. Dr. Kelly’s work in collaboration with the Center for Disease Control, the National Institute of Occupational Safety and Health, and others has contributed to the near eradication of latex allergy in these populations.

Leonard D. Stein, MD, is a pediatric rheumatologist whose research interests include rheumatoid arthritis and juvenile idiopathic arthritis.

Dr. Johnny L. Carson works in the lab. Click to enlarge.
Johnny L. Carson, PhD, works in the basic sciences with a primary focus on primary ciliary dyskinesia and other cilia-related disorders. His examination of cilia ultrastructure using high resolution transmission electron microscopy has advanced knowledge in the field and helped diagnose affected children.

Mike Kulis, PhD, rounds out the UNC Food Allergy Initiative, overseeing the operation of the food allergy lab and helping determine the direction of research projects.

Clinical Care

Providers within the Division of Pediatric AIR see patients in inpatient and outpatient settings at N.C. Children’s Hospital in Chapel Hill. They also see patients on an outpatient basis at the UNC Children’s Specialty Clinic on the Rex Healthcare campus in Raleigh.

They work in collaboration with providers in other clinical specialties to offer one-stop care for patients. The UNC Children’s asthma management program, co-led by the division’s Michelle Hernandez, MD, and Ceila Loughlin, MD, in the Division of Pediatric Pulmonology, is an important example of this collaboration. The program combines the expertise of clinicians from AIR and pulmonology with others (including emergency medicine, general pediatrics, critical care, pharmacy, respiratory therapy, and even nursing), offering a cohesive care experience and minimizing the family’s need to make multiple appointments to see various specialists.

Rheumatology continues to expand in terms of clinical offerings and research with the work of Eveline Wu, MD, who is developing a pediatric systemic lupus erythematosus clinic that combines the services of pediatric rheumatology and pediatric nephrology. The new clinic will offer a streamlined approach to care like the asthma management program, enabling patients to see multiple caregivers in one visit.

The expansion of rheumatology services will also include CHAPEL, which stands for “Chapel Hill Alliance Promoting Excellence in Lupus,” a research group which includes rheumatologists and nephrologists. 

The division’s clinical team is also held in high esteem for their advocacy efforts.

Dr. Peden was recently elected to the leadership track of the American Academy of Allergy, Asthma and Immunology. He will be secretary/treasurer followed by terms as president-elect, president, and past president.

“(UNC Children’s chief physician) Dr. (Wesley) Burks held those same posts, so that makes UNC one of the rare organizations with two serving members who have held leadership positions in the AAAAI,” observes Dr. Peden.

Research Facts and Figures

AIR faculty lead research projects administered in the Center for Environmental Medicine, Asthma & Lung Biology (CEMALB):

  • Current faculty principal investigators:
    • David Peden, MD, MS
    • Ilona Jaspers, PhD, MS
    • Neil Alexis, PhD, MHS, MS
    • Johnny Carson, PhD
    • Michelle Hernandez, MD
    • Timothy Moran, MD, PhD
  • 17 active awards in CEMALB
  • Sponsors include federal, industry, foundation, and non-profit organizations
  • Awarded research valued at approximately $4.13M in fiscal year 2015
  • Eight new or competing applications pending, reflecting up to $3.7M in new funding for fiscal year 2016

AIR faculty lead research projects administered in the Department of Pediatrics:

  • Current faculty principal investigators:
    • Wesley Burks, MD
    • Brian Vickery, MD
  • 10 active awards
  • Sponsors include federal, industry, foundation and non-profit organizations
  • Awarded research valued at approximately $2.26M in fiscal year 2015
  • Five new or competing applications pending, reflecting up to $1.61 million in new funding in fiscal year 2016