ESID Registry – Working Definitions for Clinical Diagnosis of PID

These criteria are only for patients with no genetic diagnosis*. *Exceptions: Atypical SCID, DiGeorge syndrome – a known genetic defect and confirmation of criteria is mandatory.

Available entries (Please click on an entry to see the criteria.) Page

Acquired ...... 4 Agammaglobulinemia ...... 4 Asplenia syndrome (Ivemark syndrome) ...... 4 Ataxia telangiectasia (ATM) ...... 4 Atypical Severe Combined (Atypical SCID) ...... 5 Autoimmune lymphoproliferative syndrome (ALPS) ...... 5 APECED / APS1 with CMC - Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) ...... 5 Barth syndrome ...... 6 Bloom syndrome ...... 6 Cartilage hair hypoplasia (CHH) ...... 7 CD8 deficiency ...... 7 Chronic mucocutaneous candidiasis (CMC) ...... 7 deficiency (C1q deficiency) ...... 8 Complement component 1r deficiency (C1r deficiency) ...... 8 Complement component 1s deficiency (C1s deficiency) ...... 9 deficiency ...... 9 deficiency (C3) ...... 9 deficiency (, C4B) ...... 9 deficiency ...... 10 deficiency ...... 10 deficiency ...... 10 Complement component 8 deficiency (C8A, C8B, C8G) ...... 10 Complement component 9 deficiency ...... 11 CSR defects and HIGM syndrome ...... 11 Chediak Higashi syndrome (CHS) ...... 12 Chronic granulomatous disease (CGD) ...... 12 Clericuzio-type poikiloderma with neutropenia syndrome ...... 12 COHEN syndrome ...... 13 Combined immunodeficiency (CID) ...... 13

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Common variable immunodeficiency disorders (CVID) ...... 13 Congenital neutropenia ...... 14 Cyclic neutropenia ...... 14 Defects of TLR/NFkappa-B signalling ...... 14 Defects with susceptibility to mycobacterial infection (MSMD) ...... 15 Deficiency of specific IgG (Specific deficiency - SPAD) ...... 15 DiGeorge syndrome ...... 15 Dyskeratosis congenita ...... 15 Early-onset inflammatory bowel disease ...... 16 Early-onset multi-organ autoimmune disease ...... 16 Epidermodysplasia verruciformis ...... 16 Factor B Deficiency ...... 17 deficiency ...... 17 Deficiency ...... 17 Factor H Related Deficiency ...... 17 Factor I Deficiency ...... 18 3 ...... 18 Deficiency (FC3RN) ...... 18 Familial hemophagocytic lymphohistiocytosis syndromes (FHLH) ...... 18 FOXP3 deficiency (IPEX) ...... 19 Glycogen storage disease type 1b (GS1b) ...... 19 Griscelli syndrome type 2 ...... 19 (C1inh) ...... 20 Herpetic encephalitis (HSE) ...... 20 Hermansky-Pudlak syndrome (type 2) ...... 20 HLA class I deficiency ...... 21 HLA class II deficiency (MHC2) ...... 21 Hoyeraal-Hreidarsson syndrome ...... 21 Hyper IgE syndrome (HIES) ...... 22 IgA with IgG subclass deficiency ...... 22 Immunodeficiency centromeric instability facial anomalies syndrome (ICF) ...... 22 IPEX-like disease ...... 23 Isolated IgG subclass deficiency ...... 23 Isolated congenital asplenia ...... 23 Mannose-binding lectin deficiency (MBL) ...... 24 Membrane CoFactor Protein (CD46) Deficiency ...... 24 MonoMAC (WILD) ...... 24

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Netherton syndrome ...... 25 Nijmegen breakage syndrome ...... 25 ...... 26 Papillon-Lefevre syndrome ...... 26 Partial albinism and immunodeficiency syndrome ...... 26 P factor (PFC) ...... 27 Schimke disease...... 27 Seckel syndrome ...... 27 Selective CD4 cell deficiency ...... 28 Selective IgA deficiency ...... 28 Selective IgM deficiency ...... 28 Severe combined immunodeficiency (SCID) ...... 29 Shwachman-Diamond-syndrome ...... 29 Thymoma with immunodeficiency ...... 29 Transient hypogammaglobulinaemia of infancy ...... 29 Warts infections and myelokathexis (WHIM) ...... 29 Wiskott-Aldrich syndrome (XLT/WAS) ...... 30 X-linked lymphoproliferative syndrome (XLP) ...... 30 Unclassified antibody deficiency ...... 31 Unclassified phagocytic disorders ...... 31 Unclassified disorders of ...... 31 Unclassified defects in innate immunity ...... 32 Unclassified complement deficiencies ...... 32 Unclassified autoinflammatory diseases ...... 32 Unclassified syndromic ...... 33 Unclassified immunodeficiencies ...... 33

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Acquired angioedema 9. Phenocopies of Sofia Grigoriadou, At least one of the following inborn errors of Matthew Buckland - Recurrent angioedema without urticarial rash immunity - History of predisposing disorder (e.g. autoimmune, lymphoreticular malignancy) AND No family history to suggest HAE or an alternative diagnosis AND Low complement C4 (< 2.S.D of the mean) between or during angioedema attacks AND absent C1 esterase protein or absent C1 esterase inhibitor function AND (Low C1q level OR anti-C1Q OR anti-C1E antibodies) Agammaglobulinemia 3. Predominantly 300300, 147020, Annarosa Soresina, Fewer than 2% circulating B cells (CD19 and CD20), preferably in For patients with normal antibody deficiencies 146770, 112205, Nizar Mahlaoui, two separate determinations and a normal number of T cells B cells and 300310, 300755, 147245, 604515, Hans Ochs, Isabella (CD3, CD4 and CD8) agammaglobulinaemia, 601495, 613500, 171833, 147141, Quinti AND serum IgG levels below: please consider 612692, 613501, 608360 -200 mg/dl in infants aged < 12 months “Unclassified antibody 613502, 613506, -500 mg/dl in children aged > 12 months deficiency” 616941, 615214 OR normal IgG levels with IgA and IgM below 2SD AND onset of recurrent infections before 5 years of age OR positive maternal family history of agammaglobulinemia Asplenia syndrome 6. Defects in intrinsic 602880 Nizar Mahlaoui, Asplenia or hyposplenia (Ivemark syndrome) and innate immunity David Edgar, AND Documentation of Howell-Jolly bodies on blood smears Stephan Ehl, AND radiological findings evidencing asplenia (US, CT scan, 208530 Capucine Picard, scintigraphy) Jean-Laurent AND heterotaxia defects (dextrocardia, situs inversus, other…) or Casanova other heart and great vessel defects

Ataxia telangiectasia 2. Combined 607585 Nizar Mahlaoui, Ataxia (ATM) immunodeficiencies David Edgar, AND at least two of the following : with associated or Stephan Ehl, Richard • Oculocutaneous telangiectasia 208900 syndromic features Gatti, Dominique • Elevated alpha-fetoprotein (tenfold the upper limit of Stoppa-Lyonnet normal) • Lymphocyte A-T karyotype (translocation 7;14) • Cerebellum hypoplasia on MRI

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Atypical Severe Combined 1. 179615.0016, Stephan Ehl, Alain Mutation in a SCID-causing gene Combined Immunodeficiency Immunodeficiencies 608958.0031, Fischer AND immunodeficiency (Atypical SCID) affecting cellular and 308380.0010, >100 T cells/µl humoral immunity 308380.0013 AND Absence of characteristic SCID-associated infections (PCP, symptomatic CMV, persistent respiratory or gastrointestinal virus infection) in the first year of life AND Does not fulfil the criteria for Omenn syndrome Autoimmune 4. Diseases of 134637, 134638, David Edgar, At least one of the following: For patients with lymphoproliferative immune 601762, 601763, Stephan Ehl, • lymphoproliferation syndrome (ALPS) dysregulation 602457, 123890, Frederic Rieux- • (>3 nodes, >3 months, non-infectious, and/or autoimmunity 176977, 164790 Laucat, Benedicte non-malignant) who do not fulfil these 601859, 603909, Neven • autoimmune cytopenia (>/= 2 lineages) criteria, please consider 607271, 616100, • history of lymphoma the following diagnoses: 615559, 614470 • affected family member • CVID AND at least one of the following: • Combined • TCRab+CD3+CD4-CD8- of TCRab+CD3+ T cells > 6% immunodeficiencies • elevated biomarkers (at least 2 of the following): • Unclassified • sFASL > 200pg/ml disorders of • Vitamin B12 > 1500ng/L immune • IL-10 > 20pg/ml dysregulation • Impaired FAS mediated apoptosis APECED / APS1 with CMC - 4. Diseases of 607358 Nizar Mahlaoui, Look for at least 2 of the following: Autoimmune immune Frank van de • chronic mucocutaneous candidiasis (oral, oesophageal polyendocrinopathy dysregulation Veerdonk, Desa Lilic (difficulty swallowing) genital, skin, nails) – confirm with candidiasis ectodermal culture dystrophy (APECED) • autoimmune hypoparathyroidism / hypocalcemia • autoimmune adrenocortical failure (Addison’s disease) 240300 • other autoimmune: hypergonadotropic hypogonadism, alopecia, vitiligo, autoimmune hepatitis, type 1 diabetes, gastrointestinal dysfunction • other: ectodermal dystrophy: dental enamel hypoplasia, nail dystrophy Diagnostic tests (specific for APECED / APS1): • organ-specific autoantibodies (parathyroid, adrenal, gonads, islet cell)

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) • anti-cytokine autoantibodies (IFNα & ω and/or IL17A /IL17F/ IL22) [comment: sensitivity & specificity >95% (Kisand et al, Eur J Immunol 2011), can replace AIRE genotyping as >70 known mutations]

Barth syndrome 5. Congenital defects 300394 Nizar Mahlaoui, Jean Male of phagocyte number Donadieu, Christoph AND 302060 or function Klein Cardiac features (heart failure, dilated cardiomyopathy, left ventricular non-compaction, endocardial fibroelastosis, and serious disturbances of heart rhythm such as ventricular fibrillation or tachycardia) AND Chronic Neutropenia AND at least one of the following • Neuromuscular features such as skeletal myopathy, hypotonia, delayed motor milestones, exercise intolerance, and abnormal fatigability. • Distinctive facial gestalt (most evident in infancy) • Growth delay is common in childhood Bloom syndrome 2. Combined 604610 Markus Seidel, Short stature immunodeficiencies Beata Wolska, Corry AND 210900 with associated or Weemaes, Andy • immunodeficiency (hypogammaglobulinemia, variably syndromic features Gennery reduced lymphocyte proliferation, lower respiratory tract infections) • Cytogenetics: high sister-chromatid exchange rate, chromosomal breaks AND at least one of the following • Skin: photosensitivity, butterfly erythema, café-au-lait maculae • Head: microcephaly, dolichocephaly, prominent ears and nose • Hands: syndactyly, polydactyly, fifth finger clinodactyly • Malignoma: leukemia, lymphoma, adenocarcinoma, squamous cell carcinoma

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Cartilage hair hypoplasia 2. Combined 157660 Nizar Mahlaoui, Short stature (CHH) immunodeficiencies Bobby Gaspar, AND with associated or Andrew Gennery immunodeficiency (combined immunodeficiency (variable T and 250250 syndromic features lymphopenia), AND AT LEAST one of the following: • radiographical manifestations of CHH (metaphyseal chondrodysplasia, • light-coloured hypoplastic hair / fine silky hair • gastrointestinal malabsorption or Hirschsprung’s , • hematological abnormalities (bone marrow dysplasia, pure red cell aplasia), • granulomatous (skin lesions,…), • EBV driven lymphoproliferative disease • Malignancies AND no sign of other immune-osseous dysplasia (Schimke disease) CD8 deficiency 1. 186910 Nizar Mahlaoui, CD8+ cells: Immunodeficiencies Matthew Buckland, less than 350/µl if age less than 2 years 608957 affecting cellular and Sofia Grigoriadou less than 250/µl if age betweeen 2 and 4 years humoral immunity less than 150/µl if age greater than 4 years AND Recurrent and/or severe infections AND Normal or increased CD4, CD19 and CD56 AND normal class HLA-class 1 expression AND Other primary causes of lymphopenia excluded Chronic mucocutaneous 9. Phenocopies of 607358 Nizar Mahlaoui, Look for: candidiasis (CMC) inborn errors of Frank van de • chronic, persistent or recurrent non-invasive immunity Veerdonk, Desa Lilic mucocutaneous Candida or dermatophyte infections (oral, esophageal (difficulty swallowing, esophageal cancer) genital, skin, nails) – confirm with culture • other infections: skin (boils, abscesses, eczema, rosacea) lungs (chest infections, bronchiectasis) eyes (stye, blepharitis, conjunctivitis) • autoimmunity: hypothyroidism, vitiligo, alopecia, ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 7 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) autoimmune hepatitis • vasculopathy (intracranial aneurisms, brain vascular anomalies) • family history / early age of onset

Exclude secondary causes: • predisposing conditions: HIV, diabetes, iron deficiency, neutropenia, dentures • predisposing treatments: antibiotics, immunosuppressive drugs, inhaled steroids, PPIs • exclude isolated recurrent vulvo-vaginal candidiasis (RVVC)

[Comment: Informative tests (where available): i. Th-17 & Th-22 cells and production ii. Low CD4 and B cell counts (combined immune deficiency) iii. Low iron] Complement component 8. Complement 120550, 120570, Matthew Buckland, At least one of the following; 1q deficiency (C1q deficiencies 120575 Ania Manson, Sofia • Increased susceptibility to infections with encapsulated deficiency) Grigoriadou organisms • SLE like syndrome 613652 • Family history of symptomatic C1q deficiency

AND CH50/CH100 activity less than 10% of control value with normal AP50/AP100 activity

Complement component 8. Complement 613785 Matthew Buckland, At least one of the following; 1r deficiency (C1r deficiencies Ania Manson, Sofia • Increased susceptibility to infections with encapsulated deficiency) Grigoriadou organisms • SLE like syndrome 216950 • Ehler’s Danlos Phenotype • Family history of symptomatic C1r deficiency AND CH50/CH100 activity less than 10% of control value with normal AP50/AP100 activity ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 8 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Complement component 8. Complement 120580 Matthew Buckland, At least one of the following; 1s deficiency (C1s deficiencies Ania Manson, Sofia • Increased susceptibility to infections with encapsulated deficiency) Grigoriadou organisms • SLE like syndrome 613783 • Multiple autoimmune diseases • Ehler’s Danlos Phenotype • Family history of symptomatic C1s deficiency

AND CH50/CH100 activity less than 10% of control value with normal AP50/AP100 activity

Complement component 8. Complement 613927 Matthew Buckland, At least one of the following; 2 deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent Grigoriadou pyogenic) 217000 • Discoid lupus • SLE • Family history of symptomatic C2 Deficiency AND CH50 or CH100 activity less than 10% of control activity AND Absent C2 with normal C3 and C4 complement levels Complement component 8. Complement 120700 Matthew Buckland, At least one of the following; 3 deficiency (C3) deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisseria or Grigoriadou streptococcal) 613779 • Glomerulonephritis • Family history of symptomatic C3 Deficiency AND CH50/CH100 and AP50/AP100 less than 10% of control activity AND Absent immunochemical C3 with normal Factor H and I levels Complement component 8. Complement 120810, 120820 Matthew Buckland, At least one of the following; 4 deficiency (C4A, C4B) deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) Grigoriadou • Family history of recurrent Neisserial disease 614380, 614379 AND CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 9 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Low immunochemical C4 protein or reduced bactericidal activity

Complement component 8. Complement 120900 Matthew Buckland, At least one of the following; 5 deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) Grigoriadou • Family history of recurrent Neisserial disease 609536 AND CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND Low immunochemical C5 protein or reduced bactericidal activity Complement component 8. Complement 217050 Matthew Buckland, At least one of the following; 6 deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) Grigoriadou • Family history of recurrent Neisserial disease 612446 AND CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND Low immunochemical C6 protein or reduced bactericidal activity Complement component 8. Complement 217070 Matthew Buckland, At least one of the following; 7 deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) Grigoriadou • Family history of recurrent Neisserial disease 610102 AND CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND Low immunochemical C7 protein or reduced bactericidal activity Complement component 8. Complement 120950, 120960, Matthew Buckland, At least one of the following; 8 deficiency (C8A, C8B, deficiencies 120930 Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) C8G) Grigoriadou • Family history of recurrent Neisserial disease AND 613790, 613789 CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND Low immunochemical C8 protein or reduced bactericidal activity ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 10 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Complement component 8. Complement 120940 Matthew Buckland, At least one of the following; 9 deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (Neisserial) Grigoriadou • Family history of recurrent Neisserial disease 613825 AND CH50 (or CH100) and AP50 (or AP100) activity less than 5% of control activity AND Absent immunochemical C9 protein or reduced bactericidal activity CSR defects and HIGM 3. Predominantly 600678, 191525, Stephan Ehl, Anne At least one of the following: syndrome antibody deficiencies 605257 Durandy, Teresa • increased susceptibility to infections (recurrent and/or Espanol opportunistic, including cryptosporidium) 608106, 605258, • immune dysregulation (autoimmunity, 608184 lymphoproliferation, sclerosing cholangitis) • cytopenia (neutropenia or autoimmune) • malignancy (lymphoma) • affected family member AND marked decrease of IgG (measured at least twice) AND normal or elevated IgM (measured at least twice) AND defined causes of hypogammaglobulinemia have been excluded AND no evidence of profound T-cell deficiency, defined as 2/3 of the following (mo=month, y=year of life): • CD4 numbers/microliter: 0-6mo <1000, 6mo-1y <800, 1-2y <500, 2-6y <300, 6- 12y <250, >12y <200 • % naive CD4: 0-2y <30%, 2-6y <25%, 6-16y <20%, >16y 10% • proliferation absent AND no evidence of Ataxia telangiectasia (cafe-au lait spots, ataxia, telangiectasia, raised AFP)

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Chediak Higashi syndrome 4. Diseases of 606897 Nizar Mahlaoui, At least one of: Immunodeficiency with (CHS) immune David Edgar, • recurrent bacterial infections partial albinism dysregulation Stephan Ehl, • episode of hemophagocytic lymphohistiocytosis (HLH) 214500 Genevieve de Saint • Neutropenia Basile, Despina • reduced lymphocyte degranulation/cytotoxicity Moshous • affected family member AND one of: • Typical hair shaft abnormalities • Presence of intracytoplasmic typical giant granules on blood or bone marrow smears Chronic granulomatous 5. Congenital defects 300481, 608508, Maria Kanariou, At least one of the following: disease (CGD) of phagocyte number 608512, 608515, Reinhard Seger • deep seated infection due to bacteria and/or fungi or function 601488 (abscesses, osteomyelitis, lymphadenitis) 306400, 233700, • recurrent pneumonia 233690, 233710, • lymphadenopathy and/or and/or 613960 splenomegaly • obstructing/diffuse granulomata (gastrointestinal or urogenital tract) • chronic inflammatory manifestations (colitis, liver abscess and fistula formation) • • affected family member AND absent/significantly decreased respiratory burst (NBT or DHR, measured at least twice)

Clericuzio-type 5. Congenital defects 613276 Nizar Mahlaoui, Jean Chronic neutropenia, poikiloderma with of phagocyte number Donadieu, Christoph AND neutropenia syndrome or function Klein Poikiloderma, AND 604173 Recurrent infections, AND Pachyonychia, OR Palmo-plantar hyperkeratosis

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) COHEN syndrome 5. Congenital defects 607817 Nizar Mahlaoui, Jean Chronic neutropenia. of phagocyte number Donadieu, Christoph AND at least 2 of the followings: 216550 or function Klein • intellectual deficiency (ID), • microcephaly, • facial dysmorphism, • slender extremities, • obesity, • progressive chorioretinal dystrophy

Combined 1. 603122, 300386, Stephan Ehl, Maria At least one of: immunodeficiency (CID) Immunodeficiencies 109535, 186740, Kanariou, Alain • at least one severe infection (requiring hospitalization) affecting cellular and 186910, 176947, Fischer • one manifestation of immune dysregulation 616433, 615607, 615897, humoral immunity 170260, 170261, (autoimmunity, IBD, severe eczema, lymphoproliferation, 312863, 615468, 614172, 601962, 109700, granuloma) 616098, 616740, 618131, 600005, 603200, • malignancy 233600 601863, 601861, • affected family member 602037, 604655, AND 2 of 4 T cell criteria fulfilled: 604758, 300715, • reduced CD3 or CD4 or CD8 T cells (using age-related 153390, 604011, reference values) 611432, 604965, • reduced naïve CD4 and/or CD8 T cells 309845, 186880, • elevated g/d T cells 606558, 600315, • reduced proliferation to mitogen or TCR stimulation 602354, 607210, AND HIV excluded 603517, 603258, AND exclusion of a clinical diagnosis associated with CID 190010, 605383, (e.g., defined syndromic diseases, DKC, AT, CHH) 604860, 308380 Common variable 3. Predominantly 604558, 604907, Vojtech Thon, Natalia At least one of the following: For patients <4 years old immunodeficiency antibody deficiencies 107265, 606269, Martinez, Maria • increased susceptibility to infection or patients with disorders (CVID) 112210, 186845, Kanariou, Klaus • autoimmune manifestations incomplete criteria please 120650, 606453, Warnatz, Isabella • granulomatous disease consider “Unclassified 607594, 240500, 613493, 164012, 605384, Quinti, Helen Chapel • unexplained polyclonal lymphoproliferation antibody deficiency”. 613494, 613495, 613496, 164011, 603023, • affected family member with antibody deficiency 614699, 614700, 615577, 615332 AND marked decrease of IgG and marked decrease of IgA with or For patients with 615767, 616576, 616873, without low IgM levels evidence of profound T- 617765 (measured at least twice; <2SD of the normal levels for cell deficiency, please their age); consider Combined AND at least one of the following: immunodeficiencies. ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 13 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) • poor antibody response to vaccines (and/or absent isohemagglutinins); i.e., absence of protective levels despite vaccination where defined • low switched memory B cells (<70% of age-related normal value) AND secondary causes of hypogammaglobulinemia have been excluded (e.g., infection, protein loss, medication, malignancy) AND diagnosis is established after the 4th year of life (but symptoms may be present before) AND no evidence of profound T-cell deficiency, defined as 2 out of the following (y=years of life): • CD4 numbers/microliter: 2-6y <300, 6-12y <250, >12y <200 • % naive of CD4: 2-6y <25%, 6-16y <20%, >16y <10% T cell proliferation absent Congenital neutropenia 5. Congenital defects 130130, 600871, Nizar Mahlaoui, Jean Neutropenia below 0.5 g/L measured on at least 3 occasions For other patients with of phagocyte number 605998, 611045, Donadieu OR Neutropenia below 1 g/L measured on at least 3 occasions chronic neutropenia, 202700, 613107, 610738, or function 610035, 602671, with at least one of the following: please consider 612541, 615285, 616022, 300392, 610389, • deep seated infection due to bacteria and/or fungi Unclassified phagocytic 617014, 300392 604592, 138971, • recurrent pneumonia disorders. 146928, 616012 • buccal and/or genital aphtous lesions or ulcerations • omphalitis • affected family member AND exclusion of secondary causes of neutropenia

Cyclic neutropenia 5. Congenital defects 130130 Nizar Mahlaoui, Cyclic fluctuation of Neutrophil counts (every 16 to 28 days) of phagocyte number David Edgar, During these neutropenic episodes, symptoms are at least one of 162800 or function Stephan Ehl, Jean the following: Donadieu • Increased susceptibility to infections • Oral aphthae • Abdominal pain episodes Defects of TLR/NFkappa-B 6. Defects in intrinsic 602170, 606883, Nizar Mahlaoui, Recurrent and/or severe infections signaling and innate immunity; 300248, 603258, Capucine Picard, AND at least 2 of the following: OR 164008, 603029, Jacinta Bustamante • normal T- and B-cell responses 610799, 607676, 300640, categories 2, 3, 7. 608204, 601896, • mild inflammatory reaction 604834 ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 14 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) 300584, 300636, 300301, • polysaccharide-specific serum antibodies deficiency 618204, 615592, 612132 • anhidrotic ectodermal dysplasia features in some patients

Defects with susceptibility 6. Defects in intrinsic 601604, 161561, Nizar Mahlaoui, Infections caused by weakly virulent mycobacteria, such as BCG to mycobacterial infection and innate immunity 107470, 147569, Capucine Picard, vaccines and environmental mycobacteria, tuberculosis, (MSMD) 600555, 300481, Jacinta Bustamante salmonellosis, candidiasis, other intramacrophagic bacteria, 601565, 176941, fungi, or parasites, 614891, 614890, 209950, 147571, 602943, AND 615978, 614889, 614892, 147795, Altered IFN-γ mediated immunity tests or Altered IL-12 mediated 613796, 300645, 614893, immunity tests 611521, 616126, 616622 AND no IFN-γ auto-antibodies

Deficiency of specific IgG 3. Predominantly 102582 Nizar Mahlaoui, Infections (recurrent or severe bacterial) Unclassified antibody (Specific antibody antibody deficiencies David Edgar, AND deficiencies deficiency - SPAD) Stephan Ehl, Helen normal serum/plasma IgG, A and M and IgG subclass levels Chapel, Isabella AND Quinti, Esther de Profound alteration of the antibody responses to S. pneumoniae Vries (or other polysaccharide vaccine) either after documented invasive infection or after test immunization. AND Exclusion of T cell defect DiGeorge syndrome 2. Combined 602054, 602269, Nizar Mahlaoui, Documented microdeletion 22q11 or 10p immunodeficiencies 138720, 116790, David Edgar, AND signs of immunodeficiency, i.e. infections (recurrent or 188400 with associated or 600237, 601754 Stephan Ehl severe bacterial) and/or immune dysregulation syndromic features Dyskeratosis congenital 2. Combined 300126, 612661, Nizar Mahlaoui, At least two of the following: immunodeficiencies 604319, 187270, David Edgar, • Skin pigmentation abnormalities 305000, 127550, 613989, with associated or 602322, 608833, Stephan Ehl, • Nail dystrophy 613990, 615190, 616553, syndromic features 604212, 606471, Inderjeet Dokal • Mucosal leucoplakia 613987, 224230, 613988, 606470, 609377 • Bone marrow failure 616353 AND Very short telomeres

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Early-onset inflammatory Categories 1, 4, 7. 605384, 124092, Joris van Montfrans, Histologically proven inflammatory bowel disease (IBD) bowel disease 146933, 123889 Christoph Klein, diagnosed with an onset at pediatric age. The following Nicolette Moes differentiation in age of onset applies (Uhlig et al 615767, 613148, 612567 Gastroenterologie 2014, PMID 25058236): - Infant Onset IBD: onset < 0-2 yrs - Neonatal onset IBD: onset < 28 days AND exclusion of infectious cause (bacterial, viral, parasitic) AND at least one of the following: • Failure to thrive • Increased values of calprotectine in stool Early-onset multi-organ Categories 1, 4, 7. 102582, 176947, Joris van Montfrans, This disease is featured by a variable set of presenting symptoms. autoimmune disease 606409 Andrew Cant, Mario These presenting symptoms may be “ALPS like” or “IPEX like”. Abinun 615952, 617006, 613385 At least: The onset of at least 2 separate auto immune diseases <18 yrs (such as: autoimmune cytopenias, IDDM, autoimmune thyroiditis, or organ specific autoimmunity including lung-, gastrointestinal-, hepatic- autoimmune disease, and/or other endocrine dysfunction)

AND at least one of the following: • Lymphadenopathy > 6 months in >1 region • Hepatosplenomegaly • Recurrent viral infections / reactivations such as mollusca and zoster reactivations • Skin features (eczema or vasculopathy) • Auto immune arthritis Epidermodysplasia 6. Defects in intrinsic 605828, 605829, Joris van Montfrans, Extensive flat wart-like papules, usually on extremities, trunk or verruciformis and innate immunity 162643 Jean-Laurent neck Casanova, Capucine AND at least one of the following: 226400, 618231, 305350 Picard • pityriasis versicolor-like macules on skin • development of cutaneous carcinomas

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Factor B Deficiency 8. Complement 138470 Matthew Buckland, At least one of the following; deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent 615561 Grigoriadou pyogenic including Neisseria) • Family History of symptomatic Factor B Deficiency AND AP50/AP100 activity less than 10% of control value with normal CH50/CH100 activity Or Absent Factor B activity in serum in functional or immunochemical assessment Factor D deficiency 8. Complement 134350 Matthew Buckland, At least one of the following; deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent 613912 Grigoriadou pyogenic including Neisseria) • Family History of symptomatic Factor D Deficiency AND AP50/AP100 activity less than 10% of control value with normal CH50/CH100 activity Or Absent Factor D activity in serum in functional or immunochemical assessment Factor H Deficiency 8. Complement 134370 Matthew Buckland, At least one of the following; deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent pyogenic 609814 Grigoriadou including Neisseria) • Family History of symptomatic Factor H Deficiency (Recessive or Dominant Inheritance) • Pre-eclampsia AND Reduced serum C3 (due to spontaneous activation) AND/OR Reduced AP50/AP100 and CH50/CH100 due to reduced serum C3 Or Absent Factor H by immunochemical assessment Factor H Related Protein 8. Complement 134371, 600889, Matthew Buckland, At least one of the following; Deficiency deficiencies 605336, 605337, Ania Manson, Sofia • Increased susceptibility to infections (recurrent pyogenic 608593 Grigoriadou including Neisseria) 235400, 614809 • Family History of symptomatic Factor H Deficiency (Recessive or Dominant Inheritance) AND/OR ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 17 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Normal AP50/AP100 and CH50/CH100 And Antibodies to Factor H

Factor I Deficiency 8. Complement 217030 Matthew Buckland, At least one of the following; deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent pyogenic 610984 Grigoriadou including Neisseria) • Family History of symptomatic Factor I Deficiency (Recessive or Dominant Inheritance) • Pre-eclampsia AND Reduced serum C3 (due to spontaneous activation) AND/OR Reduced AP50/AP100 and CH50/CH100 due to reduced serum C3 Or Absent Factor I by immunochemical assessment Ficolin 3 8. Complement 604973 Matthew Buckland, At least one of the following; Deficiency (FC3RN) deficiencies Ania Manson, Sofia • Increased susceptibility to infections Grigoriadou • Glomerulonephritis 613860 • Multiple Abscesses AND Absent Ficollin dependent complement activation AND/OR Absent FC3RN Familial hemophagocytic 4. Diseases of 170280, 608897, Stephan Ehl, At least one of the following: For patients with lymphohistiocytosis immune 605014, 601717, Genevieve de Saint • at least 1 episode of HLH incomplete criteria, syndromes (FHLH) dysregulation 610884, Basile, Gritta Janka (at least 5/8 criteria as defined by the Histiocyte Society) please consider • affected family member Unclassified disorders of 267700, 603553, 608898, AND at least one of the following: immune dysregulation. 603552, 613101 • recurrent disease (>4 weeks after initiating treatment for first episode) • persistent disease (no full remission can be achieved) • partial albinism • absent or significantly decreased expression in flow cytometry • at least one assay with absent degranulation (NK or CTL) or two assays with reduced degranulation

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) • at least 2 assays with absent NK cell cytotoxicity

FOXP3 deficiency (IPEX) 4. diseases of 300292 Nizar Mahlaoui, At least one of Combined immune David Edgar, • Severe and protracted enteropathy with villous atrophy in immunodeficiency 304790 dysregulation Stephan Ehl, Hans a male infant Ochs, Benedicte • Severe, often multiple endocrinopathies Neven AND Exclusion of hypogammaglobulinaemia AND at least one of the following: • Low or absent Foxp3 expression by CD4+CD25+ on flow analysis • No overt T cell defect (proliferations are normal) • Elevated IgA and IgE levels • Normal CD25 expression Glycogen storage disease 5. Congenital defects 602671 Nizar Mahlaoui, Recurrent infections type 1b (GS1b) of phagocyte number David Edgar, AND Fasting intolerance or function Stephan Ehl, Jean AND Hypoglycaemic attacks 232220 Donadieu AND Hyperlactacidemia AND Glycogen accumulation in the liver AND colitis mimicking Crohn’s disease AND one of: • neutrophil function alterations • neutropenia

Griscelli syndrome type 2 4. Diseases of 603868 Nizar Mahlaoui, At least one of the following: Immunodeficiency with immune David Edgar, • episode of hemophagocytic lymphohistiocytosis (HLH) partial albinism 607624 dysregulation Stephan Ehl, • reduced lymphocyte degranulation/cytotoxicity Genevieve de Saint • affected family member Basile, Despina AND Moshous Typical hair shaft abnormalities AND Absence of giant granules on blood smear

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Hereditary Angioedema 8. Complement 606860, 610619 Matthew Buckland, At least one of the following; (C1inh) deficiencies Ania Manson, Sofia • Recurrent angioedema without urticaria Grigoriadou • Recurrent abdominal pain and vomiting 106100, 610618 • Laryngeal oedema • Family history of angioedema AND Low complement C4 (< 2.S.D of the mean) between or during angioedema attacks AND Absent C1 esterase protein (Type 1 HAE) or absent C1 esterase inhibitor function (Type 2 HAE) AND Normal C1q level Herpetic encephalitis 6. Defects in intrinsic 603029, 608204, Nizar Mahlaoui, Sporadic Herpes Simplex virus 1 (HSV-2 are excluded) (HSE) and innate immunity 601896, 607601, Jean-Laurent encephalitis in otherwise healthy individuals, wide spectrum of 604834, 603734, Casanova, Isabelle clinical features ranging from necrosis of brain tissue (of the 613002, 610551, 614849, 601181, 600650 Meyts, Shen-Yin forebrain in 95%, of the brainstem in 5%), fever, altered behavior 614850, 617900, 616532, Zhang and disturbed consciousness, with brain image data suggesting 608033 brain lesions, and with at least one of the four following virological criteria fulfilled: 1) HSV-1 PCR positive in CSF, OR 2) HSV-1 antigen positive in CSF OR, 3) anti-HSV-1 antibodies in CSF, OR 4) sero-conversion of anti-HSV-1 antibodies in blood. Hermansky-Pudlak 4. Diseases of 603401 Nizar Mahlaoui, Oculocutaneous albinism syndrome (type 2) immune Stephan Ehl AND dysregulation Chronic neutropenia 608233 AND at least one of the following: • bleeding diathesis • recurrent infections • hemophagocytic lymphohistiocytosis (HLH) AND Defective cytotoxicity caused by impaired degranulation

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) HLA class I deficiency 1. 170260, 170261, Matthew Buckland, At least one of the following: Immunodeficiencies 601962, 109700 Ania Manson, Sofia • Predisposition to recurrent and/or opportunistic infections 604571 affecting cellular and Grigoriadou • Granulomatous skin lesions humoral immunity AND at least one of the following: • Predisposition to recurrent and/or opportunistic infections • Necrotizing granulomatous skin lesions • Low T-CD8 or lymphopenia • Absence of Ab production in response to antigens • Absence of T cell proliferation in response to antigens AND Reduced or absent HLA A,B,C expression at the surface of resting and PHA/Cytokine activated T-cells HLA class II deficiency 1. 600005, 603200, Nizar Mahlaoui, One of the following: Combined (MHC2) Immunodeficiencies 601863, 601861 David Edgar, • Recurrent and/or opportunistic infections immunodeficiency affecting cellular and Stephan Ehl, • Autoimmunity 209920 humoral immunity Capucine Picard, AND one of the following: Amos Etzioni • Hypogammaglobulinaemia • Lymphopenia • Low T-CD4 count • absence of Ab production in response to antigens or absence of T cell proliferations in response to antigens AND Reduced or absent HLA DR expression at the surface of B cells and/or monocytes Hoyeraal-Hreidarsson 2. Combined 300126, 609377, Nizar Mahlaoui, At least four of the following criteria: syndrome immunodeficiencies 604212, 608833, David Edgar, • Microcephaly and/or neurocognitive impairment with associated or 187270, 604319 Stephan Ehl, • Cerebellar hypoplasia 305000 syndromic features Inderjeet Dokal • Bone marrow failure • Immune deficiency including B cell lymphopenia • Severe enteropathy • Severe failure to thrive This can be substantiated by undertaking telomere length analysis (usually very short)

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Hyper IgE syndrome (HIES) 2. Combined 102582, 611432, Beata Wolska, David IgE > 10 times the norm for age • For patients with immunodeficiencies 176941 Edgar, Bodo AND pathologic susceptibility to infectious diseases evidence of T-cell 147060, 243700, 611521 with associated or Grimbacher, Steven AND no evidence of T-cell deficiency deficiency, please syndromic features Holland (low T cell numbers, low naive T cells, reduced consider: Combined proliferation) immunodeficiencies. AND no evidence of B cell deficiency (low B cell numbers, • For patients with hypogammaglobulinaemia) evidence of B-cell deficiency, please consider Unclassified antibody deficiency. • For other patients, please consider Unclassified immunodeficiencies.

IgA with IgG subclass 3. Predominantly Nizar Mahlaoui, Infections (recurrent or severe bacterial) Unclassified antibody deficiency antibody deficiencies David Edgar, AND deficiencies Stephan Ehl, Helen Undetectable serum/plasma IgA level (with normal/lowish IgG Chapel, Isabella and IgM levels) Quinti, Esther de AND Vries Low levels in one or more IgG subclass (documented twice) AND normal IgG antibody response to some vaccinations AND Exclusion of T cell defect

Immunodeficiency 2. Combined 602900, 614064, Markus Seidel, Immunodeficiency (variable hypogammaglobulinemia, variably centromeric instability immunodeficiencies 609937, 603946 Beata Wolska, Corry reduced T, B, and NK cells, bacterial and opportunistic infections) facial anomalies with associated or Weemaes, Capucine AND syndrome (ICF) syndromic features Picard • Head: microcephaly, hypertelorism, epicanthal folds, flat face, micrognathia, macroglossia, tongue protrusion, 242860, 614069, 616910, small upturned nose 616911 • Cytogenetics: Centromeric instability of 1, 9 and 16 with increased somatic recombination and formation of multibranched/-radial configurations AND at least two of the following • Short stature • Neurologic: variable mental retardation • Malabsorption,

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) • Sinusitis, upper and lower respiratory tract infections

IPEX-like disease 4. Diseases of 600555 Nizar Mahlaoui, At least one of Combined immune David Edgar, • Severe and protracted enteropathy with villous atrophy in immunodeficiency 614162 dysregulation Stephan Ehl, Hans a male infant Ochs, Benedicte • Severe, often multiple endocrinopathies Neven AND Exclusion of hypogammaglobulinaemia AND at least one of the following: • Normal Foxp3 expression by CD4+CD25+ on flow analysis • No overt T cell defect (proliferations are normal) • Elevated IgA and IgE levels Isolated IgG subclass 3. Predominantly 147110 Nizar Mahlaoui, Infections (recurrent or severe bacterial) Unclassified antibody deficiency antibody deficiencies David Edgar, AND deficiencies Stephan Ehl, Helen normal IgG, A and M serum/plasma levels Chapel, Isabella AND Quinti, Esther de Low levels in one or more IgG subclass (documented twice) Vries AND Normal IgG antibody response to some vaccinations ANDExclusion of T cell defect

Isolated congenital 6. Defects in intrinsic 150370, 141250 Nizar Mahlaoui, Asplenia or hyposplenia asplenia and innate immunity David Edgar,Stephan AND Documentation of Howell-Jolly bodies on blood smears Ehl, Capucine Picard, AND radiological findings evidencing asplenia (US, CT scan, 271400 Jean-Laurent scintigraphy) Casanova AND exclusion of any over developmental defect such as heterotaxia (dextrocardia, situs inversus, other…) or other heart and great vessel defects

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Mannose-binding lectin 6. Defects in intrinsic 154545 Matthew Buckland, Infections (severe recurrent bacterial) deficiency (MBL) and innate immunity Sofia Grigoriadou, AND one of the following: Ania Manson Mannose binding lectin <75 µg/L: Correlates with homozygous 614372 variant alleles and non-functional MBL which is associated with the greatest risk of infection. OR 75 - 399.9 µg/L: Correlates with functional MBL deficiency associated with increased risk of infection. OR 400 - 1300 µg/L: Correlates with heterozygous varient alleles and may show mild deficiency associated with some increased risk of infection.

note: patients should be classified as homozygous, functional or heterozygous deficient as appropriate. Membrane CoFactor 8. Complement 120920 Matthew Buckland, At least one of the following; Protein (CD46) Deficiency deficiencies Ania Manson, Sofia Increased susceptibility to infections Grigoriadou • Glomerulonephritis • Recurrent pyogenic infections • Pre-eclampsia AND AP50/AP100 activity less than 10% of control value with normal CH50/CH100 activity AND/OR Evidence of absent binding by competitive immunoassay MonoMAC (WILD) 5. Congenital defects 137295 Isabella Quinti, At least one of the following: of phagocyte number Andrew Cant • disseminated non-tubercolous mycobacterial infections 614172 or function • opportunistic fungal, and viral infections • familial myelodysplastic syndrome / acute myelogenous leukemia • pulmonary alveolar proteinosis • erythema nodosum • lymphedema • disseminated warts • anogenital dysplasia AND Monocytopenia, dendritic cell, B and NK lymphocytes lymphopenia ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 24 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) AND Bone marrow hypocellularity, fibrosis, and multilineage dysplasia

Netherton syndrome 2. Combined 605010 Joris van Montfrans At least two of the following: immunodeficiencies Ellen Renner, Hans • generalized ichthyosis ( covered by fine 256500 with associated or Ochs, Nizar scales) with an onset < 2 months of age syndromic features Mahlaoui • short hair due to broken off distal shaft, specific hair shaft abnormality called trichorrhexis invaginata or "bamboo hair" • atopic manifestations, including food allergies or elevated serum levels of IgE. AND at least one of the following: • failure to thrive in the first years of life • recurrent infections (skin and other locations) • intermittent diarrhea Nijmegen breakage 2. Combined 602667 Markus Seidel, Microcephaly syndrome immunodeficiencies Beata Wolska, Corry AND with associated or Weemaes, Andy reduced T cell number and/or elevated percentage of memory 251260 syndromic features Gennery CD4 and CD8 cells and/or reduced T cell function AND at least two of the following • Typical facial appearance • Variable hypogammaglobulinemia, and/or reduction of B cells - opportunistic and/or chronic, recurrent infections, predominantly of the respiratory tract • Skin: Café-au-lait spots and/or hypopigmented areas and/or skin granulomas • lymphoma/leukemia or other malignancy • Chromosomal instability (especially chrom. 7 and 14), increased sensitivity towards ionizing radiation and alkylating agents

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Omenn syndrome Categories 1, 2, 4. 605988, 179615, Nizar Mahlaoui, Desquamating erythroderma in the first year of life For other patients with 179616, 607210, Annarosa Soresina, AND one of the following: severe erythroderma, 603554 601837, 146661 Anna Villa, Alain • lymphoproliferation please consider: Fischer • failure to thrive • SCID • chronic diarrhoea • IPEX • recurrent pneumonia • Unclassified disorders AND or elevated IgE of immune AND T-cell deficiency (low naïve cells, reduced proliferation, dysregulation oligoclonality) • Unclassified defects AND maternal engraftment excluded in innate immunity. AND HIV excluded

Papillon-Lefevre 5. Congenital defects 602365 Isabella Quinti, Palmoplantar hyperkeratosis syndrome of phagocyte number Steven Holland, AND or function Nizar Mahlaoui severe early onset periodontitis affecting both the deciduous and 245000 permanent teeth AND at least one of the following: • mild mental retardation • pyogenic infections • hyperhidrosis • intracranial calcifications • abnormal neutrophil function tests Differential diagnosis includes: allelic variants of PLS, such as Haim-Munk syndrome and prepubertal/aggressive periodontitis. Other diseases with similar dermatologic features include localized epidermolytic palmoplantar keratoderma, Howel-Evans syndrome, Greither's disease, and keratosis punctate. Partial albinism and 4. Diseases of Nizar Mahlaoui, Partial oculo-cutaneous albinism immunodeficiency immune Stephan Ehl AND at least one of the following: syndrome dysregulation • recurrent bacterial infections • episode of hemophagocytic lymphohistiocytosis (HLH) • reduced lymphocyte degranulation/cytotoxicity • affected family member AND Exclusion of Chediak Higashi Syndrome, Griscelli Syndrome type 2, and Hermansky-Pudlak Syndrome type 2

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Properdin P factor 8. Complement 300383 Matthew Buckland, At least one of the following; complement deficiency deficiencies Ania Manson, Sofia • Increased susceptibility to infections (recurrent (PFC) Grigoriadou pyogenic including Neisseria) • Family History (X-linked inheritance pattern 312060 AND AP50/AP100 activity in at least the bottom 10% of control value with normal CH50/CH100 activity AND Absent Properdin (type I/II) or activity (type III) in serum in functional or immunochemical assessment Schimke disease 2. Combined 606622 Nizar Mahlaoui, Predominantly T cell defects (low T cell counts, low T cell immunodeficiencies David Edgar, proliferations) 242900 with associated or Stephan Ehl AND osseous dysplasia (metaphyseal usually) syndromic features AND kidney dysfunction

Seckel syndrome 606605, 601215, Markus Seidel, Short stature (pre- and postnatal growth retardation), severe 601810, 604124, Beata Wolska, Corry microcephaly 210600, 606744, 613676, 613529, 609279, Weemaes, Andy AND at least three of the following: 613529, 614728, 614851, 605925, 605958, Gennery • Head: downward slanting palpebral fissures, sloping 615807, 616777, 617253 614724, 608684, forehead, face asymmetry, prominent beaked nose, 617246 selective tooth agenesis • Hematology: pancytopenia • Cytogenetics: increased sister chromatid exchange • Neurology: mental retardation, seizures, and CNS structural abnormalities • Skeletal: fifth finger clinodactyly, hip and radius head dislocation, hypoplasia of proximal radius and proximal fibula, 11 ribs, scoliosis

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Selective CD4 cell 604011 Matthew Buckland, CD4⁺ T cell less than 350/μl (patient more than 4 years of age) or deficiency Ania Manson, Sofia less than 20% of circulating T-lymphocytes at any age Grigoriadou AND 615518 OKT4 Deficiency Excluded AND Normal or increased CD8, CD19 and CD56 AND HIV Negative And Other primary causes of lymphopenia excluded Selective IgA deficiency 3. Predominantly 604907 Vojtech Thon, At least one of the following: • For patients with antibody deficiencies Natalia Martinez, • increased susceptibility to infection abnormal vaccine 137100, 609529 Maria Kanariou, • autoimmune manifestations responses, please Klaus Warnatz, • affected family member consider Deficiency Isabella Quinti AND diagnosis after 4th year of life of specific IgG AND undetectable serum IgA (when measured with (SPAD). nephelometry less than 0.07 g/L) but normal serum IgG • For other patients, and IgM (measured at least twice) please consider AND secondary causes of hypogammaglobulinemia have been Unclassified excluded. antibody deficiency. AND normal IgG antibody response to all vaccinations AND Exclusion of T-cell defect Selective IgM deficiency 3. Predominantly Nizar Mahlaoui, Infections (either invasive or recurrent, usually bacterial) Unclassified antibody antibody deficiencies David Edgar, AND deficiencies Stephan Ehl, Helen Low IgM serum/plasma level (with normal IgG and IgG subclasses Chapel, Isabella and IgA plasma level) Quinti, Esther de AND Vries Normal IgG antibody response to all vaccinations AND Exclusion of T-cell defect

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Severe combined 1. 308380, 600173, Stephan Ehl, Alain At least one of the following: For other (e.g. older) immunodeficiency (SCID) Immunodeficiencies 146661, 151460, Fischer • invasive bacterial, viral or fungal/ patients with T-cell affecting cellular and 186790, 186830, • persistent diarrhoea and failure to thrive deficiency, consider 300400, 600802, 608971, humoral immunity 186780, 605000, • affected family member Combined IDs. 102700, 601457, 602450, 602354, 179615, AND manifestation in the first year of life 611291, 615617, 615615, 179616, 605988, AND HIV excluded 615617, 617237 611290, 601837, AND 2 of 4 T cell criteria fulfilled: 103020, 608958, • low or absent CD3 or CD4 or CD8 T cells 600899, 600838, • reduced naive CD4 and/or CD8 T cells 176947, 607210 • elevated g/d T cells • reduced or absent proliferation to mitogen or TCR stimulation Shwachman-Diamond- 5. Congenital defects 607444, 617048, Nizar Mahlaoui, Jean Neutropenia syndrome of phagocyte number 617538, 604857 Donadieu AND or function Exocrine pancreatic failure 260400, 617941 AND at least one of the following: • enlargement of metaphyseal zones on bone X-rays • cognitive retardation or behavioural problems Thymoma with David Edgar, Helen Presence of thymoma immunodeficiency Chapel AND reduced serum IgG (< 2SD below the mean reference for age) Transient 3. Predominantly David Edgar, Maria IgG below age-related normal value detected in the first three hypogammaglobulinaemia antibody deficiencies Kanariou, Esther de years of life (measured at least twice) of infancy Vries AND defined causes of hypogammaglobulinaemia have been excluded AND spontaneous resolution approx. after the 4th birthday NB: Patients will initially be registered as Unclassified antibody deficiency, in the registry and moved to THI, if there is spontaneous resolution before age 4. Warts 6. Defects in intrinsic 162643 Jean Donadieu, Neutropenia hypogammaglobulinemia and innate immunity Sarah, Beaussant AND infections and Cohen, Bodo lymphopenia myelokathexis (WHIM) Grimbacher AND monocytopenia 193670 AND Evidence of myelokathexis on bone marrow smear; ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 29 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) AND at least one of the following: • Recurrent and severe HPV infections • Recurrent bacterial infections • Mycobacterial infection(s) • Mild hypogammagobulinemia

Wiskott-Aldrich syndrome 2. Combined 300392, 602357 Annarosa Soresina, At least one of the following: (XLT/WAS) immunodeficiencies Natalia Martinez, • eczema with associated or Michael Albert, • recurrent bacterial or viral infections 301000, 614493 syndromic features Adrian Thrasher • autoimmune diseases (incl. vasculitis) • malignancy • reduced WASP expression in a fresh blood sample • abnormal antibody response to polysaccharide antigens and/or low isohemagglutinins • positive maternal family history of XLT/WAS AND male patient with thrombocytopenia (less than 100,000 platelets/mm3) (measured at least twice) AND small platelets (platelet volume < 7,5 fl) X-linked 4. Diseases of 300490, 300079 Nizar Mahlaoui, Male individual (or female with severely skewed X- lymphoproliferative immune Stephan Ehl inactivation) syndrome (XLP) dysregulation AND two of the following: • at least 1 episode of HLH (according to the Histiocyte 308240, 300635 Society criteria) • affected family member • abnormal EBV response • Hypogammaglobulinemia • Inflammatory Bowel Disease • Vasculitis • Lymphoid Neoplasm, especially if EBV-associated AND at least one of the following minor criteria: • decreased or absent SAP (for XLP1) or XIAP (for XLP2) expression assessed by Flow Cytometry • reduced frequency of iNKT cells (< 0.02% of T cells) • Normal Perforin expression in flow cytometry • Normal degranulation (NK or CTL) assays or Normal NK cell cytotoxicity assays

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) AND No partial albinism AND Normal work-up for metabolic diseases Unclassified antibody Esther de Vries, At least one of the following: deficiency Nizar Mahlaoui, • Recurrent or severe bacterial infections David Edgar, Isabella • Autoimmune phenomena (especially cytopenias) Quinti, Helen Chapel • Polyclonal lymphoproliferation • Affected family member AND at least one of the following: • marked decrease of at least one of total IgG, IgG1, IgG2, IgG3, IgA or IgM levels • failure of IgG antibody response(s) to vaccines AND secondary causes of hypogammaglobulinemia have been excluded (e.g., infection, protein loss, medication, malignancy) AND no clinical signs of T-cell related disease AND does not fit any of the other working definitions (excluding ‘unclassified immunodeficiencies’)

Unclassified phagocytic Nizar Mahlaoui, At least one of the following: disorders Capucine Picard, • deep seated infection due to bacteria and/or fungi Jacinta Bustamante • recurrent severe pneumonia • buccal and/or genital aphtous lesions or ulcerations • omphalitis • chronic inflammatory manifestations (e.g. colitis, fistula formation) • affected family member • BCGitis or BCGosis AND normal to subnormal respiratory burst (NBT or DHR, assessed at least twice) Unclassified disorders of Stephan Ehl, Maria At least one of the following: • For patients with immune dysregulation Kanariou • autoimmune manifestations evidence of profound • lymphoproliferation T-cell deficiency, • severe eczema please register these • inflammatory bowel disease as Combined • granuloma immunodeficiencies.

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OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) • vasculitis • For patients with • HLH-like disease evidence of B-cell AND at least one numeric or functional abnormal finding upon deficiency, please immunological investigation register as AND no evidence of profound T-cell deficiency, defined as 2 out Unclassified of the following (y=year of life): antibody deficiency. • CD4 numbers/microliter: 0-6mo <1000, 6mo-1y <800, 1-2y <500, 2-6y <300, 6- 12y <250, >12y <200 • % naïve CD4: 0-2y <30%, 2-6y <25%, 6-16y <20%, >16y 10% • T cell proliferation absent AND no evidence of B-cell deficiency (low B cell numbers, hypogammaglobulinemia) Unclassified defects in Nizar Mahlaoui, At least one of the following: For patients with innate immunity Maria Kanariou, • onset of disease before 5 y of age evidence of profound Capucine Picard, • pyogenic bacterial infections defect of phagocytes, Jacinta Bustamante • unusual infections and/or atypical clinical course please consider AND the dominant abnormal immunological finding concerns the Unclassified phagocytic (excluding defects in phagocyte disorders. number or function) i.e. NF-κB-dependent TLR and IL-1R immunity AND functional spleen (no Howell-Jolly bodies on blood smears) Unclassified complement Annarosa Soresina, At least one of the following: deficiencies Matthew Buckland, • one episode of bacteraemia, meningitis or systemic David Edgar Neisserial infection • recurrent respiratory infections AND persistent defect of CH50 or AP50 (in three determinations in 6 months) AND no evidence of other conventional immunological defects Unclassified David Edgar, Beata Recurrent fever (temperature >38 degrees Celsius) having autoinflammatory Wolska, Helen occurred on at least 6 occasions. diseases Lachmann AND exclusion of other known infective / inflammatory autoimmune disorders AND documented evidence of increased inflammatory markers (ESR/CRP) AND age of onset under 40 years AND predominantly but not exclusively systemic symptoms ESID Registry - Working definitions for clinical diagnosis of IEI January 22, 2019 page 32 of 33

OMIM number Suggestions for Disease for disease- Clinical criteria for a probable diagnosis alternative diagnosis and OMIM number for IUIS category Contributors associated genes (= clinical diagnosis classification) (i.e., if these criteria are disease entry (examples) (examples) not completely fulfilled) Unclassified syndromic Stephan Ehl, Alain At least one of the following: immunodeficiencies Fischer • dysmorphic features such as short stature, facial abnormalities, microcephaly, skeletal abnormalities • other organ manifestations such as albinism, hair or tooth abnormalities, heart or kidney defects, hearing abnormalities, primary neurodevelopmental delay, seizures AND at least one numeric or functional abnormal finding upon immunological investigation AND exclusion of secondary causes for immunological abnormalities (infection, malignancy) Unclassified Stephan Ehl, Alain At least one of the following: For patients with immunodeficiencies Fischer • at least one major infection syndromic • abnormal course or frequency of minor infections manifestations, consider • at least one manifestation of immune dysregulation Unclassified syndromic • failure to thrive IDs. • affected family member AND at least one numeric or functional abnormal finding upon immunological investigation AND exclusion of secondary causes for immunological abnormalities (infection, protein loss, medication, malignancy) AND does not fit any of the other working definitions (including ‘unclassified syndromic immunodeficiencies’)

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