Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
Allergy. 2022 Mar;77(3):883-896. doi: 10.1111/all.15042. Epub 2021 Aug 29.
The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety.
Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000-3000-10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated.
Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000-3000-3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study.
Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.
大多数针对过敏性鼻炎（AR）的淋巴内免疫治疗（ILIT）试验都评估了相同的给药方案，即 1000 个 SQ-U 三次，间隔一个月。本研究评估了在不影响安全性的情况下，ILIT 中的剂量递增是否可以增强临床和免疫效果。
进行了两项针对花粉引起的 AR 的淋巴内免疫治疗的随机双盲安慰剂对照试验。第一项试验包括 29 名最近结束 3 年 SCIT 的患者，第二项试验包括 39 名未接种过疫苗的患者。评估了 1000-3000-10000（5000+5000 间隔 30 分钟）个 SQ-U 的增量剂量，间隔 1 个月。
在最近进行 SCIT 后，高达 10000 SQ-U 的剂量是安全的。综合症状药物评分（CSMS）降低了 31%，血液中的草特异性 IgG4 水平增加了一倍。在新的 ILIT 中，前两名接受主动治疗的患者在接受 5000 SQ-U 治疗时出现了严重的不良反应。改良的增量给药方案；1000-3000-3000 SQ-U 似乎是安全的，但未能改善 CSMS。流式细胞术分析显示淋巴结源性树突状细胞的激活增加，但 T 细胞没有增加。在任何研究中，生活质量和鼻激发反应都没有改善。
在 SCIT 后高剂量的淋巴内免疫治疗似乎进一步减轻了草花粉引起的季节性症状，可被视为 SCIT 后未达到完全症状控制的患者的附加治疗。不应采用递增剂量方案，每月注射 3 次，超过 3000 SQ-U。
