Allergen-specific immunotherapy (AIT) is the only allergy treatment that confers long-term symptom amelioration for patients suffering from allergy. The most frequently used allergen application route is subcutaneous injection (SCIT), commonly taken as the gold standard, followed by sublingual (SLIT) or oral (OIT) application of allergen preparations. This is an up-to-date review of the clinical evidence for a novel route of allergen application, i.e., directly into lymph nodes – intralymphatic immunotherapy (ILIT). The major advantages of ILIT over the current AIT approaches are its short duration and the low allergen doses administered. The whole treatment consists of merely 3 ultrasound-guided injections into inguinal lymph nodes 1 month apart. While the number of patients included in randomised controlled trials is still limited, the clinical results for ILIT are encouraging, but more clinical trials are needed, as well as more preclinical work for optimising formulations.

Superficial granulomatous pyoderma gangrenosum, a rare variant of pyoderma gangrenosum, has been considered to be the most benign form of the disease. We present the case of a 15-year-old boy with pulmonary involvement and nodular scleritis associated with this unusual type of pyoderma gangrenosum and discuss its differential diagnosis. | CASE REPORTA 15-year-old boy presented with a pustular, warty eruption of 4 months duration. Cutaneous lesions involving the scalp, trunk, limbs, and genitals were characterized by numerous pustules surrounded by an erythematous halo and vegetative and keratotic plaques with crusts and purulent discharge overlying ulcerated, slightly painful plaques ( Figure 1A,B). Ocular examination showed erythema, conjunctival injection, and scleral nodules (Figure 2A). Several 2-to 3-mm pustules were seen on the hard palate. He also had marked digital clubbing and cyanosis ( Figure 2B), despite pulmonary auscultation with no remarkable findings, absence of dyspnea, and pulse oximetry of 92%.The patient's disease had started 9 months before with cough and he was treated for chronic bronchitis, with partial improvement.Five months before the onset of the dermatosis, he was empirically treated for pulmonary tuberculosis, but the cough persisted.During examination, a pathergy test was negative, and chest Xrays revealed a reticulonodular pattern and probable bronchiectases.Computed tomography (CT) showed pleural fibrosis, the vascular pattern was more apparent, and noncavitated nodules. Paranasal sinus CT was normal. Lung function tests showed a mild restrictive pattern. Bronchoscopy revealed mild tracheoendobronchitis with a diffuse nodular pattern. Tests were negative for microorganisms. Pulmonary hypertension was excluded. Complete blood cell count showed leukocytosis (12 9 10 3 /mm) with neutrophilia (77%). Erythrocyte sedimentation rate (22 mm/h) and C-reactive protein

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La inmunoterapia intralinfática consiste en la inyección en los ganglios linfáticos de cantidades mínimas de extractos de alérgenos y es una vía de administración más eficiente que las otras, debido a que los ganglios linfáticos son órganos linfoides secundarios y contienen una mayor cantidad de células presentadoras de antígenos, permitiendo reducir el número de inyecciones y la dosis del alérgeno y además contienen cantidades bajas de mastocitos y basófilos, lo que teóricamente hace que las reacciones de hipersensibilidad alérgica sean menos probables. Sin embargo, la inmunoterapia intralinfática tiene escasos estudios en la actualidad.