Department of Dermatology, University of Zurich, Zurich, Switzerland.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Allergy. 2024 Aug;79(8):2222-2234. doi: 10.1111/all.16138. Epub 2024 May 7.
Intralymphatic immunotherapy (ILIT) represents a promising novel approach treating allergic diseases. However, no standardized procedures or recommendations have been established or reported, despite the recognized fact that treatment efficacy relies on the ability to inject the allergen intranodally.
We aim to provide a critical appraisal of ILIT as a method of allergen immunotherapy and to deliver practical recommendations for accurate ILIT.
One hundred and seventy-three ILIT injections were performed in 28 (47%) women and 32 (53%) men with median age of 29 years (21-59). The injections were ultrasound-guided and recorded for retrospective analysis with respect to injection location, needle visibility, medication release, and patient characteristics.
The results show that the correct positioning of the needle within the lymph node (LN) was most critical. If the whole length of the needle bevel was not inserted into the LN, substance backflush into the interstitium was observed. Selecting a more superficial LN and inserting the needle at a smaller angle towards the LN significantly improved needle visibility in the ultrasound. Longitudinal results showed that continuous practice significantly correlated with improved needle visibility and more accurate ILIT injections.
Based on our results and practical experience, we propose several recommendations for LN selection and the correct handling of ultrasound probe and needle. We are confident that ILIT standardization and training will be important as to meet the goals of good safety and efficacy of ILIT.
淋巴内免疫疗法（ILIT）代表了一种治疗过敏性疾病的有前途的新方法。然而，尽管人们认识到治疗效果取决于将过敏原注射到淋巴结内的能力，但尚未建立或报道任何标准化程序或建议。
我们旨在对 ILIT 作为过敏原免疫疗法的方法进行批判性评估，并为准确的 ILIT 提供实用建议。
对 28 名（47%）女性和 32 名（53%）男性进行了 173 次 ILIT 注射，中位年龄为 29 岁（21-59 岁）。这些注射是在超声引导下进行的，并记录了注射部位、针的可视性、药物释放和患者特征等方面的回顾性分析。
结果表明，将针正确定位在淋巴结（LN）内是最重要的。如果针的斜面没有完全插入 LN，则会观察到物质反冲到间质中。选择更表浅的 LN 并以较小的角度向 LN 插入针，可显著提高超声中的针可视性。纵向结果表明，持续练习与提高针可视性和更准确的 ILIT 注射显著相关。
根据我们的结果和实践经验，我们提出了一些关于 LN 选择和正确处理超声探头和针的建议。我们相信，ILIT 的标准化和培训将是非常重要的，以实现 ILIT 的良好安全性和疗效目标。
