Remission of hyper-IgE syndrome treated with plasmapheresis and cytotoxic immunosuppression

A patient with a hyper-IgE syndrome was treated with 60 plasmaphereses over a period of 2 years in conjunction with cytotoxic immunosuppressive drug therapy. During this time her severe dermatitis of 8 years' duration became almost completely inactive, and her circulating IgE level was reduced by 73%. An elevated pretreatment ratio of CD4+/CD8+ T lymphocytes fell to subnormal. The beneficial results of treatment may be attributed to the reduction of lymphocyte populations responsible for IgE production by the combined action of plasmapheresis and of cytotoxic drugs as well as the direct effect of removal of circulating IgE and possibly IgE-potentiating factors.