Generations of medical expertise

Christina Chia Price, MD, assistant professor of medicine and of pediatrics, and clinical chief of allergy and immunology, is at the forefront of her field. She conducts critical research on aspects of clinical immunology including COVID-19, yet at cocktail parties everyone seems to think she is the person to ask about their allergy to cats. “I'm an allergy immunologist. But most people, when they think of allergies, they’re thinking of allergy shots. But immunology is a very robust field,” she said.

In addition to her duties at Yale School of Medicine, Price, a board-certified allergist and clinical immunologist, is also chief of allergy and immunology at the VA Connecticut Healthcare System in West Haven. She has a particular expertise in patients with immunodeficiencies and immune dysregulation. Price explained that she is unusual in that she sees adult patients with immune deficiencies, as most allergy immunologists specializing in immunodeficient patients are pediatricians. Price said, “There is actually a significant portion of adults with immune deficiencies—some that are subtle and some that are not as subtle. I have an expertise in patients with immune deficiency and immune dysregulation, and how to immunosuppress the immunodeficient.”

Price has long been drawn to the complexities, challenges, and promises of the human immune system. “I remember when I was a student, I thought—if these patients have a hard time generating the protective antibodies to fight infections, then they would have less chance of having autoimmune disease, but it's actually the opposite. It's that the ability to generate functional good antibodies to fight infection is so distorted that they also often generate auto-antibodies.”

It is not a surprise that Price was thinking about these complexities at a young age. Her father and brother are doctors; her aunts are nurses; and some cousins are doctors. When Price’s grandfather, Yee Yu Chia, was a young boy, his family sent him away for safety during a period of civil war in China. Her grandfather went on to become a practitioner of Chinese herbal medicine in Chinatown in Kuching, the capital of the state of Sarawak in Malaysia. “My father, grandfather, and great-grandfather—all went into medicine.”

When Price was growing up in St. Louis, Missouri, she didn’t see a lot of her grandfather in Malaysia. “I remember it took a whole day and we had to take three planes and it was a journey to get over there.” When her 11-year-old son Jacob was working on a family tree for a school project, Price shared a fascinating family photo of her grandfather. She said, “My son was so cute. He was like, wow, how far does this go?” They had discovered that the Chia family (Price’s maiden name) had been in medicine for generations.

Several years ago, Chia felt a little homesick and searched the Internet to see whether anything came up for her grandfather’s medicine shop in Chinatown. Price was hoping for a picture of a storefront or even just a picture of Kuching’s Chinatown to ease her homesickness. When she searched for Chinese medicine shop in Kuching, Malaysia, to her surprise the first image that came up was a picture of her grandfather in his shop.

He’d passed away a few years before, but a Lonely Planet photographer had taken photos of him and posted them online. Price contacted the photographer and bought a few photos, one of which is now framed and hanging in her living room. “Those old-fashioned Chinese medicine shops look so antique. They had canisters full of medical ingredients and a grinder—a wheel guided by your feet,” she said. Price also said she hasn’t been back recently, but her mother told her that much of her grandfather’s medical equipment ended up in a museum in Chinatown.

Now, instead of fielding questions about food and pet allergies, Price finds herself living through history as the COVID-19 pandemic has fostered a new awareness of her immunological work. “Because of COVID, everybody knows about antibodies and neutralizing antibodies and how important it is to have antibodies that work and do what they're supposed to do. And importantly, not do what they’re not supposed to do.” Price’s research was recently featured in the national conversation about COVID-19 treatments. In the October 2020 issue of the journal Chest, Price was the lead author of a study on the drug tocilizumab (Actemra). She and her fellow clinician-researchers reported their results on the drug.

“Because this was not a randomized control trial, we couldn’t say at that time patients who were treated with tocilizumab had a survival advantage, but compared to other published data on survival and mechanical ventilator outcomes, patients at Yale seemed to be doing better.” Since the publication of the Yale study, randomized control trials have shown that tocilizumab, when given to very sick patients and in addition to such corticosteroids as dexamethasone, had significantly improved survival, saving one in 12 lives and cutting the time spent in hospital by a week to 10 days.

Price was also asked by the magazine Rolling Stone to weigh in on the drug dexamethasone (Dextenza), used to treat rheumatoid arthritis. The magazine reported that Price was paying close attention to the results of a dexamethasone trial because she was a co-author of the peer-reviewed paper on tocilizumab. Both drugs are anti-inflammatory and were thought to be a possible effective treatment for hospitalized COVID-19 patients. Price told Rolling Stone, “The hyperinflammation that happens in some cancer patients as a result of T-cell immunotherapy resembles the cytokine storm in COVID-19 … During the cytokine storm … the body’s immune system overreacts, and immune cells and fluid flood into the lungs. … This condition leads to respiratory failure and death in the most severely ill patients.”

A leading researcher on immunotherapy to treat cancer, Price said, “The really groundbreaking and revolutionary treatment in cancer therapy has been immunotherapy, which is turning on the immune system to fight cancer right through these checkpoint inhibitors.” She explained how it is like working on the brakes of the immune system, easing up on them a little bit so that they can fight your cancer. “But you could imagine that in return, letting up the brakes a little bit might cause you to fight your own cells, resulting in immunotoxicity, and this would be related to immune dysregulation.”

Price has strong ties to Yale’s Cancer Center, having initiated an immunology clinic there. “We call it an immune wellness clinic because we didn’t want to call it an immune toxicity clinic,” she said. Owing to scientific advances, rather than using the medical equivalent of a sledgehammer, they can now use precision medicine to treat immunotoxicities and inflammatory events, whether they are connected to COVID-19 or to cancer.

Given a choice between conversations about allergies to cats and humanity freed from worries over COVID-19, Price might take the former, but no such choice is forthcoming. “Science and medicine won’t be the same after this,” Price said. “There’s no turning back, for better and for worse.”