Lymphocyte membrane antigen expression and intracellular cytokine patternsin an asymptomatic patient with persistently high serum levels of IgE

Background: Patients completely asymptomatic with extremely high levels of IgE have rarely been reported. One such case, in which the immunophenotype pattern of lymphocyte subsets and their cytokine profile were investigated, is described here. Objective: To assess whether the cytokine production was consistent with a T helper 2-type immune response, as suggested by theories regarding the fun ctional polarization of helper and cytotoxic T cells in hyper-IEE condition s. Methods: An asymptomatic 79-year-old man presented with persistent high lev els of serum IgE and sporadic hypereosinophilia without any evidence of an underlying pathologic condition. We investigated the immunophenotype of cir culating lymphocytes, the expression/release of CD30 (a member of the tumor necrosis factor receptor family preferentially associated with T helper 2- type immune responses) and the intracellular patterns of interferon-gamma ( IFN-gamma), Interleukin-2 (IL-2), IL,-4, IL-5, and IL-10 production by T ce ll subsets, as evaluated by single-cell flow-cytometric analysis. Results: The majority of lymphocytes displayed the membrane immunophenotype of NK cells. Both CD4(+) and CD8(+) T cells were reduced and expressed the "memory" (CD4(+)/CD45RO(+)) and the "naive" (CD8(+)/CD45RA(+)) phenotypes, respectively. Among CD4(+) T cells, CD30 expression was increased in the r esting condition and was further inducible following stimulation with mitog enic anti-CD3, Interleukin-4, IL-2, and IL-10 production by CD4(+) T cells was increased, whereas IFN-gamma was reduced as compared with normals. Conclusions: The data suggest that a polarization of CD4(+) T cells towards a T helper 0/2-type cytokine pattern occurred in this patient in spite of CD4(+) cell reduction and NK cell expansion.