Immunology

Leadership

David J. Rawlings, MD
Professor
Division Chief
Director, Center for Immunity and Immunotherapies
Co-Director, Northwest Genome Engineering Consortium
Children's Guild Association Endowed Chair in Pediatric Immunology

Overview

The Division of Immunology provides diagnostic and therapeutic services for both children and adults with a suspected or known primary immune deficiency disorder (PIDD). We see patients referred from throughout the WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho) and serve as a tertiary referral base for a regional population of more than 10 million. We also evaluate and treat PIDD patients referred from throughout the U.S. and abroad.

Members of our faculty each have active research programs within the Center for Immunity and Immunotherapies (CII) at Seattle Children’s Research Institute. Our faculty have played key roles in identifying the molecular basis for many of the now more than 140 molecularly defined PIDD’s, and in pioneering clinical care for these diseases. Our faculty also work closely with members of Fred Hutchinson Cancer Research Center (FHCRC) and Seattle Cancer Care Alliance (SCCA) to coordinate care for PIDD patients undergoing hematopoietic stem cell transplants. As part of this work, our clinicians utilize cutting-edge protocols to optimize successful transplantation while concurrently limiting its associated toxicities.

Our Division also operates an extensive molecular testing program that identifies genetic alterations leading to many of the most common PIDD’s including: severe combined immunodeficiency, agammaglobulinemia, hyper-IgM syndromes, common variable immunodeficiency and many other unique immune disorders. The immunology diagnostic program also provides high-resolution flow cytometry-based analysis of T and B cell developmental subsets (important for delineating unique developmental defects within distinct PIDDs); expression and functional analysis of potential mutant surface or intracellular proteins; analysis of thymic activity via T cell excision circles; and assessment of T cell repertoire. Additionally, we carry out in vivo evaluations of antibody response to the T cell-dependent neoantigen Bacteriophage ΦX174. These combined approaches provide a unique capacity to evaluate genetic alterations and their effects on the immune system, as well as to monitor immune reconstitution in post-transplant patients.

Clinical Programs

Seattle Children’s is one of the few places in the world where doctors are both carrying out cutting-edge research and providing treatment for primary immune deficiency disorders. We are the only referral center in the Northwest that specifically cares for pediatric and adult patients with PIDD. Our experts in immunology are internationally known for their work in identifying these serious disorders, as well as for their leadership in caring for children and adults with PIDD. Our laboratory offers the newest and most extensive testing to identify these disorders and their causes, and are at the forefront of research to find ways to treat and cure PIDD. We work closely with Fred Hutchinson Cancer Research Center (FHCRC) and Seattle Cancer Care Alliance (SCCA) to coordinate care for our patients who need bone marrow transplants.

Meet the Immunology care team.

Conditions we treat

Seattle Children's Immunology team diagnoses and treats many primary immune deficiency disorders (PIDD), including among others:

• Severe combined immunodeficiency (SCID)
  SCID is actually a group of inherited disorders that cause severe abnormalities of the immune system. These disorders lead to reduced or malfunctioning T- and B-lymphocytes, the specialized white blood cells made in the bone marrow to fight infection. When the immune system doesn’t function properly, it can be difficult or impossible for it to battle viruses, bacteria, and fungi that cause infections.

• Agammaglobulinemia
  Agammaglobulinemia is a disorder that blocks the development of a type of blood cell called B-lymphocytes. Mature B-lymphocytes release substances called antibodies that fight infection. People with agammaglobulinemia don’t have very many antibodies in their blood to fight off infections.

• Common variable immunodeficiency (CVID)
  CVID is a group of disorders that can be passed on from parent to child (genetic). People with CVID have low levels of infection-fighting antibodies in their blood. This makes it hard for them to fight off infections and illness. CVID can occur in children, but it is most common in young adults.

• Hyper-IgM syndrome (HIGM)
  Hyper-IgM syndrome is a disorder that can be passed on from parent to child (genetic). People with HIGM do not have enough of the most efficient infection-fighting antibodies. They usually have very low levels of both immunoglobulin A (IgA) and immunoglobulin G (IgG). This makes it hard for them to fight off infections and illness.

• Chronic Granulomatous Disease (CGD)
  CGD is a disorder that can be passed on from parent to child (genetic). It causes some infection-fighting white blood cells to be unable to break down bacteria. This makes it hard for people with CGD to get rid of certain types of bacteria and fungi, making them open to getting skin and lung infections.

• Wiskott-Aldrich Syndrome (WAS)
  Wiskott-Aldrich syndrome is a disorder that can be passed on from parent to child (genetic). People with WAS have very low numbers of platelets, the cells that cause blood to stick together (clot). This can cause problems with bleeding. Because WAS also affects the immune cells that fight infections, people with this disorder can get infections easily.

• Immune dysregulation Polyendocrinopathy Enteropathy X-linked (IPEX)
  IPEX is a disorder that can be passed on from parent to child (genetic). People with IPEX lack a type of white blood cell that regulates the immune system, the body’s natural defense against disease. Without the regulating white blood cell, the immune system can attack parts of the body itself. This can cause diarrhea, rash and sometimes diabetes.

• Hyper-IgE Syndrome (HIES)
  Hyper-IgE syndrome is a disorder that can be passed on from parent to child (genetic). It causes cells in the immune system to react abnormally to infections. This makes it hard for people with HIES to fight off infections, especially in the lungs and skin.

For additional information, as well as the steps required for testing for these conditions, please contact the CII Immunology Diagnostic Laboratory.

For Appointments:

Telephone/Fax:
Immunology Main Phone: (206) 987-7450
Immunology Main Fax: (206) 987-3890
Scheduling Clinic Appointments: (206) 987-7450 Option 1
Immunology Intake Fax Line for Physician Referrals: (206) 985-3121
New Appointment Request Form (PDF)

To reach the Immunologist on call: (206) 987-2000 (Switchboard)

Address:
Immunology Clinic:
Seattle Children's Hospital
Division of Immunology
4800 Sand Point Way NE
P.O. Box 5371/R-5441
Seattle, WA 98105
Map & directions

Immunology Clinic Hours:
8:00 a.m. – 1:00 p.m. Tuesdays
9:00 a.m. – 1:00 p.m. Thursdays

Immunology Faculty location:
Seattle Children's Research Institute
1900 Ninth Avenue
Mail-Stop: C9S-6
Seattle, WA 98101

If you would like a referral to the Immunology Division, please talk to your primary care provider.

Research Programs

Our faculty carry out research within the Center for Immunity and Immunotherapies (CII) at Seattle Children’s Research Institute. Our Center, also directed by Dr. Rawlings, brings together a dynamic group of distinguished experts across multiple disciplines to solve some of the immune system’s most complex problems. CII researchers treat patients in the Immunology, Rheumatology and other clinics at Seattle Children’s Hospital with the ultimate goal of applying what is learned in research to progressively advance the care of our patients.

Research within the CII extends full-circle, rapidly evolving from clinical questions to laboratory-based investigation and back to patients in the form of improved diagnostic tools for primary immune deficiency and autoimmune diseases, advanced therapies for genetic disorders, innovative vaccine strategies and enhanced immune monitoring techniques.

Harnessing the Immune System’s Healing Potential

We begin with the premise that a child’s immune system has vast healing potential. We focus on harnessing that potential by manipulating the immune system to treat pediatric diseases, including immune deficiency, autoimmunity, allergies, organ transplant rejection, infections and cancer. As part of this work, we are improving the molecular definition and diagnosis of immunological disorders, developing disease-specific cell therapies and stem cell transplantation approaches, modulating immune function through small-molecule therapeutics and working to cure immune deficiencies through cutting-edge gene therapy and gene repair.
Gene Therapy on CII
Northwest Genome Engineering Consortium (NGEC)

Working Collaboratively to Achieve Improved Health and Better Outcomes

Because the challenges are exceedingly complex, we search broadly for answers. For example, we leverage the strengths of our investigators and the broad expertise of our collaborators within the Northwest Genome Engineering Consortium (NGEC) in Seattle, along with other prominent academic and biotech research groups here and around the world. We are actively recruiting researchers who are leaders in the field — as well as graduate students, postdoctoral researchers from within, and beyond, the University of Washington Department of Immunology and technicians with outstanding scientific talent — to join our thriving research community and complement our existing expertise by bringing new approaches, innovations and capabilities.

Above all, we are motivated by our patients’ courage and are committed to helping them achieve improved health and better outcomes.

To take a tour of the Center for Immunity and Immunotherapy programs, please visit our website at:
http://seattlechildrens.org/research/immunity-and-immunotherapies/

Training Programs

The Division of Immunology also provides inpatient and outpatient training experience for adult and pediatric Allergy/Immunology, Rheumatology, and Infectious Disease fellows. Our faculty also co-direct the University of Washington-based Allergy and Immunology Fellowship program.

For more information on the program, please visit the Allergy and Immunology Fellowship Program webpage.

A&I residents are involved in basic and translational laboratory research and/or related scholarly activity. The first year of our training program is devoted entirely to research with a combination of research and clinical activities qualifying for American Board of Allergy and Immunology (ABAI) certification taking place in years 2 and 3 of the program. The University of Washington Allergy/Immunology fellows may choose among any relevant research laboratory throughout the UW system. For more information about the research faculty mentors participating in the Immunology research training, visit the UW Immunology website’s faculty page and the CII faculty website.

Fellowship coordinator:

Grace White
Administrative Director
ASTHMA, Inc.
4540 Sand Point Way NE, Suite 100
Seattle , WA 98105
Tel. 206.528.4725 (direct)
E-mail: gwhite@asthmainc.org