Conjoint Immune Dysregulation Clinic
We provide care for patients with autoimmune conditions affecting their blood cells.
Our immunologists and hematology-oncology physicians work together to provide comprehensive care for patients with conditions including:
- Complex autoimmune cytopenia conditions: Conditions in which antibodies in the body destroy healthy blood cells.
- Lymphoproliferative conditions: Conditions that involve intermittent or prolonged enlargement of the lymph nodes or spleen.
- Hyper inflammatory diseases: Conditions that cause patients to develop high fevers and signs of systemic inflammation.
We provide in-depth immune phenotyping and genetic sequencing to accurately diagnose patients’ conditions. Treatment to promote blood cell growth includes the use of biological therapies targeting specific immune pathways. Biological therapies are types of medications that are created using advanced technologies and allow us to suppress or stimulate a patient’s immune system in a highly-targeted way.
The team, led by Jolan Walter, M.D., Ph.D., with Irmel Ayala, M.D., offers a personalized treatment approach to address your child’s specific condition and underlying cause, so they receive treatment that meets their individual needs. For immune deficient patients who are prone to infection, this helps us to better balance their immune system.
Among the individual conditions we treat are:
- Autoimmune hemolytic anemia
- Autoimmune neutropenia
- Immune thrombocytopenia (ITP)
These conditions are complex, and it can be difficult to diagnose the underlying cause. We estimate that 10-40% of these patients have an underlying immune deficiency. There are hundreds of genes that can cause immune deficiencies, with new ones continually identified. Our understanding of all these genes changes rapidly. As an academic medical center, our experts have the clinical and research experience needed to diagnose and treat these complex conditions.
Our in-house immunological tools allow us to evaluate our patients more quickly, provide an accurate diagnosis (and in some cases, correct a previous misdiagnosis), and provide highly targeted treatment for diseases linked to immune dysregulation that can otherwise be misunderstood.
Research
We are active in research related to immune dysregulation and deficiency. View select publications below:
-
- Patel PK, Chinga ML, Yilmaz M, Joychan S, Ujhazi B, Ellison M, Gordon S, Nieves D, Csomos K, Eslin D, Afify ZA, Meznarich J, Bohnsack J, Walkovich K, Seidel MG, Sharapova S, Boyarchyk O, Latysheva E, Tuzankina I, Shaker AB, Ayala I, Sriaroon P, Westermann-Clark E, Walter JE. Clinical and Treatment History of Patients with Partial DiGeorge Syndrome and Autoimmune Cytopenia at Multiple Centers. J Clin Immunol. 2024;44(2):42. Epub 20240117. doi: 10.1007/s10875-023-01607-3. PubMed PMID: 38231436.
- Wang C, Shi Y, Lim XR, Walter JE. The clinical spectrum of thymoma-associated immunodeficiency: Good syndrome and beyond. Eur J Intern Med. 2024. Epub 20240413. doi: 10.1016/j.ejim.2024.04.006. PubMed PMID: 38616482.
- Wang C, Sun B, Wu K, Farmer JR, Ujhazi B, Geier CB, Gordon S, Westermann-Clark E, Savic S, Secord E, Sargur R, Chen K, Jin JJ, Dutmer CM, Kanariou MG, Adeli M, Palma P, Bonfim C, Lycopoulou E, Wolska-Kusnierz B, Dbaibo G, Bleesing J, Moshous D, Neven B, Schuetz C, Geha RS, Notarangelo LD, Miano M, Buchbinder DK, Csomos K, Wang W, Wang JY, Wang X, Walter JE. Clinical, immunological features, treatments, and outcomes of autoimmune hemolytic anemia in patients with RAG deficiency. Blood Adv. 2024;8(3):603-7. doi: 10.1182/bloodadvances.2023011264. PubMed PMID: 37883797; PMCID: PMC10837476.
-
- Chitty Lopez M, Yilmaz M, Diaz-Cabrera NM, Saco T, Ishmael L, Sotoudeh S, et al. Separating the Wheat From the Chaff in Asthma and Bronchiectasis: The Saga Trajectory of a Patient With Adult-Onset RAG1 Deficiency. J Allergy Clin Immunol Pract. 2023;11(6):1972-80.
- Sauerwein KMT, Geier CB, Stemberger RF, Rossmanith R, Akyaman H, Illes P, et al. Functionally impaired antibody response to BNT162b2 booster vaccination in CVID IgG responders. J Allergy Clin Immunol. 2023;151(4):922-5.
- Walter JE, Ziegler JB, Ballow M, Cunningham-Rundles C. Advances and Challenges of the Decade: The Ever-Changing Clinical and Genetic Landscape of Immunodeficiency. J Allergy Clin Immunol Pract. 2023;11(1):107-15.
- Sadighi Akha AA, Csomós K, Ujházi B, Walter JE, Kumánovics A. Evolving Approach to Clinical Cytometry for Immunodeficiencies and Other Immune Disorders. Clin Lab Med. 2023;43(3):467-483.
- Chitty Lopez M, Yilmaz M, Diaz-Cabrera NM, Saco T, Ishmael L, Sotoudeh S, Bindernagel C, Ujhazi B, Gordon S, Potts DE, Danziger R, Bosticardo M, Kenney H, Illes P, Lee S, Harris M, Cuellar-Rodriguez J, Patel KN, Csomos K, Dimitrova D, Kanakry JA, Notarangelo LD, Walter JE. Separating the Wheat From the Chaff in Asthma and Bronchiectasis: The Saga Trajectory of a Patient With Adult-Onset RAG1 Deficiency. J Allergy Clin Immunol Pract. 2023;11(6):1972-80. Epub 20230423. doi: 10.1016/j.jaip.2023.04.005. PubMed PMID: 37088379; PMCID: PMC10332246.
-
- Petrov A.A., Adatia A., Jolles S., Nair P., Azar A., Walter J.E. (2021) Antibody deficiency, Chronic Lung Disease, and Comorbid Conditions: A Case Based Approach. J Allergy Clin Immunol Pract. PubMed PMID: 34592394.
- Westermann-Clark, E., Ballow, M., & Walter, J. E. (2022). The new quest in CTLA-4 insufficiency: How to immune modulate effectively? J Allergy Clin Immunol PMID: 34915039
- Sauerwein, K. M. T., Geier, C. B., Stemberger, R. F., Akyaman, H., Illes, P., Fischer, M. B., Eibl, M. M., Walter, J. E., & Wolf, H. M. (2022). Antigen-Specific CD4+ T-Cell Activation in Primary Antibody Deficiency After BNT162b2 mRNA COVID-19 Vaccination. Frontiers in Immunology, 13. PMID: 35237272
- Otani, I. M., Lehman, H. K., Jongco, A. M., Tsao, L. R., Azar, A., Tarrant, T., Engel, E., Walter, J. E., Truong, T. Q., Khan, D. A., Ballow, M., Cunningham-Rundles, C., Lu, H., Kwan, M., & Barmettler, S. (2022). Practical Guidance for the Diagnosis and Management of Secondary Hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Altered Immune Response Committees. J Allergy Clin Immunol. PMID: 35176351
- Geier CB, Ellison M, Cruz R, Pawar S, Leiss-Piller A, Zmajkovicova K, McNulty SM, Yilmaz M, Evans MO 2nd, Gordon S, Ujhazi B, Wiest I, Abolhassani H, Aghamohammadi A, Barmettler S, Bhar S, Bondarenko A, Bolyard AA, Buchbinder D, Cada M, Cavieres M, Connelly JA, Dale DC, Deordieva E, Dorsey MJ, Drysdale SB, Ehl S, Elfeky R, Fioredda F, Firkin F, Förster-Waldl E, Geng B, Goda V, Gonzalez-Granado L, Grunebaum E, Grzesk E, Henrickson SE, Hilfanova A, Hiwatari M, Imai C, Ip W, Jyonouchi S, Kanegane H, Kawahara Y, Khojah AM, Kim VH, Kojić M, Kołtan S, Krivan G, Langguth D, Lau YL, Leung D, Miano M, Mersyanova I, Mousallem T, Muskat M, Naoum FA, Noronha SA, Ouederni M, Ozono S, Richmond GW, Sakovich I, Salzer U, Schuetz C, Seeborg FO, Sharapova SO, Sockel K, Volokha A, von Bonin M, Warnatz K, Wegehaupt O, Weinberg GA, Wong KJ, Worth A, Yu H, Zharankova Y, Zhao X, Devlin L, Badarau A, Csomos K, Keszei M, Pereira J, Taveras AG, Beaussant-Cohen SL, Ong MS, Shcherbina A, Walter JE. (2022). Disease Progression of WHIM Syndrome in an International Cohort of 66 Pediatric and Adult Patients. J Clin Immunol. PMID: 35947323
- Csomos, K., Ujhazi, B., Blazso, P., Herrera, J.L., Tipton, C.M., Kawai, T., Gordon, S., Ellison, M., Wu, K., Stowell, M., Haynes, L., Cruz, R., Zakota, B., Nguyen, J., Altrich, M., Geier, C.B., Sharapova, S., Dasso, J.F., Leiding, J.W., Smith, G., Al-Herz, W., de Barros Dorna, M., Fadugba, O., Fronkova, E., Kanderova, V., Svaton, M., Henrickson, S.E., Hernandez, J.D., Kuijpers, T., Kandilarova, S.M., Naumova, E., Milota, T., Sediva, A., Moshous, D., Neven, B., Saco, T., Sargur, R., Savic, S., Sleasman, J., Sunkersett, G., Ward, B.R., Komatsu, M., Pittaluga, S., Kumanovics, A., Butte, M.J., Cancro, M.P., Pillai, S., Meffre, E., Notarangelo, L.D., Walter, J.E. (2022). Partial RAG deficiency in humans induces dysregulated peripheral lymphocyte development and humoral tolerance defect with accumulation of T-bet+ B cells. Nature Immunology. PMID: 35902638
- Wang, W., Min, Q., Lai, N., Csomos, K., Wang, Y., Liu, L., Meng, X., Sun, J., Hou, J., Ying, W., Zhou, Q., Sun, B., Hui, X., Ujhazi, B., Gordon, S., Buchbinder, D., Schuetz, C., Butte, M., Walter, J. E., Wang X Wang, J. Y. (2022). Cellular Mechanisms Underlying B Cell Abnormalities in Patients With Gain-of-Function Mutations in the PIK3CD Gene. Frontiers in Immunology, 13. PMID: 35799777
- Ballow, M., Sánchez-Ramón, S., Walter, J.E. (2022). Secondary Immune Deficiency and Primary Immune Deficiency Crossovers: Hematological Malignancies and Autoimmune Diseases. Front Immunol. PMID: 35924244
- Wang, C., Walter, J.E. (2022). Autoantibodies in immunodeficiency syndromes: The Janus faces of immune dysregulation. Blood Rev. PMID: 35428517.
- Phillips, E.J., Walter, J.E. (2022). Precision Medicine in Allergy and Immunology Through the Lens of Immunogenomics. J Allergy Clin Immunol Pract. PMID: 35809990.
- Mammadova, J., Redden, A., Cruz, R., Ujhazi, B., Gordon, S., Ellison, M., Gatewood, T., Duff, C., Cannella, A., Somboonwit, C., Sriaroon, C., Csomos, K., Dasso, J. F., Harville, T., Ismail-Khan, R., & Walter, J. E. (2022). Corrigendum: Case report: Initial treatment adjustments and complications in ovarian cancer patient with inborn error of immunity. Frontiers in Oncology. PMID: 36226071
- Blazso P, Csomos K, Tipton CM, Ujhazi B, Walter JE. Lineage Reconstruction of In Vitro Identified Antigen-Specific Autoreactive B Cells from Adaptive Immune Receptor Repertoires. Int J Mol Sci. 2022;24(1).
- Yilmaz M, Potts DE, Geier C, Walter JE. Can we identify WHIM in infancy? Opportunities with the public newborn screening process. Am J Med Genet C Semin Med Genet. 2022;190(2):215-21.
-
- Calabrese, L.H., Winthrop, K., Strand, V., Yazdany, J., Walter, J.E. (2021). Type I interferon, anti-interferon antibodies, and COVID-19. Lancet Rheumatol. PMID: 33655222
- 2021 Arkwright, P.D., Walter, J.E. (2021). Introducing a New Epoch in Inborn Errors of Immunity. J Allergy Clin Immunol Pract. PMID: 33551040
- Gaefke, C.L., Metts, J., Imanirad, D., Nieves, D., Terranova, P., Dell’Orso, G., Gambineri, E., Miano, M., Lockey, R.F., Walter, J.E., Westermann-Clark, E. (2021). Case Report: A Novel Pathogenic Missense Mutation in FAS: A Multi- Generational Case Series of Autoimmune Lymphoproliferative Syndrome. Frontiers in Pediatrics. PMID: 33816397
- Westermann-Clark E., Meehan C.A., Meyer A.K., Dasso J.F., Amre D., Ellison M., Patel B., Betensky M., Hauk C.I., Mayer J., Metts J., Leiding J.W., Sriaroon P., Kumar A., Ayala I., Walter J.E. (2021) Primary Immunodeficiency in Children With Autoimmune Cytopenias: Retrospective 154-Patient Cohort. Front Immunol, 12:649182. PubMed PMID: 33968040; PMCID: PMC8100326.
- Zeitler K., Walter J., Khan F., Sriaroon C. (2021) Recurrent disseminated Mycobacterium avium in a female patient from Thailand with anti-interferon-gamma autoantibodies: dilemma on treatment approach. BMJ Case Rep, 14(1). PubMed PMID: 33509870; PMCID: PMC7845683.
-
- Cruz, R.J., Dasso, J.F., Duff, C., Krasnopero, D., Long, Z., Ellison, M., Nieves, D., Sriaroon, P., Asante-Koran, A., Walter, J.E. (2020). Hyaluronidase-Facilitated high-dose subcutaneous IgG effectively controls parvovirus B19 infection in a pediatric cardiac transplant patient with severe T-cell lymphopenia. Open Forum Infec Dis. PMID: 32391400
- Hossny E., Condino-Neto A., Hammarstrom L., Walter J.E. (2020) Editorial: Screening for Primary Immunodeficiency Disorders (PIDDs) in Neonates. Front Immunol, 11:633266. PubMed PMID: 33424872; PMCID: PMC7793736.
- Chitty-Lopez M., Westermann-Clark E., Dawson I., Ujhazi B., Csomos K., Dobbs K., Le K., Yamazaki Y., Sadighi Akha A.A., Chellapandian D., Oshrine B., Notarangelo L.D., Sunkersett G., Leiding J.W., Walter J.E. (2020) Asymptomatic Infant With Atypical SCID and Novel Hypomorphic RAG Variant Identified by Newborn Screening: A Diagnostic and Treatment Dilemma. Front Immunol, 11:1954. PubMed PMID: 33117328; PMCID: PMC7552884.
- Engel E.R., Walter J.E. (2020) Rituximab and eculizumab when treating nonmalignant hematologic disorders: infection risk, immunization recommendations, and antimicrobial prophylaxis needs. Hematology Am Soc Hematol Educ Program, 2020(1):312-8. PubMed PMID: 33275746; PMCID: PMC7727502
-
- Farmer, J.R., Foldvari, Z., Ujhazi, B., De Ravin, S.S., Chen, K., Bleesing, J.J.H., Schuetz, C., Al-Herz, W., Abraham, R.S., Joshi, A.Y., Costa-Carvalho, B.T., Buchbinder, D., Booth, C., Reiff, A., Ferguson, P.J., Aghamohammadi, A., Abolhassani, H., Puck, J.M., Adeli, M., Cancrini, C., Palma, P., Bertaina, A., Locatelli, F., Di Matteo, G., Geha, R.S., Kanariou, M.G., Lycopoulou, L., Tzanoudaki, M., Sleasman, J.W., Parikh, S., Pinero, G., Fischer, B.M., Dbaibo, G., Unal, E., Patiroglu, T., Karakukcu, M., Al-Saad, K.K., Dilley, M.A., Pai, S.Y., Dutmer, C.M., Gelfand, E.W., Geier, C.B., Eibl, M.M., Wolf, H.M., Henderson, L.A., Hazen, M.M., Bonfim, C., Wolska-Kuśnierz, B., Butte, M.J., Hernandez, J.D., Nicholas, S.K., Stepensky, P., Chandrakasan, S., Miano, M., Westermann-Clark, E., Goda, V., Kriván, G., Holland, S.M., Fadugba, O., Henrickson, S.E., Ozen, A., Karakoc-Aydiner, E., Baris, S., Kiykim, A., Bredius, R., Hoeger, B., Boztug, K., Pashchenko, O., Neven, B., Moshous, D., Villartay, J.P., Bousfiha, A.A., Hill, H.R., Notarangelo, L.D., Walter, J.E. (2019). Outcomes and Treatment Strategies for Autoimmunity and Hyperinflammation in Patients with RAG Deficiency. J Allergy Clin Immunol Pract. PMID: 30877075
- Purswani, P., Meehan, C.A., Kuehn, H.S., Chang, Y., Dasso, J.F., Meyer, A.K., Ujhazi, B., Csomos, K., Lindsay, D., Alberdi, T., Joychan, S., Trotter, J., Duff, C., Ellison, M., Bleesing, J., Kumanovics, A., Comeau, A.M., Hale, J.E., Notarangelo, L.D., Torgersen, T.R., Ochs, H.D., Sriaroon, P., Oshrine, B., Petrovic, A., Rosenzweig, S.D., Leiding, J.W., Walter, J.E. (2019). Two Unique Cases of X-linked SCID: A Diagnostic Challenge in the Era of Newborn Screening. Front Imm. PMID: 31024866, PMCID: PMC6460992
- Dorna, M.B., Barbosa, P.F.A., Rangel-Santos, A., Csomos, K., Ujhazi, B., Dasso, J.F., Thwaites, D., Boyes, J., Savic, S., Walter, J.E. (2019). Combined Immunodeficiency with Late-Onset Progressive Hypogammaglobulinemia and Normal B Cell Count in a Patient With RAG2 Deficiency. Front Pediatr. PMID: 31058115, PMCID: PMC6477099
- Sriaroon, P., Chang, Y., Ujhazi, B., Csomos, K., Joshi, H.R., Zhou, Q., Close, D.W., Walter, J.E., Kumánovics, A. (2019). Familial Immune Thrombocytopenia Associated with a Novel Variant in IKZF1. Front Pediatr. PMID: 31069201, PMCID: PMC6491668
- 2019 Walter, J.E., Ballow, M. (2019). The WHIM Syndrome Is No Longer a Whim. J Allergy Clin Immunol Pract. PMID: 31076063
- Wu, K.Y., Purswani, P, Ujhazi, B., Csomos, K., Snezhina, M., Elissaveta, N., Stefanov, S., Sharapova, S., Ellison, M., Milojevic, D., Savic, S., Sargur, R., Walter, J.E. (2019). Arthritis in Two Patients With Partial Recombination Activating Gene Deficiency. Front Pediatr. PMID:31334206
- 2019 Bulkhi, A.A., Dasso, J.F., Schuetz, C., Walter, J.E. (2019). Approaches to patients with variants in RAG genes: from diagnosis to timely treatment. Expert Rev Clin Immunol. PMID:31535575.
- Chinn, I.K., Chan, A.Y., Chen, K., Chou, J., Dorsey, M.J., Hajjar, J., Jongco, A.M 3rd., Keller, M.D., Kobrynski, L.J., Kumanovics, A., Lawrence, M.G., Leiding, J,W., Lugar, P.L., Orange, J.S., Patel, K., Platt, C.D., Puck, J.M., Raje, N., Romberg, N., Slack, M.A., Sullivan, K.E., Tarrant, T.K., Torgerson, T.R., Walter, J.E. (2019). Diagnostic interpretation of genetic studies in patients with primary immunodeficiency diseases: A working group report of the Primary Immunodeficiency Diseases Committee of the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. PMID:31568798
- Walter, J.E., Ayala, I.A., Milojevic, D. (2019). Autoimmunity as a continuum in primary immunodeficiency. Curr Opin Pediatr. PMID:31693597
-
- Westermann-Clark, E., Grossi, A., Fioredda, F., Giardino, S., Cappelli, E., Terranova, P., Palmisani, E., Farmer, J.R., Foldvari, Z., Yamazaki, Y.7., Faraci, M., Lanino, E., Notarangelo, L.D., Dufour, C., Ceccherini, I., Walter, J.E.*, Miano, M.* (*shared senior co-authors) (2018). RAG deficiency with ALPS features successfully treated with TCRαβ/CD19 cell depleted haploidentical stem cell transplant. Clinical Immunology. PMID: 29104089, PMCID: PMC5941932
- Goda, V., Malik, A., Kalmar, T., Maroti, Z., Patel, B., Ujhazi, B., Csomos, K., Hale, J.E., Chen, K., Bleesing, J., Palma, P., Cancrini, C., Comeau, A.M., Krivan, G., Walter, J.E. (2018). Partial RAG deficiency in a patient with varicella infection, autoimmune cytopenia, and anticytokine antibodies. J Allergy Clin Immunol Pract. PMID: 29410113, PMCID: PMC6072614
- Henrickson, S.E., Walter, J.E., Quinn, C., Kanakry, J.A., Bardakjian, T., Dimitrova, D., Ujhazi, B., Csomos, K., Bosticardo, M., Dobbs, K., Nasrallah, M., Notarangelo, L.D., Holland, S.M., Fadugba, O. (2018). Adult-Onset Myopathy in a Patient with Hypomorphic RAG2 Mutations and Combined Immune Deficiency. J Clin Immunol. PMID: 30159811
- Meehan, C., Bonfim, C., Dasso, J.F., Costa-Carvalho, B.T., Condino-Neto, A., Walter, J.E. (2018). In Time: The value and global implications of newborn screening for severe combined immunodeficiency. Rev Paul Pediatr. PMID: 30540106
Make an Appointment
We accept referrals from your child’s primary care physician or self-referrals and see patients by appointment only. To schedule an appointment, please call 727-828-6390.
Records from your primary or referring physician must be sent before your child’s first appointment. Records may be faxed to 727-828-6398.
We see patients in the Johns Hopkins All Children’s Outpatient Care, St. Petersburg (main campus) and Outpatient Care, Tampa.
