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Home > Patients and Visitors > Specialties and Services > Rheumatology, Allergy and Immunology

Overview

The Department of Rheumatology, Allergy and Immunology is a referral centre for patients with rheumatologic and allergic disorders in Singapore and the region, established initially by Prof Feng Pao Hsii in 1979, with Clinical Immunology/Allergy (CIA) added in 1988 upon the return of Prof Chng Hiok Hee from her HMDP Training.

On 1 January 2001, the Department was renamed Department of Rheumatology, Allergy & Immunology (RAI). The Department presently has 14 Senior Consultants, 3 Consultants, 1 Associate Consultants and 5 Senior Residents. They are supported by 3 Clinical Immunology/Allergy and 2 Rheumatology Nurse Clinicians, and 1 Advance Practice Nurse (APN) in Rheumatology.

List of Services

Rheumatologic disorders affect the muscles, bones and joints. Some of these disorders may also affect major organ systems like the kidneys, nerves, heart and lungs.

New patients may be referred to:

  • Consultant's Personal Clinic
    All named or private referrals may be made to any of our consultant rheumatologists.
  • General New Case Clinic
    Referrals for any suspected rheumatic disease.
  • Urgent New Case Clinic
    Referrals that need attention within 1-2 weeks.

Stable patients are internally referred by our rheumatologists for continuing care to the following clinics:

  • Lupus Clinic
  • Rheumatoid Arthritis Clinic
  • Spondyloarthropathy Clinic
  • Psoriatic Arthritis Clinic
  • Connective Tissue Disease Clinic
  • Mixed Connective Tissue Disease/Scleroderma Clinic
  • Gout Clinic
  • Osteoporosis Clinic

    Where appropriate, patients are referred to the following services available within TTSH for further treatment:

    • Disease-specific education programmes/group therapy run by Rheumatology Nurse Clinicians
    • Physiotherapy
    • Occupational therapy
    • Podiatry
    • Orthopaedic surgery
    • Acupuncture service
    • Pain Clinic

    This is run by rheumatologists trained in musculoskeletal ultrasonography.

    It provides diagnosis and treatment for patients with arthritis and soft tissue rheumatism including ultrasound-guided aspiration of joints, biopsies and injections. ​

    Examination of the nailfold capillaries can be diagnostic in patients with certain disorders including Raynaud's phenomenon, systemic sclerosis and dermatomyositis.

    This centre provides ancillary outpatient services including:

    • Intravenous cyclophosphamide infusion
    • Infusion of biologic agents for refractory arthritis/spondyloarthritis
    • Infusion of bisphosphates for osteoporosis
    • Minor procedures:
      • Minor salivary gland biopsy
      • Soft tissue and joint aspirations/injections

    We evaluate and manage adolescents (above 16 years of age) and adults with the following conditions:

    • Anaphylaxis from any cause
    • Drug allergy (note: the allergy centre does not conduct evaluation of allergies to unknown drugs or substances, and does not conduct screening for potential drug allergies)
    • Food allergy and intolerance
    • Insect venom allergy
    • Primary immunodeficiency diseases
    • Urticaria and angioedema (including assessment and management of Hereditary Angioedema)

    New patients may be referred to:

    • Consultant's Personal Clinic
      All named or private referrals may be made to any of our consultant clinical immunologist/allergists
    • CIA New Case Clinic (unnamed referrals)
      • Immunodeficiency Clinic
      • Allergy Clinic
        All referrals are screened by allergist to ensure right siting, and priority is given to urgent cases

    The following diagnostic and therapeutic services are available:

    • Skin prick testing for allergens (e.g. food, insect venom, local aeroallergens)
    • Skin prick and intradermal testing for drug allergy
    • Provocation/ challenge tests (e.g. to food, drug)
    • Drug desensitisation where indicated
    • Allergen-specific immunotherapy (for insect venom allergy, allergic rhinitis and asthma)
    • Monthly intravenous immunoglobulin replacement (for antibody deficiency). Education and counselling is provided by the Clinical Immunology/ Allergy Nurse Clinician. These include allergen avoidance, emergency management of anaphylaxis (including epinephrine autoinjector use), use of intranasal steroids, inhalers and skin care for atopic dermatitis.

    • Ankylosing Spondylitis
    • Anaphylaxis
    • Airway allergy, chronic sinusitis and polyposis
    • Anti-phospholipid syndrome (APS)
    • Behcet's Disease
    • Drug Allergy
    • Drug Induced Rheumatic Disorders
    • Food Allergy
    • Gout and crystal arthropathy
    • Henoch-Schönlein Purpura (HSP)
    • Inflammatory Myopathies (eg. Dermatomyositis, Polymyositis)
    • Idiopathic Thrombocytopenic Purpura
    • Immunodeficiency
    • Insect venom allergy
    • Joint hypermobility
    • Miscellaneous allergic and immunologic disorders
    • Osteoarthritis
    • Osteoporosis
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sarcoidosis
    • Sjogren's syndrome
    • Fibromyalgia
    • Repetitive Strain Syndromes
    • Systemic sclerosis
    • Systemic vasculitides
    • Infectious Arthritis
    • Juvenile Chronic Arthritis
    • Systemic Lupus Erythematosus
    • Urticaria and angioedema













     

    ​Laboratory Services

    The Clinical Immunology Laboratory (CIL) of Tan Tock Seng Hospital provides diagnostic tests that are vital for the management of patients with rheumatologic, allergic or immunologic diseases.

    We offer the complete range of clinically relevant investigations that are performed accurately and expeditiously. These include autoantibody tests for systemic and organ-specific autoimmune diseases, various serological tests for syphilis, genotyping for HLA-B27, HLA-B*5701 and HLA-B*5801, total and specific IgE to various aeroallergens and food allergens.

    This laboratory service was initiated by clinicians to fulfill a clinical role and this has remained our mission. The range of tests and the way they are reported are designed to aid the clinician in his or her practice. The laboratory is under the charge of a practising Rheumatologist who is available for discussions about the test interpretation.

    Quality is very important to us. We subscribe to two external audit programs: the National External Quality Assurance Scheme (NEQAS) from UK and the College of American Pathologists (CAP) Survey from the USA. For tests that are not offered by the CIL, our personnel will help the physician source for an alternate accredited laboratory and arrange the transport of the specimen.

    Our laboratory has been accredited by the CAP since 2001.

    Our Services

    • Diagnostic Autoimmune, Allergy and Immunology Testing
    • Autoantibodies in Rheumatology
    • Organ-specific Autoantibodies
    • Allergen-specific IgE Determinations
    • Component resolved diagnostics for allergens
    • Syphilis Serology
    • Human Leucocyte Antigen B27 (HLA B27)
    • Human Leucocyte Antigen genotype testing for drug hypersensitivity syndromes, severe cutaneous adverse reactions

    Tests Conducted

    The laboratory offers these classes of tests:

    1. Autoantibody testing, including:
      • antinuclear antibody
      • anti-CCP
      • anti-double stranded DNA antibody
      • anti-Ro
      • anti-La
      • anti cardiolipin
      • anti-beta2-glycoprotein1 lgG
    2. Organ-specific auto-antibodies, such as:
      • anti-thyroid peroxidase (anti-TPO)
      • thyroglobulin antibody
      • TSH receptor antibody (TRAB)
      • anti-liver and kidney microsomal antibody (anti-LKM)
      • anti-smooth muscle antibody (anti-SMA)
      • anti-glomerular basement membrane antibody (anti-GBM)
      • anti-islet cell antibody
    3. Total Immunoglobulin E as well as food-, insect-venom- and environmental-specific immunoglobulin E concentrations specialised immunology tests:
      • serum tryptase level
      • immunoglobulin G subclasses and nitroblue tetrazolium test
      • anti-endomysial
      • anti-tissue transglutaminase and anti-gliadin peptides tests for coeliac disease
      • Tetanus Toxoid IgG antibody & Streptococcus pneumoniae IgG antibodies

    Download Service Manual (231 kb, DOC)

    Download Allergy Form (30 kb, PDF)

    Download Immunology Form (30 kb, PDF)


    ​The Immunology Research Laboratory (IRL) was restructured from the department's Autoimmune Research Laboratory (ARL). The ARL was set up by the Department of Rheumatology and Immunology in 1994 for the purpose of research in autoimmune systemic rheumatic diseases.

    In 1999, the ARL was restructured into the Clinical Immunology Laboratory (CIL) which supports the clinical services of the department and hospital, and the Immunology Research Laboratory (IRL) which supports the department's research in rheumatology, clinical immunology and allergy.

    The IRL is presently funded through research grants. Our main research interests are in SLE, rheumatoid arthritis and drug allergy.





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    2019/11/12
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