The Respiratory Immunology Clinic

Our clinical immunology service attracts regional referrals and referrals from other departments within Royal Papworth Hospital for the diagnosis and management adults with immune deficiency disorders.

These are predominantly associated with lung disease and/or infection and we also accept patients transitioning to the eastern region from paediatric immunology services. 

Our consultant immunologists also provide clinical and laboratory support for the CCLI and Royal Papworth Hospital as a whole, within an integrated clinical/pathological/radiological approach. 

Clinical immunology is embedded within the CCLI and provides a streamlined service covering a wide spectrum of conditions characterised by difficult lung infection. There is patient flow between the clinics, multidisciplinary clinics, and meetings to meet patient need.

CCLI provides a home IV (intravenous) service, accessed by a daily, weekday ambulatory clinic where patients requiring emergency/prompt evaluation and escalation of treatment are seen.

The focus of the immunology service is on the diagnosis and management of immune deficiency disorders, providing integrated care with the respiratory service of CCLI and working closely with other specialists within region to manage the multisystemic nature of many immune deficiency diseases.

Criteria for referral includes the investigation and management of:  

Primary immunodeficiency

• Classical antibody and cellular immunodeficiencies presenting with infections
• Immunodeficiencies presenting with autoimmune/allergic diseases
• Non-classical immunodeficiencies - narrow spectrum of infection and/or autoimmunity
• Sequelae of primary immunodeficiency presenting in childhood
• Ataxia Telangiectasia (classical and variant): immunology support is provided as part of the national adult Ataxia Telangiectasia Service delivered at Royal Papworth Hospital to address the immunological problems these patients encounter.

Secondary immune deficiency

• Associated with cancer treatment including:
  • leukaemia and lymphoma
  • post-bone marrow/ haematopoietic stem cell transplantation (BMT / HSCT)
  • post all cause cancer chemotherapy
• Associated with treatment of autoimmune disorders
• Premature immune ageing associated with increasing infection vulnerability
• Adult congenital heart disease and genetic syndromes with associated immune deficiency: including 22q11 ds and Trisomy 21
• Complex, recurrent or non-resolving lung infection of unknown cause
• Young people transitioning to adult immunology service:
  • we accept young people transitioning from paediatric to adult services. The transition pathway is generally bespoke to the service based on patient need. 

Exclusions 

• Allergy: patients referred on to Addenbrooke's allergy service
• Hereditary angioedema: patients referred onto Addenbrooke's clinical immunology service
• Mast Cell Activation Syndrome: referral to Addenbrooke's allergy service

Immunoglobulin replacement therapy 

The clinical immunology service provides antibody replacement therapy in accordance with national guidelines (Clinical Commissioning Policy: for the use of therapeutic immunoglobulin (Ig) England (2025).

This is given by intravenous (IVIG) or subcutaneous (SCIG) treatment depending on patient choice and feasibility. Most of our patients choose to be trained to manage their own treatment at home and receive training from our immunology nurse specialists in immunoglobulin home therapy on Ward 4SE.

They are then supported through protocol driven annual reviews and specialist clinics for:

• immunoglobulin infusions – IVIG, SCIG and manual push injection method as appropriate
• Homecare therapy training and nurse-led reviews of immunoglobulin therapy.

Home IV (intravenous) service 

CCLI provides a home IV Service to train patients in administering self-mixed and pre-mixed antibiotics which is delivered through the ambulatory care unit at Royal Papworth Hospital. 

This runs daily (08:30-18:00, Monday to Friday) for patients requiring emergency/prompt evaluation and escalation of treatment.

Patients are seen by a doctor from the lung defence service and are trained to administer IV antibiotics at home to treat respiratory infections that have not resolved with oral antibiotics and/or are relapsing and/or involve multi-resistant bacteria. Patients are reviewed by a respiratory doctor on day 7 and day 14 of treatment for tolerability and efficacy of treatment and treatment modification, if required. 

Referral to the Clinical Immunology Service and Management of Appointments

Patients may be referred into the immunology service from primary, secondary and tertiary health service providers and within Royal Papworth Hospital through written referral.

On receipt of referral and consultant triage, we aim for our patients to be seen as soon as possible with first consultation within six weeks of referral being received. 

The immunology clinics are provided under two formats:

• multidisciplinary Team (MDT) clinics - with immunology and respiratory consultant and immunology nurse specialist providing an integrated respiratory-immunology review (generally face-to-face although virtual attendance options are available).
• immunology consultant clinic - face-to-face and virtual attendance options are routinely used. 

The patient will be seen by a consultant immunologist in the first instance for clinical assessment. Immune investigations may be made on the day of the clinic visit or a day case appointment made for more comprehensive evaluation.

At clinic attendance the plan of investigation, treatment and follow up will be discussed with the patient and summarised by clinic letter to the patient and referrer within two or three weeks of consultation. 

Non-attendance at first appointment

Patients who do not attend are not given a further appointment (in line with our general hospital policy) unless there is significant clinical need. A letter is written to the referrer and copied to the patient confirming non-attendance and requesting re-referral if remains clinically indicated. 

Non-attendance at follow-up appointment

Patients who do not attend a follow-up appointment will be contacted to clarify their reason for non-attendance and the follow up plan agreed. When there is frequent non-attendance, the patient may be discharged back to original referrer or GP depending on individual circumstance. 

Research

The immunology team actively participate in clinical and translational research both within Cambridge, the UK and internationally to understand the molecular genetic causes of primary immune deficiency and how best to optimise management of complications of primary and secondary immune deficiency.

The team is part of:

• the National Clinical Immunology Association (UKPIN)
• the European Society of Immunodeficiency (ESID)
• the International Nursing group for Immunodeficiencies (INGID)

Patient information leaflets

• Lung defence unit telephone support service

Patient Organisations

• UK Primary Immune–deficiency Patient Support
• Immunodeficiency UK
• The Jeffrey Modell Foundation (JMF)
• AT Society
• Asthma + Lung UK