Last month, James Hildebrand, medical technologist and supervisor of the Duke Allergy Lab, became one of the year’s four recipients of the Presidential Award, one of the highest awards given to Duke faculty and staff. In his 27 years at Duke, Hildebrand has formulated almost 120,000 customized allergy vaccines. He also assisted in the development of electronic record-keeping software for the lab, years before Duke Medicine went digital. He recently spoke with The Chronicle about making customized allergy vaccines, the jump from paper cards to digital notation and receiving the Presidential Award.
The Chronicle: How do you go about making the customized allergy vaccines?
James Hildebrand: All these vials are custom made for each patient because everyone is different. We buy liquid extracts, mostly from Greer Laboratories here in North Carolina, based on the results of allergy skin tests for the different grasses, tree pollens, cat and dog extracts—all sorts of things. Based on exactly what the patient reacts to, the allergy physician makes a formula requesting so much of certain items. For example, if they’re allergic to red oak, [the physician will] put a certain volume of red oak extract into that vial. From that you have a custom made vial that a patient receives their shots from. When a patient receives their shots, we make four or five dilutions from that maintenance vial—the full strength vial. When a patient starts out they receive a very weak solution, and the proteins in it gradually stimulate the immune system to later on recognize the allergen as non-foreign. All the symptoms are hopefully reduced because the body has been exposed to these proteins gradually with the vials. The patients work through these vials, each one getting stronger, until they get their shots from that last vial.
TC: How often do patients receive the treatment?
JH: Patients usually get the shots every week, or every few weeks. It varies by patient. Patients will stay on those shots for maybe several years, and then depending on how they respond—if their symptoms go away for the most part—they stop the shots. If the symptoms are not improved or they go away for a while and come back, then we have to do the skin testing again, and maybe change that formula—maybe make something stronger or see if the patient became allergic to something new.
TC: How many vaccines do you make on average?
JH: Some allergists are very conservative with giving people shots and then you can run into allergists who will put many people on shots. I think that goes to how these doctors were trained and their own personal philosophy. We’re probably only making up to 200 vials a month, but 15 plus years ago, there were times where we made over 10,000 maintenance vials in a year.
TC: What were you doing before you came to Duke?
JH: I come from a hospital lab background... doing all the blood testing, blood chemistry and all the other things that are really critical to physicians making decisions on how to treat patients. So when I came to Duke in 1985, I brought that mindset with me. The setting here wasn’t as stressful and you didn’t have all the standard blood work and other things that you have to do in a typical hospital lab. I’ve worked for five different allergists as our lab directors. We’ve had a good crew of people over the years, but right now it’s really down to myself and another woman and we’re managing the volume of work that’s there.
TC: What about the software you helped develop for keeping track of the vaccines?
<b.JH: Dr. C. Edward Buckley III, the allergist that hired me in 1985, started working on an allergy vaccine database that maintained the vaccine records so we didn’t have to keep them on paper cards. I wasn’t writing the code, but I’m the person that basically has to tell the programmer what to write or at least how we want the database to appear. We have two Microsoft access applications—one that manages the vaccines and one that manages our skin test results. That database has basically replaced one full time employee easily. This has been in place since the mid ’90’s, so there’s no telling how much money it’s saved. We’re trying to do the best we can and we’ll keep on it.
TC: Can you tell me a little bit about winning the Presidential Award?
JH: I didn’t know that I had been nominated, so when I got the letter from President [Richard] Brodhead, it was a surprise. It’s nice to be recognized like this.
TC: What are your goals for your future research?
JH: It’s an ongoing thing over here. We do whatever we need to do to make sure we are providing the best patient care that we can. We prepare each allergy vaccine for the allergy shots like we’re preparing them for our parents, brothers, sisters or own kids.
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.