Brief Communication: Basic and Clinical Immunology
High serum thymus and activation-regulated chemokine levels in the lymphocytic variant of the hypereosinophilic syndrome,☆☆,

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Abstract

The idiopathic hypereosinophilic syndrome is associated with expansion of an IL-5-producing T-cell subset in a subgroup of patients. Identification of such patients is critical to adequate management because there is some evidence that they present an increased risk for development of T-cell lymphoma. Although the TH2-like cells often bear an aberrant surface phenotype and can readily be detected with flow cytometry, we now show that lymphocyte phenotyping might be normal in some cases. In contrast, serum thymus and activation-regulated chemokine levels are consistently increased in such patients compared with others with persistent idiopathic hyper-eosinophilia and could therefore represent a useful diagnostic tool. (J Allergy Clin Immunol 2002;110:476-9.)

Section snippets

Patients

Patients with IHES fulfilled the diagnostic criteria initially proposed by Chusid et al1 in 1975. In addition to those reported in our previous series2 (patients 1-9), we recruited 3 additional patients (patients 10-12) and included 5 patients provided by H.-U. Simon (patients 13-17; patients 13-15 correspond to patients 4, 14, and 9, respectively, in the study by Simon et al3). Sera from hyper-eosinophilic patients with allergic disorders (dermatitis, n = 4; asthma, n = 5; or both, n = 5;

Identification of patients with the LV of IHES

Patients with IHES were first assessed for evidence of the LV by investigating IL-5 production by circulating T cells. As shown in Table I, increased IL-5 production was observed in 13 of 17 patients. IL-5 hyperproduction was spontaneous for 5 patients (patients 13-17), whereas stimulation with phorbol myristate acetate plus anti-CD28 mAb was needed for patients 1 to 5 and 10 to 12. An aberrant T-cell subset was identified by means of flow cytometry in 9 patients only, including 7 patients with

Discussion

Considering increased IL-5 production by circulating lymphocytes as a defining feature of the LV, 17 patients with IHES were assessed for evidence of this variant. Because measurement of serum IL-5 levels is not reliable in this regard,2 we studied production of this cytokine in vitro by PBMCs and observed increased IL-5 levels in 13 patients (Table I). Indeed, affiliated hospitals preferentially referred patients with IHES to our center when they presented features suggestive of the LV.

Acknowledgements

We thank P. Stordeur for providing serum from healthy donors.

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*A. de Lavareille and F. Roufosse contributed equally to this work.

☆☆

Supported by the Fonds National de la Recherche Scientifique and the Télévie Programme (Belgium), as well as the Swiss National Science Foundation (grant No. 31-58916.99) and Stiftung für Krebsbekämpfung (Zurich).

Reprint requests: Michel Goldman, Department of Immunology, Hôpital Erasme, 808 Route de Lennik, 1070 Brussels, Belgium.

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