Serum IL-8 in Patients with Dermatitis Herpetiformis is Produced in Response to Dietary Gluten

Abstract

Patients with dermatitis herpetiformis (DH) have a gluten-sensitive enteropathy and while on gluten-containing diets have elevated levels of serum IL-8. We hypothesized that the mucosal immune response to gluten is responsible for the elevated serum IL-8. Six DH patients were studied while on a gluten-free diet (GFD), whereas four continued on a normal diet. Patients were followed for a mean 2.2 years and serum IL-8 was analyzed. Small bowel biopsies from five DH patients on normal diets, two DH patients on GFD, and six subjects with no small bowel abnormalities were analyzed for IL-8 mRNA. Serum IL-8 levels normalized in five of six patients on GFD and decreased in one, whereas serum IL-8 levels showed no statistically significant change in DH patients on normal diets. Small bowel biopsies from DH patients on normal diets had increased expression of IL-8 mRNA compared to normal subjects, whereas patients on a GFD showed no significant increase in small bowel mRNA. No significant IL-8 mRNA was detected in normal skin biopsies from patients with DH. These observations suggest that the IL-8 in the serum of patients with DH originates from the small bowel as a mucosal immune response to gluten ingestion.

Serum cytokine elevations in celiac disease: Association with disease presentation

“…The levels of this cytokine remained elevated despite a GFD and remained so even after a year of gluten exclusion. This was in contrast to what has been described in patients with dermatitis herpertiformis, in whom the serum levels of IL-8 returned to normal levels within 2 years on a GFD [47]. The reason for this difference is not known, but could reflect prolonged activation of the inflammatory response in patients with intestinal predominant CD compared with those with dermatitis herpetiformis.…”

Inflammation Markers and Major Depressive Disorder in Patients With Chronic Heart Failure

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Dermatitis Herpetiformis: From the Genetics to the Development of Skin Lesions

“…Although elevated levels of serum IL-8 are seen in patients with active skin disease, IL-8 is also elevated in patients who are on gluten-containing diets but have no active skin lesions owing to therapy with dapsone. These observations suggest that the gastrointestinal mucosa, and not inflamed epidermis, may be the source of IL-8 [75]. …”