Clinical Evaluation Of Intralymphatic Allergen Immunotherapy In The Treatment Of Dust Mite-induced Allergic Rhinitis

Objection:Intralymphatic allergen immunotherapy(ILIT)and subcutaneous specific immuno-therapy(SCIT)were performed in patients with allergic rhinitis(AR)to compare the differences in efficacy,safety and compliance between ILIT and SCIT,and further explore the possible immune mechanism of ILIT.Methods:Patients with moderate to severe persistent AR with house dust mite and/or dust mite allergy were recruited.The patients were divided into two groups according to their own wishes and were treated with ILIT and SCIT respectively.Questionnaires including visual analog scale(VAS)and Rhinoconjunctivitis quality of life(RQLQ)were administered to the two groups at points 0,12,16 and 24 weeks of treatment.Peripheral blood serum samples of ILIT group were collected at three time points at week 0,12 and 24 to detect inflammatory indicators such as immunoglobulin G4(IgG4),interleukin-10(IL-10),interferon alpha(IFN-),interleukin-4(IL-4)and interleukin-17(IL-17).During the whole treatment process,the occurrence of local or systemic adverse reactions in the two groups was observed and recorded,and the patient compliance and influencing factors were evaluated.SPSS20.0 software was used for statistical processing of the data.P<0.05 was considered statistically significant.Result:1.Clinical efficacy:(1)After immunotherapy,VAS score of nasal symptoms in SCIT group and ILIT group decreased significantly compared with that before treatment(p<0.05);At the early stage of treatment(weeks 12 and 16),nasal symptoms in the ILIT group improved significantly compared to those in the SCIL group(p<0.05).After immunotherapy,quality of life score of patients in SCIT group and ILIT group decreased significantly compared with that before treatment(p<0.05).At week 12,week 16,and week 24,the quality of life scores in the ILIT group were significantly lower than those in the SCIL group(p<0.05).2.Hematological testing:After receiving Intralymphatic allergen immunotherapy,serum levels of IgG4,IL-10 and IFN-γ in ILIT group were significantly higher than before treatment(p<0.05),and levels of IL-17 and IL-4 were significantly lower than before treatment(p<0.05).3.Adverse event:A total of 99 lymph node injections were performed in the ILIT group,and 5 local adverse reactions occurred,accounting for 5.05%of the total number of injections.No systemic adverse reactions occurred in the ILIT group.All patients in the SCIT group had local reactions during immunotherapy,among which 5 of them had 7 systemic adverse reactions(1.18),none of which was fatal.The incidence of systemic adverse events in the SCIT and ILIT groups during the 24-week immunotherapy period was 1.18%and 0%,respectively,with statistically significant differences(p<0.001).4.Compliance comparison:A total of 35 patients were enrolled in the SCIT group,and 30 patients completed the 24-week treatment,with a compliance rate of 85.7%;In the ILIT group,35 patients were recruited,and 31 patients completed treatment and follow-up,with a compliance rate of 88.6%.There was no significant difference in compliance rate between the two groups.Conclusion:Intralymphatic allergen immunotherapy is a safe,effective and efficient immunotherapy method.Compared with conventional subcutaneous immunotherapy,it has a similar effect and has the advantages of fast onset,low incidence of adverse reactions and less treatment times,which is worthy of clinical promotion.