Evaluation of Intralymphatic Immunotherapy in Allergic Rhinitis Patients: A Systematic Review and Meta-analysis

Abstract

Background. Intralymphatic immunotherapy (ILIT) is short-course administration of allergen-specific immunotherapy (AIT). This study is aimed at assessing the clinical efficacy and safety of ILIT in patients with allergic rhinitis (AR). Methods. MEDLINE, PUBMED, and Cochrane Library were used to conduct electronic searches for clinical trials comparing ILIT and placebo in patients with AR. The final search took place on August 24, 2022. Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias in the included studies. The outcomes included combined symptom and medication scores (CSMS), visual analog scale (VAS), allergic rhinoconjunctivitis quality of life (RQLQ), Skin-prick test (SPT), and adverse events (AEs). Data were synthesized as mean difference (MD)/standard mean difference (SMD) or risk difference (RD) and 95% confidence interval (CI). Results. Thirteen studies (454 participants) were included in this study. The ILIT group had better clinical improvement on the CSMS (random effects model, SMD-0.85, 95% CI [-1.58, -0.11], P = 0.02 ) and RQLQ (fixed-effects model, MD-0.42, 95% CI [0.69, 0.15], P = 0.003 ) than the placebo group. The booster injection was beneficial for CSMS ( P < 0.0001 ), and the 4-week injection interval was superior to the 2-week injection period for improving VAS ( P < 0.0001 ). Local swelling or erythema was the main AE following injection (random effects model, RD 0.16, 95% CI [0.05, 0.27], P = 0.005 ). Discussion. For individuals with AR, ILIT is safe and effective. ILIT alleviates clinical symptoms and reduces pharmaceutical consumption without causing severe AEs. However, the validity of this study is compromised by the substantial heterogeneity and risk of bias in the included researches. RegistrationCRD42022355329.

Intralymphatic Immunotherapy : A Novel Route to Ameliorate Allergic Rhinitis Due to Pollen

“…Our studies are in line with previous findings [69] that ILIT seems to be safe. Local reactions at the injection site are common, but only mild to moderate.…”

“…In a meta-analysis of 10 ILIT-trials, including in total of 1,123 injections, only local swelling and erythema were more common in those treated with ILIT than among those who received placebo injections. There were no significant differences between the ILIT and placebo groups for local urticarial reaction, abdominal pain or nausea, fatigue, eye or nasal symptoms, headache, or pulmonary symptoms [69]. In one study with high-dose pollen ILIT updosing from 1,000 to 3,000-10,000 SQ-U (divided into 5,000+5,000 SQ-U), two patients reacted with anaphylaxis after receiving 5,000 SQ-U [51].…”

“…The following year, 2022, a Danish review and meta-analysis of 14 studies, including our first double-blind randomised clinical trial published in 2022 [67], found that injecting allergen directly into a lymph node strengthens the protective immune response, is safe, induces desensitisation, and very likely induces tolerance as well [68]. A Chinese metaanalysis from 2023 [69] concludes that for individuals with AR, ILIT is safe and effective. ILIT alleviates clinical symptoms and reduces pharmaceutical consumption without causing severe adverse events.…”