The examinations include items listed in the examination blueprint as determined by the ABAI Board of Directors as well as current ACGME Program Requirements for Residency Education in Allergy and Immunology.
Candidates for certification must be familiar with the fundamental elements of the immune system, such as the types of immune cells and the anatomical organs that constitute the immune system, the circulation patterns of immune cells, the biologic roles of products of the immune system, and the abnormal conditions of the immune system that constitute immunopathology. Moreover, the candidate will be expected to be proficient in understanding the molecular basis of allergic and other immune reactions, including interaction between immune cells, cell membrane signal transduction pathways, gene expression, cytokine release, receptor targeting, cellular differentiation and death. Proficiency must be demonstrated in the diagnosis and treatment of allergic and other immunologic diseases.
Allergic and Immunologic Diseases
Because the ABAI is a conjoint board representing pediatric and adult medicine, the candidate must master the spectrum of allergic and immunologic diseases as it presents in children and adults. In addition to a familiarity with allergic diseases, including allergic rhinitis, asthma, atopic dermatitis, and urticaria, the candidate must be knowledgeable in autoimmune conditions.
Primary Immunodeficiency States
Equally important as competence in diseases of immune dysfunction is the knowledge of human pathology that results from an absence of immunity, either whole or partial, congenital or acquired. Thus, an understanding of the primary immunodeficiency states is required, including congenital disorders, absence of specific complement components, lack of specific neutrophil function, absence of specific adhesive cellular glycoproteins, and dysfunctional states of the immune system produced by external agents.
Clinical and Laboratory Tests
It is important for the candidate to demonstrate proficiency in the proper selection of appropriate clinical and laboratory tests, which aid the formulation of a clinical diagnosis based upon first obtaining a detailed medical history and performing a complete physical examination. The candidate must understand the scientific basis of the following list (non-inclusive) of tests: serum immunoglobulin determination, functional antibody measurement, complement component and functional assays, lymphocyte subset analysis using monoclonal antibodies and flow cytometry, cytokine assays, lymphocyte proliferation assays with mitogen and antigens, and neutrophil and monocyte chemotaxis, phagocytosis, and killing assessment. Candidates must also have familiarity with the misuse of standard tests and with controversial tests in allergy and immunology.
Molecular Diagnostic Techniques
In addition, competence must be demonstrated with the use of molecular diagnostic techniques involving the binding of ligands to nucleic acid or polypeptide sequences. The importance of DNA replication technology must be understood. The molecular basis for immediate hypersensitivity skin testing must be understood in the context of the detailed molecular events occurring in the tissue mast cell and blood basophil, particularly the release of preformed mediators, and in the generation of newly formed mediators. Similarly, skin testing for T cell competence with recall antigens must be understood in relation to antigen presentation, cytokine secretion and interaction, and lymphocyte subset activation and function.
Experimental and Clinical Studies
The candidate must understand the principles and analytic methods employed in experimental clinical studies for determining the diagnostic utility of specific tests and in evaluating the safety, toxicity, efficacy and outcomes of treatments and drugs for allergic and immunologic disease. Candidates must be familiar with the principles and methods employed in epidemiologic studies.
Pathophysiology, Clinical Presentation, and Immunologic Testing
A corollary of the competence of the candidate in understanding the pathophysiology, clinical presentation, and immunologic testing of allergic and other immunologic diseases is the knowledge of appropriate treatment options. For example, the common aspect of all types of asthma is the presence of airway inflammation. Definitive treatment of asthma demands that therapies be utilized that include interruption of the inflammatory response. Thus, candidates for certification must understand use of drugs that decrease airway inflammation in asthma.
Based upon the molecular knowledge of the allergic response, the candidate must appreciate the importance of allergen avoidance and medical treatment of allergic rhinitis before initiation of the more intense treatment of immunotherapy.In the latter therapy, the candidates must demonstrate competence in allergen selection and administration in successful treatment regimens.
Therapy for Immunologic Diseases
Therapy for immunologic diseases must be understood, such as (non-inclusive): intravenous immune globulin for antibody deficiency, treatment of immunodeficiency with biologic response modifiers, HLA-identical and HLA-haploidentical (T cell-depleted) bone marrow transplants for cellular immunodeficiencies, and gene replacement therapy currently used for the immunodeficiency associated with adenosine deaminase deficiency as well as theoretical principles/potential approaches in other congenital immune disorders.
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