From the Division of Rhinology, Department of Otorhinolaryngology/Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Allergy Asthma Proc. 2021 Jul 1;42(4):283-292. doi: 10.2500/aap.2021.42.210028.
Only a fraction of patients with allergic rhinitis receive allergen-specific immunotherapy (AIT). AIT is most commonly delivered subcutaneously in a series of injections over 3-5 years. Common obstacles to completing this therapy include cost and inconvenience. Intralymphatic immunotherapy (ILIT) has been proposed as a faster alternative, which requires as few as three injections spaced 4 weeks apart. This systematic review and meta-analysis evaluated the current evidence that supports the use of ILIT for allergic rhinitis. Clinical trials were identified in the published literature by using an electronic search strategy and were evaluated by using a risk of bias tool. Treatment outcome (symptom scores, medication scores, and combined symptom and medication scores) and provocation testing results (nasal provocation and skin-prick testing) were included in a meta-analysis of standardized mean difference with subgrouping by using a random-effects model. Overall adverse event rates were tabulated, and overall risk ratios were calculated by using a random-effects model. We identified 17 clinical trials that met eligibility criteria. The standardized mean difference of ILIT on the symptom and medication score was -0.72 (95% confidence interval [CI], -0.98 to -0.46; p < 0.0001) ( = 10). The standardized mean difference of ILIT on nasal provocation and skin-prick testing was -1.00 (95% CI, -1.38 to -0.61; p < 0.0001) ( = 7) and -0.73 (95% CI, -0.99 to -0.47; p < 0.0001) ( = 7), respectively. No statistically significant heterogeneity was detected. The overall adverse event rate was 39.5% for ILIT and 23.5% for placebo. Also, 98.4% of adverse events were mild. Our meta-analysis demonstrated that ILIT was safe, conferred desensitization to seasonal and nonseasonal allergens, alleviated allergic rhinitis symptoms, and reduced medication use. A larger randomized, double-blind, placebo controlled trial will be necessary for wider adaptation of this form of AIT.
仅有一小部分过敏性鼻炎患者接受了过敏原特异性免疫治疗（AIT）。AIT 最常通过皮下注射，在 3-5 年内进行一系列注射。完成这种治疗的常见障碍包括费用和不便。淋巴内免疫疗法（ILIT）已被提出作为一种更快的替代方法，其只需进行 3 次注射，间隔 4 周。本系统评价和荟萃分析评估了支持 ILIT 用于过敏性鼻炎的现有证据。通过使用电子搜索策略在已发表的文献中确定临床试验，并使用偏倚风险工具进行评估。治疗结果（症状评分、药物评分和症状与药物联合评分）和激发试验结果（鼻激发和皮肤点刺试验）被纳入标准化均数差的荟萃分析中，并使用随机效应模型进行亚组分析。总体不良事件发生率被列表总结，总体风险比通过随机效应模型计算。我们确定了符合入选标准的 17 项临床试验。ILIT 在症状和药物评分上的标准化均数差为-0.72（95%置信区间[CI]，-0.98 至-0.46；p<0.0001）（ = 10）。ILIT 在鼻激发和皮肤点刺试验上的标准化均数差分别为-1.00（95%CI，-1.38 至-0.61；p<0.0001）（ = 7）和-0.73（95%CI，-0.99 至-0.47；p<0.0001）（ = 7）。未检测到统计学上显著的异质性。ILIT 的总体不良事件发生率为 39.5%，安慰剂组为 23.5%。此外，98.4%的不良事件为轻度。我们的荟萃分析表明，ILIT 安全，使季节性和非季节性过敏原脱敏，缓解过敏性鼻炎症状，并减少药物使用。需要进行更大规模的随机、双盲、安慰剂对照试验，以更广泛地采用这种形式的 AIT。
