Immunology is the study of the body’s defence (immune) system and how it fights against, and contributes to, infection and health problems. Immunodeficiency occurs when the body’s immune system is not able to adequately protect itself against infection and illness.
The respiratory immunology clinic at Royal Brompton Hospital welcomes regional and national referrals for severe, persistent, unusual, or recurrent (SPUR) chest infections. It offers specialist assessment and management for primary and secondary immunodeficiency, as well as lung infections that are common in patients with immunodeficiency (bacterial, mycobacterial and fungal).
Our respiratory immunology clinic specialises in:
In people with primary immunodeficiency, part of the body's immune system is missing or working incorrectly due to an inherited health condition. Primary immunodeficiency can present itself as:
- Classical antibody and cellular immunodeficiencies presenting with sinopulmonary infections
- Immunodeficiencies presenting with autoimmune/allergic diseases
In people with secondary immunodeficiency, part of the body's immune system is missing or working incorrectly due to co-mordbidities (the presence of more than one illness or disease in the same person), medication or environmental factors.
Depending on the condition, patients may be treated in a number of ways:
- Treatment with immunosuppressant medication for a range of conditions, including:
- Auto-immune disorders (e.g. rheumatoid arthritis, systemic lupus erythematosus, psoriasis)
- Respiratory disease (e.g. asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease)
- In the context of cancer and cancer therapy for haematological malignancies (e.g. leukaemia, lymphoma, myeloma):
- Post-haematopoietic stem cell transplantation (BMT / HSCT)
- Post-chemotherapy for all cancers
- In the context of other rare disease:
- Congenital heart disease
- Haematological malignancies (e.g. lung graft-versus host disease)
- Solid-organ malignancy (e.g. drug-related lung immune toxicity such as from immune checkpoint inhibitors)
The respiratory immunology clinic is held weekly on a Wednesday morning and afternoon. Additional consultant respiratory input, where needed, is available on a Wednesday morning.
Patient cases are discussed at a weekly multi-disciplinary team meeting made up of a respiratory immunologist, respiratory consultant with expertise in respiratory immunology and infection, respiratory specialist pharmacist and respiratory specialist nurses. The respiratory immunology service is also supported by the respiratory physiotherapy department.
In light of the Covid-19 pandemic, appointments may take place by telephone or video, if deemed suitable by the clinical team involved in the patient’s care. When required, in-clinic outpatient consultations are also be available.
Clinical assessment may also take place on our lung and heart day unit (LHDU) where we care for patients who are undergoing treatment - such as intravenous (IV) antibiotic therapy - that allows them to be admitted to and discharged from the hospital the same day. Further information about the lung and heart day unit can be found here.
Immunoglobulin replacement therapy
Our service also offers immunoglobulin therapy, supporting more than 170 patients with immune deficiency to undergo treatment in the hospital (through intravenous immunoglobulin (IVIG) or at home (through subcutaneous immunoglobulin (SCIG). Patients are supported through clinic annual reviews and have access to urgent clinic appointments if needed.
Further information about immunoglobulin therapy can be found here
Intravenous immunoglobulin replacement therapy is administered on Royal Brompton’s Lung and Heart day unit. The unit is supported by a specialist team of nurses and consultants who provide a range of treatments and interventions on the unit.
The respiratory immunology team
- Dr Peter Kelleher, consultant immunologist
- Dr Ricardo José, consultant respiratory physician with a special interest in respiratory infection and immunology, and respiratory complications of cancer therapy
- Mrs Erin Whitson, specialist nurse
- Mrs Hazel Russell, specialist nurse
- Mrs Elaine Bowman, specialist pharmacist
How to refer
We accept referrals from primary, secondary and tertiary health service providers through a referral letter or the NHS e-Referral service. Following receipt of referral and a triage assessment, we aim to book patients in for their first consultation within six weeks.
Please write to Dr Ricardo José or Dr Peter Kelleher:
Royal Brompton Hospital
If you would like to speak to the secretary for Dr Kelleher or Dr Jose, please telephone:
Sandra Denis (Dr Ricardo José) on 02073518337
Clare Sharp (Dr Kelleher) on 020 7352 8121
Support for current patients and their healthcare professionals can be obtained by sending an email to HostDefence@rbht.nhs.uk
Emergency advice can be obtained by contacting the on-call respiratory medicine specialist registrar via the hospital switchboard: 01223 638000
If you have a primary or secondary immunodeficiency, advice about COVID-19 (coronavirus) can be found on the PID UK website: www.piduk.org
- For the latest national advice about COVID-19 (coronavirus), please visit: www.gov.uk/coronavirus
- If you, or someone in your household, experiences the following symptoms – a new, continuous cough and/or a high temperature – use the NHS 111 online service for advice on next steps. If you usually take rescue antibiotics for cough and fever we advise you to start taking these promptly as you would normally. If your symptoms worsen, please call 111
- If you have a medical emergency please attend your local emergency department unless you have symptoms of COVID-19 (coronavirus) – this is a high temperature,a new, continuous cough, or change in the sense of taste or smell.