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Penicillin allergies are commonly reported throughout the American population, but yet a small percentage of people are actually allergic to the antibiotic. This can be problematic in pregnant women, who often need antibiotics throughout the course of their pregnancy and after delivery. The Allergy, Asthma & Immunology Care in Pregnant Mothers Program identifies Yale Medicine obstetrical patients who report a penicillin allergy and asks them if they would like to visit an allergist to be tested, with the goal of clearing unnecessary penicillin allergies from their medical charts. Penicillin is typically the first antibiotic medication tried for an infection, and if it can’t be used, medical professionals need to try a broader antibiotic, which has increased risks and contributes to antibiotic resistance. And pregnant women who are believed to have penicillin allergies may have higher rates of C-sections and stay longer in the hospital, in addition to other risks. Therefore, it is key for pregnant women to know if they are actually allergic to penicillin, especially since many people who think they have an allergy either never actually had one or they outgrew it. For patients in the Allergy, Asthma & Immunology Care in Pregnant Mothers Program who agree to be tested, the procedure they undergo is typically done during the third trimester and involves a tiny needle poke of penicillin under the skin. If a rash doesn’t appear within 20 minutes, another poke is given. If the skin is still clear after 20 more minutes, the patient receives an oral dose of amoxicillin, a form of penicillin. The woman is carefully monitored in the office. If there is no reaction, she is cleared of the allergy on her medical chart. The program is led by a board-certified allergy and immunology specialist and a high-risk obstetrician-gynecologist. The physicians work with Ob/Gyns throughout Yale Medicine to educate pregnant women about the importance of allergy testing.

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

We provide expert evaluation and treatment to adult and pediatric patients across the entire spectrum of allergic and immunologic disorders. Our board-certified specialists have specific clinical and scientific expertise, and are highly capable of providing comprehensive, thoughtful care from the most common to the rarest conditions. Our physicians meet weekly to discuss the management of complicated cases. Yale has been the site of several key research breakthroughs in the field, including the discovery of new inherited immunological diseases and the development of a crucial understanding of the underlying causes of allergies. We offer comprehensive evaluation of both common and rare allergy and immunology conditions, including allergy skin and blood testing, oral food challenges, drug allergy testing, and contact dermatitis patch testing. We offer allergic rhinitis and asthma care through recommendations for environmental controls and pharmacological controller therapy, and biologic therapies for severe asthma, chronic rhinosinusitis with nasal polyposis, as well as chronic urticaria and hereditary angioedema. We have expertise in management of immune deficiencies with intravenous and subcutaneous immunoglobulin replenishment. We also provide consultations for drug allergy desensitization when needed. Among the conditions we treat are: Allergic rhinoconjunctivitis (nasal and eye allergies) Asthma Chronic rhinosinusitis Food allergy Insect sting allergy Medication allergy Urticaria (hives) Angioedema Hereditary angioedema Atopic Dermatitis Contact Dermatitis Common variable immunodeficiency Secondary immune deficiencies Our service has specific strength in the management of inherited immune deficiencies, with a dedicated service that closely collaborates with experts across other specialties. Through a long-standing collaboration with Yale Laboratory Medicine, patients have access to a broad array of state-of-the-art immunological testing. Our care for children and adolescents includes treatment for: Asthma Our doctors collaborate with colleagues in the Pediatric Asthma Program to ensure that our patients receive comprehensive asthma care, including: Evaluation, diagnosis, and management of childhood asthma for patients with varying degrees of severity Testing for allergic precipitants Mechanical analysis of respiratory function Outreach care at patients' homes when needed Allergy Testing for allergens, desensitization, and immunotherapy Allergic rhinoconjunctivitis Drug allergy Food allergy Insect venom allergy Urticaria (hives), mastocytosis, anaphylaxis Hereditary angioedema Primary Immunodeficiency and Recurrent Infections Testing for antibody deficiency, cellular immunodeficiency, and complement disorders Treatment of primary immunodeficiency diseases, including intravenous immunoglobulin therapy Evaluation and management of recurrent infections, including fungal infections

Integrative medicine focuses on the whole person, is informed by evidence, and seeks to complement cancer therapy with appropriate therapeutic and lifestyle approaches to achieve optimal health and healing. Smilow Cancer Hospital’s Integrative Medicine Program provides evidence-based guidance about a wide range of complementary therapies commonly used by cancer patients and survivors. Our program aims to address the serious physical and emotional symptoms often experienced by patients before, during, and after cancer therapy. Our team has expertise in the practice and evaluation of complementary medicine, and can guide patients to make effective decisions on integrative therapies throughout their treatment program and beyond. We collaborate closely with each patient’s oncology care team to provide safe and effective care. Integrative medicine consultations Integrative medicine clinical consultations provide guidance for the safe use of dietary supplements/natural products, acupuncture, massage, meditation, and other complementary therapies. Massage Experienced and licensed therapists are trained in oncology massage, focusing on mitigating side effects from cancer and its treatment. Research has shown that massage therapy may reduce pain, promote relaxation, and boost mood in cancer patients. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Reiki Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. This is to promote relaxation and produce stress-reduction effects. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Nutrition Consultation The Integrative Medicine team offers guidance from our Oncology-certified Registered Dietitian to help individuals reach specific goals during or after completion of their treatment. Integrative Medicine Nutrition also supports the Supplement Clinic, where vitamins and supplements may be discussed to ensure they are safe and effective. They may also provide guidance on how to optimize their diet and obtain nutrients from foods whenever possible. Group Sessions Gentle yoga Group classes incorporate breathing techniques, physical postures, meditation, and relaxation, adapted to patient needs and limitations. T’ai Chi/Qigong T’ai Chi/Qigong is a centuries-old martial art and energy practice that uses gentle movement through postures to help promote mental focus, breathing, and relaxation. Students are taught the fundamentals of breath work, movement, and postures that develop into the T’ai-Chi form. The benefits are improved strength, mobility, alignment, pain control, and overall physical and mental rejuvenation. Meditation Meditation is a mind and body practice that has a long

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi

Covering every aspect of health care for adults, Internal Medicine is the largest department in the Yale School of Medicine, and the largest clinical service at Yale New Haven Hospital. We provide comprehensive and specialized services in all areas in a variety of outpatient settings as well as the Veterans Affairs (VA) Connecticut Health Care System campus in West Haven. Our culture of collaboration and research gives patients access to expert opinions from nearly 1,000 doctors, as well as opportunities to get tomorrow’s health care today through more than 100 clinical trials. Most importantly, we attend to our diverse community of patients with compassionate, thorough care. Specialized care is offered in the following areas: Allergy & clinical immunology Cardiovascular medicine Digestive diseases Endocrinology General internal medicine Geriatrics Hematology Infectious diseases Medical oncology Occupational health & environmental medicine Nephrology Pulmonology, critical care & sleep medicine Rheumatology International reputation for work in understanding function, independence, and quality of life in older persons Key research breakthroughs of the past decade that include the development of a protective Lyme bacillus disease vaccine, exploration of the underlying causes of allergic disease, and the discovery of novel inherited immunological diseases Largest interventional cardiology program in Connecticut Major referral center for patients with type 1 and type 2 diabetes, as well as other metabolic conditions Nationally ranked program in kidney diseases and the largest kidney transplant program in New England, with multidisciplinary care clinics One of the largest peripheral vascular programs in the country, with leadership and participation in multiple new percutaneous device trials Once of only a few motility centers in Connecticut to provide all motility procedures and services Unique medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S.

Annually, approximately 32,000 new patients are diagnosed with multiple myeloma, a cancer of a type of white blood cell, or plasma cell. Overall survival in patients with myeloma has shown improvement in recent years, with new treatments approved by the Food and Drug Administration (FDA) as recently as this year. Yale Cancer Center and Smilow Cancer Hospital have several clinical trials available for patients with myeloma in need of new options, or looking to receive the latest treatment advances. The treatment of multiple myeloma is usually given in phases and depends on the overall health and age of a patient at diagnosis. Induction therapy is used to reduce the amount of disease, followed by consolidation therapy to maximize response to treatment and reduce any remaining cancer cells. Maintenance therapy is administered after the initial treatment to help keep the disease well controlled. Autologous stem cell transplant, where patients serve as their own donor, is another treatment commonly used to treat multiple myeloma. When receiving therapy for multiple myeloma, our patients will be cared for by an expert, multidisciplinary team that can include the patient’s hematologist, focused on the treatment of myeloma and related diseases; stem cell transplant specialists; pathologists; and radiation oncologists, among other providers. The CAR T-Cell Therapy Program at Smilow Cancer Hospital brings innovative immunotherapy treatment options to patients with certain blood cancers. For adults with relapsed or refractory multiple myeloma, an FDA approved therapy ABECMA is available, which uses a patient’s own T-cells to help fight myeloma. This is the first cell-based gene therapy approved by the FDA for the treatment of multiple myeloma and is currently available at Smilow Cancer Hospital. Ongoing research and clinical trials in the field continue to provide patients with new options for care.

Our program, focused on adult primary care, is known for its excellence and emphasis on prevention and wellness. We efficiently manage potential medical problems as they arise, and collaborate with specialists when needed. Our practice includes internal medicine physicians, advanced nurse practitioners, a clinical psychologist, a social worker, registered-nurse patient care coordinators, licensed practical nurses, medical assistants, clerical office staff, and a practice supervisor. Our goal is to provide patients with the highest quality, personalized healthcare in the Patient-Centered Medical Home (PCMH) model of care. The PCMH model of care focuses on five areas: Building strong, collaborative health care teams that work together to meet the needs of patients Providing patient-centered care addressing the whole person, respecting patients’ values and preferences Coordinating comprehensive health care through clear communication among patients, families, caregivers, medical and behavioral health providers, hospitals, and other facilities Improving patients’ access to care, through such initiatives as expanded office hours and providing email access to electronic medical records Improving health care quality and standards by providing evidence-based care, patient and family education, and self-management support We would like to hear your direct feedback regarding your experience as a patient/family member of our clinic. Please visit the YIMA Patient/Family Comment Box to provide your feedback. Sign up for MyChart , our secure online patient portal, that gives you access to all of your Yale health information whenever you need it, wherever you may be.

Our uncompromising faculty and staff are dedicated to the welfare of children and adolescents. One of two major pediatric centers in Connecticut, Yale offers an extensive range of services for patients through our 14 specialties. In addition, we have several interdisciplinary centers and programs that involve collaborations with multiple departments throughout Yale Medicine and Yale New Haven Children’s Hospital. Thanks to our reputation for comprehensive pediatric care, we serve as a regional and national center for referral and consultation. Many of our physicians are internationally recognized for their innovative approaches to the diagnosis and treatment of conditions including arrhythmias, diabetes, cystic fibrosis, childhood cancers, juvenile diabetes, dyslexia, blood disorders, infectious diseases, and complications of premature birth, as well as many other disorders. We are leaders in the global pediatric community, advocates for childhood health and development, and innovators in research. We rank among the top pediatric centers in the country with respect to National Institutes of Health support for research. Neonatal and pediatric ICUs that serve our most vulnerable patients with the highest level of care 24/7 subspecialty telephone consultation service for primary care clinicians with expected response time of three minutes More than 20 years of experience with neonatal and pediatric Extracorporeal Membrane Oxygenation, a sophisticated machine that acts as an artificial heart and lungs, crucial for some seriously ill infants One-call center that provides centralized appointment scheduling for all pediatric specialties Close collaboration with other Yale departments to provide such services as molecular and genetic diagnostic services, state-of-the art management of high-risk fetuses and newborns, bone marrow transplantation, and management of complex malignancies

Treating complicated pregnancies is our priority. We provide care for the entire spectrum of conditions related to high-risk pregnancy, and for women whose pregnancies require special testing, monitoring, treatment, and care . We offer state-of-the-art approaches to caring for women with high-risk pregnancies related to diabetes, hypertension, heart disease, and genetic disorders, among other medical conditions that can complicate a pregnancy. Maternal-Fetal Medicine (MFM) at Yale pioneered the development of chorionic villus sampling (CVS) and fetal blood sampling (FBS), and has the most experienced team for these procedures in New England. In addition, our skilled specialists, who are internally recognized for their expertise, conduct fetal echocardiography to diagnose congenital heart disorders of the fetus. We offer a variety of services for our patients across the following specialty programs: High-Risk Pregnancy Program, which supports ongoing care and management for women with a history of pregnancy risks or current medical complications. Prenatal Genetic Diagnostic Program, which provides expert genetic screening and testing for MFM patients. Available tests include first-trimester screening, CVS, amniocentesis, and FBS. After diagnosis, we provide counseling and connect patients when necessary to appropriate support networks to help parents adjust to and prepare for their child's special needs. Recurrent Pregnancy Loss Program, offered in conjunction with Yale’s Reproductive Endocrinology and Infertility Section. Our multidisciplinary team of pathologists, geneticists, and perinatologists uses a whole-patient approach to help couples with recurrent miscarriages and/or pregnancy losses. Other services offered in our MFM section include: First-trimester risk assessment for Down Syndrome Targeted ultrasound Fetal therapy, including percutaneous umbilical blood sampling (PUBS) and intrauterine transfusion Antenatal testing Diabetes management MFM physicians can also co-manage patients with high-risk pregnancies with referring practitioners. We can develop care plans with community obstetricians for cases that require intensive oversight by the team, or consultative guidance alone.

Yale Medicine serves as Connecticut’s premier primary immunodeficiency center for pediatric and adult patients. Primary immunodeficiencies, also known as inborn errors of immunity (IEI), present with features involving a disruption of the body’s immune system. The alteration of the immune system can lead to various clinical manifestations, including recurrent infection, autoimmunity, hematopoietic malignancy, lung disease, and enteropathy. These conditions are caused by monogenetic and polygenetic defects or epigenetic changes. We focus on the evaluation, diagnosis, and management of patients with primary immunodeficiency through in-depth genetic and immunological laboratory tests. In addition to patient care, our group works through research to help advance our understanding of immunodeficiency.

The Yale Allergy & Immunology Contact Dermatitis Program serves patients affected by one of the most common causes of both personal and occupational allergic skin diseases: allergic contact dermatitis (ACD). ACD is an immune reaction that typically causes a rash in response to a substance in personal care products, medications, or even diet. Other potential allergic sources include occupational exposures and biomedical implants, all of which can result in chronic and sometimes debilitating symptoms. Identification of the offending allergen is key to the rapid diagnosis and resolution of ACD. Patch testing, in which allergens are placed in chambers held in place with adhesive patches on the back, is the gold standard for the diagnosis of ACD. The testing usually takes place during three visits over the course of a week after the initial consultation is completed. At the first visit, the patches are placed, and a second visit occurs 48 hours later for patch removal. Between 72-96 hours after the initial patch placement, a third visit occurs with a final diagnosis and a physician follow-up. Occasionally, a fourth visit is needed for delayed reads of certain allergens. We have the ability to test to multiple extended allergen series, medications, occupational and healthcare-specific substances, as well as some product brought in by patients. We take a personalized approach to the diagnosis and care of patients with contact dermatitis. From the initial consultation and testing phase, where potential allergens will be determined, a custom patch test prescription is prepared, and, ultimately, allergen identification/avoidance strategies and a treatment plan are formulated.