Hyperimmunoglobulin E syndrome: A sign of TH1/TH2 imbalance?

We report on a patient with hyperimmunoglobulin E syndrome, who developed p ruritic vesiculopapules from the age of six months and also had recurrent e pisodes of skin abscesses and oral thrush. Serum IgE was extremely elevated at 59,514 IU/ml and specific IgE antibody to Staphylococcus aureus was pos itive. Histological examination from a vesiculopapule on the face revealed that eosinophil-rich infiltration involved hair follicles, similar to eosin ophilic pustular folliculitis, We also examined cytokine profiles of circul ating CD4(+) T cells by intracellular cytokine staining and flow cytometry. The ratio of cells positive for interferon-gamma was significantly reduced compared with a control. Several reports have shown decreased interferon-g amma production by peripheral blood mononuclear cells of patients with hype rimmunoglobulin E syndrome. We think that this cytokine profile and the his tological findings of our patient support the hypothesis that TH1/TH2 imbal ance is involved in hyperimmunoglobulin E syndrome.