Top of his Field

Dr. Richard Lockey, who leads USF Health’s nationally-recognized Division of Allergy and Immunology, became president of the World Allergy Organization this January.

Richard Lockey, MD

Dr. Richard Lockey’s 40-year career reads like a “Who’s Who” in the field of Allergy and Clinical Immunology. To name just a few accomplishments, he’s a fellow and past president of the American Academy of Allergy, Asthma and Immunology; a past director of the American Board of Allergy and Immunology, which oversees certification of allergists and immunologists; and a member of a special National Institutes of Health task group helping define sub-types of asthma to allow more targeted treatments.

Dr. Lockey, Distinguished University Health Professor and director of Allergy and Immunology at USF and James A. Haley Veterans’ Hospital, topped that list when he was recently elected president of the World Allergy Organization (WAO). For two-year term, which began this January, he will lead the international umbrella organization representing 84 regional and national allergy and clinical immunology societies across the world. By collaborating with member societies, WAO provides direct educational outreach programs, symposia and lectureships to members in 92 countries.

“It’s a tremendous opportunity to influence government policy, education, and training and research funding impacting the care of patients with allergic and immunological diseases,” said Dr. Lockey, who has served on WAO’s executive board since 1995.

One of his major goals is to expand the organization’s online training opportunities for physicians, especially in countries where allergists and immunologist are underrepresented such some parts of the Middle East, Africa, Latin America and Eastern Europe. He also hopes to open the door to programs that would lead to accreditation of allergists and immunologists in China.

During his tenure, Dr. Lockey said, the WAO through its educational offerings and position papers, will focus on the competency of allergists/immunologists to diagnose and treat other associated conditions that exacerbate allergies and asthma such as gastroesophageal reflux disease, sinusitis, sleep disorders, obesity and vocal cord dysfunction.

Michael Kaliner, MD, a past WAO president and director of the Institute for Asthma and Allergy in Chevy Chase, MD, says that heading a global alliance like the WAO requires the ability to work with many different personalities, styles and cultures. “Dick has met this challenge well. He’s a very hard worker who gets things accomplished.”

For example, Dr. Kaliner said, Dr. Lockey tackled the project of developing from scratch an up-to-date WAO website with resources for all physicians, including specialists, other healthcare professionals and patients. The site includes a monthly online newsletter, which is translated into seven languages and accessed by more than 35,000 physicians. “With those two accomplishments alone,” Dr. Kaliner said, “he’s done as much as anyone to open up communications among allergists and immunologists around the world.”

Dennis Ledford, MD, professor of medicine in the USF Division of Allergy and Immunology, who has known Dr. Lockey’s for 28 years says his colleague has the skills and drive to lead a diverse organization like the WAO.

“Dr. Lockey is a physician who looks forward and embraces the new while honoring the past. His energy seems boundless,” said Dr. Ledford, who will become president-elect of the American Academy of Allergy, Asthma and Immunology this March. “He is inclusive, but his standards and ethics are not negotiable or situational. The result is a leader with vision, passion and commitment.”

In 2011, Dr. Dennis Ledford, right, will become president of the American Academy of Allergy, Asthma and Immunology (he’s president-elect this March), as Dr. Lockey finishes serving his two-year term as president of the World Allergy Organizations. Faculty from the same university leading two of the premier allergy and immunology organizations is “one in a million,” Dr. Lockey says.

Increase in allergic diseases

While the Center for Health Workforce Studies projects shortages of physicians trained in allergy and immunology within the next decade, the demand for this subspecialty continues to rise along with the large increase in the occurrence of allergic diseases – predominately in developed nations. “The prevalence of allergic problems used to be quite low 30 to 40 years ago,” Dr. Lockey said. “Now, by some epidemiological estimates, up to 30 percent of children have some sort of allergic problem, including hayfever, asthma, eczema and food allergies.”

The “hygiene hypothesis” is the most widely accepted theory to explain this pronounced increase in Western nations. It holds that the immune systems of babies are underexposed to bacteria, some viruses and other potentially deadly germs in the environment, largely because of vaccinations against diseases, widespread use of antibiotics, and better living conditions.

“We live cleaner and better than ever before, but in the process we’ve created a tendency to develop more allergies,” Dr. Lockey said. “In the process of eliminating diseases like tuberculosis, polio and smallpox, we’ve set up a situation whereby the immune system is prone to over-react to allergens in the environment that would ordinarily be harmless, like dust mites, pollen, mold and pet dander.”

If the risk of allergic and immune diseases has increased, so have the options for treatment – and the promise of technologically-advanced therapies.

Setting stage for next generation of therapies

The USF Division of Allergy and Immunology’s Clinical Research Unit, which Dr. Lockey oversees, has participated in most major drug innovations for the treatment of allergies and asthma. Since 1973, patients from across West Central Florida have come to the unit for drug trials — everything from non-drowsy antihistamines like Claritin and nasal allergy sprays like Flonase to inhalers like Xopenex, a quick-relief asthma medicine. The Division collaborates with James A. Haley Veterans’ Hospital to routinely measure and report pollen and mold concentrations in Tampa. Upcoming clinical studies include investigating the effectiveness of pine cone extract in alleviating hayfever and evaluating the potential link between intermittent oxygen deficiency (experienced by patients with sleep apnea) and worsening of asthma.

Meanwhile, the division’s Basic Research Laboratory, directed by Shyam Mohapatra, PhD, MBA, continues working on harnessing nanoparticles – particles too small to be seen with the naked eye – to more effectively detect and treat lung diseases such as asthma or lung cancer. The research encompasses using these extraordinarily tiny materials to deliver drugs or therapeutic genes to cells lining the lungs, or even magnetic nanoparticles to target and destroy diseased cells.

Dr. Lockey is enthusiastic and optimistic about the potential of nanomedicine, though he doesn’t use the word “cure” lightly. Similarly, he’s skeptical that prevention — avoiding the substances that trigger allergic reactions — will be sufficient to curb the rise in allergic diseases. He’s had too many patients with pet allergies refuse to part with their cats or dogs, and it’s virtually impossible to stay away from oak pollen blown across many miles on a breezy spring day.

“There are so many potential triggers for allergies and asthma that I think it’s going to be easier to find innovative treatments that control the disease or put it into remission for long periods of time,” he said. “That doesn’t mean treatment should exclude prevention, but changing behavior is extremely difficult. It’s probably more realistic to find ways to modify the immune system through safe, cost-effective technologies.”

Stepping up to lead

One of the College of Medicine’s early recruits, Dr. Lockey joined USF in 1973. When Samuel Bukantz, MD, stepped down as director of the division of allergy and immunology and chief of the section at the VA, Dr. Lockey stepped up.

“I was very fortunate to have been mentored by the some of the medicine’s best and brightest educators, researchers and clinicians – Dr. Bukantz, Dr. Robert Good, Dr. Roy Behnke, and Dr. Andor Szentivanyi,” Dr. Lockey said.

Building on the strong foundation laid by Dr. Bukantz, Dr. Lockey propelled the division to national prominence. He established a highly competitive fellowship program, which receives 80 to 100 applications for two spots each year and has trained more than 42 allergists and immunologists – many whom have assumed leadership positions in academia and clinical practice. Last year, the division was selected to create a pilot online educational program to train fellows across North America how to use fiberoptic rhinoscopy to evaluate upper airway diseases – the first of its kind approved by the National Residency Review Committee.

The USF Division of Allergy and Immunology, Department of Internal Medicine, continues to build on the success of its basic science and clinical research enterprises.

The division’s faculty have attracted research funding from the National Institutes of Health, Veterans Affairs, American Lung Association, Office of Naval Research, Florida Department of Health (Biomedical Research Awards), and Florida Hi-Tech Corridor, to name a few. Its teaching and research endowments have grown to $11 million, including the Joy McCann Culverhouse Professorship in Allergy and Immunology (held by Dr. Lockey) and the Mabel & Ellsworth Simmons Professorship in Allergy and Immunology (held by Dr. Mohapatra).

Dr. Lockey’s division, housed in Internal Medicine, works closely with the Department of Pediatrics Division of Allergy and Immunology, directed by John Sleasman, MD. Based at All Children’s Hospital in St. Petersburg, the pediatric program is known for its expertise in immune deficiency diseases, including HIV and primary immunodeficiencies. Trainees from the pediatric allergy and immunology fellowship program rotate through the internal medicine program and vice-versa.

Immunological underpinnings of disease

In both allergic diseases and immune diseases, the body’s immune system is out of whack. The immune system may be hypersensitive to an otherwise harmless substance (allergy), mistake the body’s cells for harmful invaders, such as bacteria, and attack them (autoimmune disorders like rheumatoid arthritis and multiple sclerosis), or have an inherited defect in one of its functions (primary immunodeficiency diseases like X-linked agammaglobulinemia or severe combined immunodeficiency).

Discoveries in immunology have led to advances in vaccine development, bone marrow and organ transplantation and immune therapies for a whole host of diseases, not just allergies and asthma, Dr. Lockey said. “Problems with immunity cross over into renal, gastrointestinal, neurological, cardiovascular and other diseases,” he said. “Much of the underlying science coming out of the field of allergy and clinical immunology is making a huge difference in understanding disease processes and patient outcomes.”

For example, in multiple sclerosis, immune modulators – medications that control the body’s immune response — have shown promise in slowing the progression of neurological impairment and disability. Immunotherapy has also improved the success of treating non-Hodgkin’s lymphoma, a cancer of the immune system, and treatment-resistant psoriasis, a chronic skin disease.

With a strong presence locally and globally, the Division of Allergy and Immunology will continue to be on the leading edge of advances that make life better for patients, Dr. Lockey said. “USF can be proud that we have a team of scientists and clinicians in our Division second to none.”

- Story by Anne DeLotto Baier, and photos by Eric Younghans; USF Health Communications

Center That Studies Tiny Things Grows Bigger