Study On Efficacy And Safety Of Intralymphatic Immunotherapy For Adult Atopic Dermatitis

Objective:To investigate molecular immunologic mechanism, clinical efficacy and safety of intralymphatic immunotherapy with dermatophagoides pteronyssinus allergen vaccine for atopic dermatitis. Methods:60 patients with atopic dermatitis to dermatophagoides pteronyssinus were divided randomly into intralymphatic group and control group 30 cases respectively. Patients in control group received essential drugs while patients in intralymphatic group received above drugs and 6 ultrasound-guided injecting in superficial inguinal lymph nodes with standardized aluminum-adsorbed dermatophagoides pteronyssinus allergen vaccine(Alutard ALK, Denmark) every 4 week. serum dermatophagoides pteronyssinus s Ig E is detected by Fluorescent enzyme-linked immunoassay. Efficacy was evaluated by serum s Ig E of dermatophagoides pteronyssinus,SCORAD(Scoring Atopic Dermatitis) in the baseline and after treatment and compared with control group. Adverse reactions were recorded. Efficacy was assessed 3years after discontinued intralymphatic immunotherapy.85 patients with atopic dermatitis, who were sensitized to dermatophagoides pteronyssinus, were randomly divided into conventional group(51 cases) and intralymphatic group(34 cases). Patients in intralymphatic group received 6 ultrasound-guided intra-superficial lymph node injections by using standardized aluminum-adsorbed dermatophagoides pteronyssinus allergen vaccine every four weeks, while patients in conventional group received specific immunotherapy by subcutaneous injections by using above allergen in a 16-week incremental-dose phase at a week intervals and a 52-week maintenance-dose phase at 4-week intervals. Clinical efficacy was evaluated by SCORAD, medication scores, serum s Ig E of dermatophagoides pteronyssinus. Adverse reactions were recorded.72 patients with atopic dermatitis to dermatophagoides pteronyssinus were divided randomly into intralymphatic group and control group 36 cases respectively. Patients in control group received essential drugs while patients in treatment group were received above drugs and intralymphatic immunotherapy, interleukin-4( IL-4) and interferon-γ( INF-γ) values detected by euzymelinked immunosorbent assay in patients with atopic dermatitis before and after immunotherapy. Results:Comparing with patients in control group, intralymphatic immunotherapy significantly reduces SCORAD, medication scores and serum s Ig E of dermatophagoides pteronyssinus. Of 180 intralymphatic injections in 30 patients, no local and systemic adverse reaction occurred. Efficacy of intralymphatic immunotherapy lasts 3years.32 patients in intralymphatic group and 31 patients in conventional group were completed the study. Comparing with SCORAD, patients’ in intralymphatic group reduced significantly at 16 week and 20 week after treatment. Comparing with SCORAD, medication score and serum s Ig E to dermatophagoides pteronyssinus of pre-treatment patients, post-treatment patients’ in both group reduced significantly at 68 week, but no significantly deference between two groups at 68 week. Of 1024 subcutaneous injections in 51 patients in conventional group, there were 12 systemic adverse reactions in 5 patients occurred, but there no severe systemic adverse reaction occurred. Of 198 intralymphatic injections in 34 patients, there no systemic reactions occurred.The results show that 36 patients in treatment group and 36 patients in control group complete the study. We found that intrlymphatic immunotherapy reduced serum s Ig E to dermatophagoides pteronyssinus and IL-4 of patients in treatment group significantly, comparing with that of pre-treatment and that of in control group(P<0.01). We also found that comparing with INF-γ values of pre-treatment and that of in control group, patients’ in treatment group increase significantly(P<0.01). Conclusion:Intralymphatic allergen administration markedly reduced serum s Ig E to dermatophagoides pteronyssinus and IL-4 values, and significantly increased serum INF-γ value in patients with atopic dermatitis, So reducing serum s Ig E and adjusting serum IL-4 and INF-γ balance may be the molecular immune mechanism of intralymphatic immunotherapy. Intralymphatic allergen administration enhanced efficacy and safety of immunotherapy, markedly reduced the course of immunotherapy and the number and dose of injection, and decreased the adverse reaction. Therefore, intralymphatic immunotherapy with standardized dermatophagoides pteronyssinus allergen vaccine for atopic dermatitis is a fast affective and safe causative treatment.