Intralymphatic Pollen-Specific Immunotherapy for Nasal Allergy: Clinical Efficacy and Effects on the Induction of Pollen- Specific Antibody

Rationale: Pollen immunotherapy is an effective treatment for seasonal allergic rhinitis. The most common administration route is subcutaneous, which may necessitate more than 50 allergen injections during 3 to 5 years. The newer sublingual immunotherapy is more patient friendly, but treatment duration could not be shortened. Recent evidence suggests that direct intralymphatic injections could yield faster beneficial results with considerably lower allergen doses and markedly reduced numbers of injections. In this study, we sought to improve immunotherapy by using intralymphatic allergen administration.

Methods:

In an open pilot investigation followed by a double-blind, placebo-controlled study, patients with allergic rhinitis were treated with 3 intralymphatic inguinal injections of Cry j1 or placebo. At visit 2 to 4, the study subjects received three 0.1 ml injections with either placebo or 20 JAU of a standardized Japanese pollen extracts. Using ultrasound guidance and a 25-gauge needle, a superficial inguinal lymph node in right groin was aseptically injected for 30 seconds. Clinical pre and post treatment outcomes and the activation pattern of peripheral antibodies were assessed.

Results: Intralymphatic immunotherapy (ILIT) with Cry j1 did not elicit any severe adverse events. Patients receiving active treatment displayed an initial increase in allergen-specific IgE and IgG level. A clinical improvement was seen in active treatment group, but not in the placebo group.

Conclusions: ILIT with Japanese pollen extracts indicate the clinical improvement without causing severe adverse events.