Linda S. Cox, MD

Former Allergy Fellow Leads Initiative to Standardize Allergy Testing and Immunotherapy

National Jewish Health alumni embrace leadership. They are leaders in academic medicine, in private practice, in research and industry. They chair influential committees, advocate for excellence and train the next generation of leaders. For former Fellow, Linda S. Cox, MD, the decision to lead was simple—she recognized a problem and wanted to help create a solution.

Dr. Cox was a fellow in Allergy and Immunology at National Jewish Health from 1989-1991 where she trained in the lab of Henry Clayman, MD, working on IgE production in murine graft-vs-host disease. She also worked closely with other faculty mentors including Hal Nelson, MD. Before coming to National Jewish Health, Dr. Cox completed a fellowship in Internal Medicine at University of Miami, Jackson Memorial Hospital and attended medical school at Northwestern University School of Medicine.

"My fellowship at National Jewish Health was the greatest educational experience of my life," says Dr. Cox. "Whether in the lab, clinic or during one of our evening Allergy Journal Club meetings, my mentors challenged me to not only improve my skills and understanding but to seek the answers that could impact the field as a whole."

Impacting Clinical Practice

Dr. Cox has been running a solo adult and pediatric allergy and immunology practice in Fort Lauderdale since 1992, where she sees more than 5,000 patients each year. Already a fellow in the American Academy of Allergy, Asthma and Immunology (AAAAI), she joined the Immunotherapy Committee in 1998, became Vice Chair in 2003 and has chaired the Committee since 2004. Under her leadership, the Committee focused on an initiative to standardize documentation, administration and tracking of allergy skin tests and immunotherapy.

"Despite tremendous growth in the role of allergy skin testing and immunotherapy, there were no systemized tracking or practice parameters to guide specialists. Each practice performed and documented testing and therapy in their own way," says Dr. Cox. After three years of collaborative work between AAAAI committees, Board of Directors and the Joint Task Force on Practice Parameters, the Immunotherapy committee developed a series of forms that are now available via download on the Academy website (www.aaaai.org). The forms consist of five sets of documents addressing skin tests, immunotherapy prescription, immunotherapy administration, a pre-immunotherapy injection healthscreening questionnaire and an anaphylaxis treatment record form. There is also an Immunotherapy Worksheet, which summarizes key components of immunotherapy prescription writing such as effective therapeutic dose and cross-reactivity between allergens.

Education and Advocacy

Once the forms were developed, the Immunotherapy Committee faced the challenge of educating their colleagues about their availability, validity and usefulness. Form samples were included in the 2003 Joint Task Force: Allergen Immunotherapy: A Practice Parameter which was published in the Annals of Allergy, Asthma and Immunology as a supplement and made available on the AAAAI website. Dr. Cox and her colleagues presented nationally and met with many groups to ensure widespread utilization of the forms.

"There was a great deal of education and advocacy that needed to done to ensure that our colleagues understood and were comfortable customizing the forms for their practice," says Dr. Cox. The Academy further supported the initiative by developing an annual symposium dedicated to immunotherapy and the standardization of forms, dosing and guidelines.

"I am an optimist and we've received great feedback, so I believe that many allergists are using the forms and parameters to guide their practice," says Dr. Cox. "This was an important step toward advancing the field and improving care for our patients."

Legacy of Leadership

In addition to her work with the Immunotherapy committee, Dr. Cox is currently working on a Task Force with Dr. Nelson to evaluate the effectiveness of sublingual immunotherapy (SLIT). SLIT has been widely utilized in Europe for the past decade but is not currently approved for use in the United States. She is also active in the American College of Allergy, Asthma and Immunology (ACAAI) and is the current chair of the ACAAI's Immunotherapy and Diagnostics Committee. She is past president of the Florida Allergy, Asthma and Immunology Society and one of the founders and president of the Broward Palm Beach Allergy Society, which has been meeting monthly since 1999. Dr. Cox lives in West Palm Beach with her husband and two children. She commutes to her office in Fort Lauderdale with her husband/office manager Bob Wolfgram.

"Linda is a shining example of the strong leaders that are the legacy of the National Jewish Health allergy training program," says Dr. Nelson. "Her clinical, research and educational contributions to the field of allergy and immunology are exceptional and I have no doubt there will be more to come from this outstanding alumnus."