Intracellular interleukin-4 profiles during high-dose intravenous immunoglobulin treatment of therapy-resistant atopic dermatitis

Only a few reports of the use of high-dose intravenous immunoglobulin (hdIVIg) in atopic dermatitis and no randomly selected case-controlled studies have been published.1,2 Ours is the first patient in whom intracellular cytokine analysis has been used to determine a possible mechanism of action in atopic disease. The technique allows the assessment of cytokine production within a cell population defined by surface markers (eg, CD3 and CD4 on a peripheral blood sample).3 Information from this method may contribute to an understanding of pathogenesis and future therapy, particularly in a condition like atopic dermatitis that is believed to be associated with helper T-cell type 2 (Th2) dysregulation.4,5 HdIVIg has been proposed to act by several nonexclusive mechanisms; functional blockade of Fc receptors on splenic macrophages, inhibition of complement-mediated damage, neutralization of circulating autoantibodies by anti-idiotypic antibodies in IVIg, modulation of the production of cytokines and cytokine antagonists, and neutralization of any pathogens involved in the cause of the autoimmune condition.6