Expression of interleukin-4 and interferon-gamma in the small bowel of patients with dermatitis herpetiformis and isolated gluten-sensitive enteropathy

Although possessing a morphologically similar small bowel abnormality to pa tients with isolated gluten-sensitive enteropathy (GSE), patients with derm atitis herpetiformis (DH) have few gastrointestinal symptoms and exhibit bl istering skin lesions and cutaneous IgA deposits. To determine whether clin ical discrepancies between these gluten-sensitive conditions might be the r esult of different patterns of small bowel cytokine expression, duodenal bi opsies were obtained from eight DH patients and nine isolated GSE patients. Biopsies were evaluated for interleukin-4 (IL-4) and interferon-gamma (IFN -gamma) expression by reverse-transcriptase polymerase chain reaction (mess age) and immunohistochemistry (protein), In DH patients, most of whom had n o gut symptoms, IFN-gamma mRNA expression was significantly less than in is olated GSE patients with symptomatic gut disease. Conversely, IL-4 mRNA exp ression in DH patients was greater than that found among isolated GSE patie nts. These findings suggest that the different clinical phenotypes of glute n sensitivity may be caused by variation in cytokine expression in the smal l bowel response to gluten.