Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China,
Department of Allergy, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China.
Int Arch Allergy Immunol. 2023;184(8):754-766. doi: 10.1159/000529025. Epub 2023 Apr 27.
Intralymphatic immunotherapy (ILIT) is an emerging type of allergen immunotherapy with fewer injections and shorter course for allergic rhinoconjunctivitis (ARC). The efficacy and safety have not been confirmed by informative and powerful evidence yet.
A systematic review and meta-analysis were conducted through electronic searching with PubMed, Web of Science, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). The safety (incidence of adverse events [AEs]), compliance (percent of patients completing treatment), and clinical efficacy of ILIT were evaluated. Clinical efficacy could be assessed by improvement of subjective symptom and rescue medication use or the nasal tolerance to specific allergen. This study is registered with PROSPERO (CRD42022353562).
12 randomized controlled trials (RCTs) comparing ILIT with placebo and 3 trials (2 RCTs and one case-control study) comparing ILIT and SCIT were included in this review. Totally, 582 patients diagnosed as AR or ARC were enrolled. Almost all the AEs were mild-to-moderate reactions except 2 patients developed anaphylactic reactions at the intralymphatic injection dose 5,000 SQ-U in one study. ILIT got higher incidence of local AEs than placebo, but their incidence of systemic AEs was similar. ILIT was safer than SCIT (p < 0.05). Almost all the patients could complete ILIT treatment, and the most common reason for discontinuation of ILIT was AEs. The compliance of patients receiving ILIT seemed higher than patients receiving SCIT. ILIT could significantly ameliorate subjective allergic symptoms, especially for seasonal ARC, and increase nasal tolerance, similar to SCIT.
ILIT was a safe and effective treatment for ARC and could achieve comparable clinical improvement with SCIT with shorter duration and higher compliance. Moreover, ILIT was safer than SCIT.
淋巴内免疫疗法（ILIT）是一种新兴的变应原免疫疗法，与过敏性鼻结膜炎（ARC）相比，注射次数更少，疗程更短。其疗效和安全性尚未得到充分有力的证据证实。
通过电子检索 PubMed、Web of Science、Embase、Scopus 和中国知网（CNKI），进行系统评价和荟萃分析。评估了 ILIT 的安全性（不良反应[AE]发生率）、依从性（完成治疗的患者比例）和临床疗效。临床疗效可通过主观症状和急救药物使用的改善或对特定变应原的鼻耐量来评估。本研究已在 PROSPERO（CRD42022353562）注册。
本综述纳入了 12 项比较 ILIT 与安慰剂的随机对照试验（RCT）和 3 项比较 ILIT 与 SCIT 的试验（2 项 RCT 和 1 项病例对照研究），共纳入 582 例诊断为 AR 或 ARC 的患者。几乎所有 AE 均为轻中度反应，除 1 项研究中 1 例患者在接受 5000 SQ-U 淋巴内注射剂量时发生过敏性反应外，均为轻度。ILIT 的局部 AE 发生率高于安慰剂，但全身 AE 发生率相似。ILIT 比 SCIT 更安全（p < 0.05）。几乎所有患者都能完成 ILIT 治疗，ILIT 治疗中断的最常见原因是 AE。接受 ILIT 治疗的患者的依从性似乎高于接受 SCIT 的患者。ILIT 可显著改善主观过敏症状，尤其是季节性 ARC，增加鼻耐量，与 SCIT 相似。
ILIT 是一种治疗 ARC 的安全有效方法，与 SCIT 相比，其疗程更短，依从性更高，可获得相当的临床疗效。此外，ILIT 比 SCIT 更安全。
