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Background  T-helper cell type 1 (Th1) polarization in chronic immune thrombocytopenia (cITP) has been reported at the protein and mRNA levels. We evaluated the impact of Th1/Th2 cytokine and cytokine receptor functional polymorphisms on both susceptibility to, and severity of, cITP. We analysed  IFN-γ  + 874 T/A,  IFN-γR  -611G/A,  IL-4  -590C/T, and  IL-4Rα  Q576R polymorphisms in 126 cITP patients (male/female: 34/92; median age: 47.7 years) and 202 healthy control donors. Genotyping was determined by PCR and direct sequencing. The Th1/Th2 ratio was detected in peripheral blood mononuclear cells via flow cytometry.    Results  cITP patients had a higher frequency of the  IL-4Rα  576 non-QQ genotype compared to healthy subjects ( P  = 0.04). cITP patients with the  IFN-γ  +874 non-AA genotype (high expression type) showed more severe thrombocytopenia than those with the AA genotype ( P <  0.05). cITP patients had a significantly higher Th1/Th2 ratio than control patients ( P  < 0.01); this ratio was inversely correlated with platelet counts. Furthermore, patients with both  IFN-γ  +874 non-AA genotype (high expression type) and  IFN-γR − 611 non-AA genotype (high-function type) had a significantly higher Th1/Th2 ratio ( P  < 0.05).    Conclusions  The cytokine polymorphisms affecting Th1/Th2 increase the susceptibility to, and severity of, chronic ITP.