Professor Mamidipudi Thirumala Krishna PhD, FRCP, FRCPath

Professor Mamidipudi Thirumala Krishna

Institute of Immunology and Immunotherapy
Chair of Allergy, Clinical Immunology and Global Health
Honorary Consultant Allergist and Immunologist

Contact details

Address
Institute of Immunology and Immunotherapy
College of Medical and Dental Sciences
Institute of Biomedical Research
University of Birmingham
Birmingham
B15 2TT

Professor Krishna (TK) is Chair of Allergy, Clinical Immunology and Global Health, Honorary Consultant Allergist and Immunologist and Head of Postgraduate School of Pathology for WM NHSE Education.

He has a special clinical and research interest in allergic diseases. His research has involved multi-disciplinary approach employing mixed methods including qualitative, quantitative, laboratory and epidemiological tools to answer some key questions in wide ranging and important clinical topics in allergic diseases. In recent years, he has taken a keen interest in studying allergic diseases in Low-Middle Income Countries and amongst British ethnic minority groups.

TK was awarded the prestigious Jack Pepys lectureship in 2021 by the British Society for Allergy and Clinical Immunology in recognition for his contribution to the science of Allergy and Clinical Immunology at an international level.

Professor Krishna - Google Scholar Profile

Professor Krishna - PubMed Publications

Qualifications

  • FRCPath, Immunology, The RCPath, London, 2007
  • FRCP, General Medicine, The RCP, London, 2006
  • MRCPath, Immunology, The RCPath, London, 2003
  • PhD in Allergy and Immunology, University of Southampton, 1998
  • DNB in General Medicine, National Board of Examinations, New Delhi, India, 1997
  • MRCP (UK) in General Medicine, The RCP, London, 1992
  • MBBS, Madras Medical College, University of Madras, Chennai, India, 1989

Biography

TK is a clinical academic with international recognition for his expertise in allergic diseases. His clinical and research interest in allergic diseases stemmed from working with top international experts in University of Southampton including Professor Sir Stephen Holgate and Late Professor Anthony Frew and a number of UK and international Fellows. This gave him an opportunity to gain basic knowledge and skills in the application of clinical, physiological, laboratory and qualitative methodology in a multi-professional environment.

This was further complimented by wide clinical experience in general and specialist allergy and clinical immunology. His doctoral work gave him an opportunity to conduct controlled exposures to air pollutants, allergen challenges, bronchoscopy, sputum induction and immunohistochemistry. These skills enabled him to pursue novel research to unravel acute inflammatory responses in the airway lining fluid and bronchial mucosa in seminal studies and contribute to clinical trials in allergic rhinitis and asthma that were published in high impact journals.

After re-locating to Birmingham in 2005, he established (clinical lead: 2005-19) a comprehensive multi-disciplinary regional allergy service and research which has gained national (RCP; 2016 and 2021) and international recognition (WAO; 2020) as a Centre of Excellence.

He served as a substantive NHS consultant between 2005-22 and held a honorary status with University of Birmingham. He was promoted as Honorary Professor in 2016 and to substantive Chair in 2022.

TK is the lead author for the BSACI guideline on hymenoptera venom immunotherapy and has co-authored guidelines on penicillin allergy (x2), allergen-specific immunotherapy and pollen-food syndrome.

His team conducted a number of important observational studies in anaphylaxis presenting to emergency unit and in a peri-operative setting including validation of international consensus equation for mast cell activation, highlighted the burden of inaccurate penicillin allergy labels in secondary care and development of safe and stratified pathways for de-labelling, characterised hypersensitivity reactions to anti-TB drugs and described the disparities in immune-mediated diseases amongst ethnic minority groups.

TK leads an international professional network in LMICs to phenotype and endotype allergic rhinitis and asthma and characterise drug allergies.

He contributes to allergy postgraduate education in the UK (Birmingham, Southampton, London), India and Sri Lanka.

Teaching

UK

  • Lead for Allergy Module, MSc in Respiratory Medicine, UoB (2023 onwards)
  • Invited Lectures for MSc Allergy, University of Southampton (2021, 2022, 2023)
  • Invited Lectures for MSc Allergy, Imperial College, London (2021, 2022, 2023)
  • BSACI National Allergy Training days, The Royal Brompton Hospital (2010 onwards)
  • West Midlands Respiratory Specialist Trainees, Allergy, (2015 onwards)

India

  • Lectures for Diploma in Asthma and Allergy course, Christian Medical College, Vellore, India (2019 onwards)
  • Lectures on Drug Allergies for Postgraduate Doctors in Sri Lanka (organised by Sri Lanka Medical association, Sri Lanka College of Paediatrics and Sri Lanka College of Anaesthetists)

Postgraduate supervision

Research

  • Currently supervising 3 PhD students (Drug Allergy)
  • Supervised 1 international training fellow (2021-23)
  • Clinical supervisor for Allergy and Immunology specialist trainees (2005 onwards)

Research

Research interests:

Anaphylaxis

  • Novel biomarkers
  • Validation of acute serum total tryptase measurement in immediate hypersensitivity reactions
  • Impact on health-related quality of life
  • Insect sting allergy

Drug allergy

  • Anaphylaxis during general anaesthesia
  • Adverse impact of inaccurate penicillin allergy on antibiotic stewardship, clinical & microbiological outcomes and pharmacoeconomics
  • Multiple Drug Allergies and Intolerances

Application of qualitative research in allergic diseases

Long term risk of autoimmune disorders in allergic diseases

Ethnicity-based disparities in immune-mediated disorders

Immunological validation of Der p 1 peptides for treatment of house dust mite allergy

Development of national guidelines and policy making

Global Health:  Asthma and Allergic diseases in Low-Middle Income Countries (LMICs)

  • Investigating reasons underpinning poor asthma management in India
  • Endotyping and phenotyping allergic rhinitis and asthma in India
  • Characterisation and Improvement of drug allergy management systems in LMICs

Current and recent projects:

  • Immunological validation of Der p 1 peptides in house dust mite allergy; MRC CiC; completed collaboration with Professor David Wraith, University of Birmingham.
  • A Multicentre Study to Investigate Feasibility of a Protocol-Driven Multidisciplinary Service Model to Tackle ‘Spurious Penicillin Allergy’ in Secondary Care (SPACE study) HS&DR, NIHR129069; completed; Chief investigator.
  • Food hypersensitivities: Capturing Quality of Life (QoL), Behavioural Measures and Willingness to Pay (WTP) in the UK. Food Standards Agency (FSA), FS430406 -completed; Co-investigator.
  • A Pilot Study to Investigate Reasons for Poor Asthma Control and to Characterise Asthma and Allergic Rhinitis in the Indian Subcontinent (SIRPAC India study & CAAR India study) – A Mixed Methods Approach. May’21 onwards; GCRF; Institute of Global Innovation (IGI) and Institute of Advanced Studies (IAS), University of Birmingham. Chief investigator.
  • Addressing inequalities in the management of food allergy in South Asian adults – a qualitative study shaping composite supportive interventions. NIHR Research for Patient Benefit Programme (NIHR204048, 01 Feb’23 onwards. Chief investigator.

Other activities

Professional Roles and Leadership

  • Lead Author of British Society for Allergy and Clinical Immunology (BSACI) guideline (Hymenoptera Venom Allergy) and co-author in 4 other guidelines (Immunotherapy for Allergic Rhinitis; Penicillin Allergy; Penicillin Allergy De-labelling by a non-specialist and Pollen Food Syndrome)
  • Member of Standards of Care Committee, BSACI, 2009–20
  • Lead physician for national audits, BSACI, 2010-20
  • Member of National Clinical Reference Group (CRG) for Specialised Immunology and Allergy Services, April 2013–2015
  • Membership, Specialist Advisory Committee (SAC), Allergy and Immunology, RCP London, 2007-13; 2016-20
  • Steering group membership, BRIT Registry, BSACI, 2020-21
  • Membership, Joint Committee in Allergy and Immunology (RCP and RCPath), 2015-21
  • Senior Advisor, Standards of Care Committee, BSACI, 2021 onwards
  • Clinical Lead, National Allergy Accreditation Programme (IQAS), RCP London, 2005-21
  • Co-Lead for national survey to assess impact of COVID-19 pandemic on Allergy and Immunology services in the UK NHS, the Royal College of Physicians of London, Jun’20
  • Chair of BSACI working group on ‘Equality, Diversity and Inclusion’ (Jul’20 onwards)
  • BSACI representative for Inequalities in Health Alliance, an initiative of The Royal College of Physicians, London (Aug’20 onwards)
  • Allergy in the Military (Working Group, BSACI) – 2018 onwards
  • Idiopathic Anaphylaxis (Guideline writing group, BSACI) – 2023 onwards

International

  • Member of editorial board for the Journal ‘Allergy’ [official journal of the European Academy of Allergy and Clinical Immunology], Jan’10 – Dec’11
  • Sole Editor – Textbook ‘Anaphylaxis – Principles and Practice’, 2013, Nova Publishers Inc., NY, USA [textbook for specialists in Allergy and Clinical Immunology with contributions from a panel of international authors in this field]
  • Guest Editor-in-Chief, for ‘Frontiers in Immunology’, ‘Research Topics’ in Anaphylaxis (co-editors Professors M B Bilo and M Worm)
  • Associate Editor, Clinical Experimental Allergy, April 2021 onwards
  • Guest Editor, Clinical Experimental Allergy, Special issue - Allergy and Asthma in India, 2022
  • Visiting Professor, Department of Pulmonary Medicine, Christian Medical College, Vellore, India (2020 onwards)

Publications

Recent publications

Article

Krishna, MT, Bhogal, R, Ng, BY, Kildonaviciute, K, Jani, YH, Williams, I, Sandoe, JAT, Pollard, R, Jones, N, Dunsmure, L, Powell, N, Hullur, C, Balaji, A, Moriarty, C, Jackson, B, Warner, A, Daniels, R, West, R, Thomas, C, Misbah, SA & Savic, L 2024, 'A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling ‘low risk’ patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems', Journal of Infection, vol. 88, no. 3, 106116. https://doi.org/10.1016/j.jinf.2024.01.015

Buka, R, Thirumala Krishna, M & Sutton, D 2024, 'Fatal drug reaction to andexanet alfa: a case report', EJHaem.

Knibb, RC, Hawkins, L, Screti, C, Gowland, MH, Krishna, MT, du Toit, G & Jones, CJ 2024, 'Risk assessment behaviour when eating out in adults with food hypersensitivity', Clinical and Translational Allergy, vol. 14, no. 2, e12336. https://doi.org/10.1002/clt2.12336

Mansur, AH, Marsh, J, Bahron, A, Thomas, M, Walters, G, Busby, J, Heaney, LG & Krishna, MT 2023, 'Difficult‐to‐treat asthma patients from ethnic minority groups in central England are at an enhanced risk of house dust mite sensitisation', Clinical and Translational Allergy, vol. 13, no. 10, e12303. https://doi.org/10.1002/clt2.12303

Jagpal, P, Marriott, J, Thirumala Krishna, M & Alshareef, S 2022, 'Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: a systematic review', Clinical and Translational Immunology, vol. 12, no. 8, e12190. https://doi.org/10.1002/clt2.12190

Bhogal, R, Hussain, A, Savic, L, Misbah, SA, Balaji, A, Hullur, C, Marriott, J, Krishna, M & Bhogal, R 2022, 'Heterogeneity in direct oral penicillin challenge protocols in penicillin allergy de-labelling', Infection Prevention in Practice, vol. 4, no. 3, 100185. https://doi.org/10.1016/j.infpip.2021.100185

Krishna, MT, Vedanthan, PK, Vedanthan, R, El Shabrawy, RM, Madhan, R, Nguyen, HL, Kudagammana, T, Williams, I, Karmacharya, B, Hariharan, S, Krishnamurthy, K, Sumantri, S, Elliott, R, Mahesh, PA & Marriott, JF 2021, 'Is spurious penicillin allergy a major public health concern only in high-income countries?', BMJ Global Health, vol. 6, no. 5, e005437. https://doi.org/10.1136/bmjgh-2021-005437

Krishna, M, Subramanian, A, Adderley, N, Zemedikun, D, Gkoutos, G & Nirantharakumar, K 2019, 'Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis', European Respiratory Journal, vol. 54, no. 5, 1900476. https://doi.org/10.1183/13993003.00476-2019

Beck, SC, Wilding, T, Buka, RJ, Baretto, RL, Huissoon, AP & Krishna, MT 2019, 'Biomarkers in Human Anaphylaxis: A Critical Appraisal of Current Evidence and Perspectives', Frontiers in immunology, vol. 10, no. APR, 494. https://doi.org/10.3389/fimmu.2019.00494

Krishna, MT, York, M, Chin, T, Gnanakumaran, G, Heslegrave, J, Derbridge, C, Huissoon, A, Diwakar, L, Eren, E, Crossman, RJ, Khan, N & Williams, AP 2014, 'Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase', Clinical & Experimental Immunology, vol. 178, no. 2, pp. 399-404. https://doi.org/10.1111/cei.12424

Letter

Williams, I, Daniel, J, Mansur, AH, Christopher, DJ & Krishna, MT 2024, 'Exploring facilitators and barriers in asthma management in rural, semi-urban and urban populations in Vellore, India: an interview study of patients and primary care physicians', Clinical & Experimental Allergy . https://doi.org/10.1111/cea.14477

Alqahtani, A, Jagpal, P, Kudagammana, T, Vedanthan, PK, Krishnamurthy, K, Hariharan, S, El Shabrawy, RM, Maharaj, S, Marriott, J & Thirumala Krishna, M 2023, 'Drug allergy management in Egypt, Sri Lanka and the Caribbean: A qualitative study', Clinical and Experimental Allergy , pp. 1-3. https://doi.org/10.1111/cea.14437

Subramanian, A, Adderley, N, Gkoutos, G, Margadhamane Gokhale, K, Nirantharakumar, K & Krishna, M 2020, 'Ethnicity‐based differences in the incident risk of allergic diseases and autoimmune disorders: A UK‐based retrospective cohort study of 4.4 million participants', Clinical and Experimental Allergy , vol. 51, no. 1, pp. 144-147. https://doi.org/10.1111/cea.13741

Review article

Wraith, DC & Krishna, MT 2021, 'Peptide allergen-specific immunotherapy for allergic airway diseases-State of the art', Clinical and Experimental Allergy , vol. 51, no. 6, pp. 751-769. https://doi.org/10.1111/cea.13840

Jani, Y, Williams, I & Krishna, M 2020, 'Sustaining and spreading penicillin allergy de-labelling: a narrative review of the challenges for service delivery and patient safety', British Journal of Clinical Pharmacology, vol. 86, no. 3, pp. 548-559. https://doi.org/10.1111/bcp.14190, https://doi.org/10.1111/BCP.14190

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