Is intralymphatic immunotherapy ready for clinical use in patients with grass pollen allergy?

Witten, Marianne; Malling, Hans‐Jørgen; Blom, Lars; Poulsen, Britta C.; Poulsen, Lars K.

doi:10.1016/j.jaci.2013.07.033

Cited by 91 publications

(162 citation statements)

References 16 publications

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“…126 The intralymphatic route, using a grass pollen extract and a modified cat allergen extract, showed efficacy in some trials 127,128 but not in others. 129 …”

Section: Strength Of Recommendationmentioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

594

705

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drawn on data from a systematic review of the literature, more recent published studies and multistakeholder expert clinical opinion. This Guideline is aimed at healthcare professionals who are encouraged to take the recommendations into account in the context of delivering clinical care. This Guideline is not a substitute for professional clinical judgment, which professionals need to exercise in the context of delivering personalised healthcare. AbstractAllergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach.The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass 766 | ROBERTS, PFAAR ET AL. tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children. | ME TH ODOLOGYThis Guideline was produced using the Appraisal of Guidelines forResearch & Evaluation (AGREE II) approach, 17,18 a structured approach to guideline production (see Table S1). This is designed to ensure appropriate representation of the full range of stakeholders, a careful search for and critical appraisal of the relevant literature, a systematic approach to the formulation and presentation of recommendations and steps to ensure that the risk of bias is minimized at each step of the process. The process started on April 2015 beginning with detailed face-to-face discussions agreeing on the process and the key clinical areas to address, followed by face-to-face meetings, and regular web conferences in which professional and lay representatives participated. | Clarifying the scope and purpose of the guidelinesThe scope of this EAACI Guideline is multifaceted...

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“…126 The intralymphatic route, using a grass pollen extract and a modified cat allergen extract, showed efficacy in some trials 127,128 but not in others. 129 …”

Section: Strength Of Recommendationmentioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

594

705

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“…If anything, symptoms tended to worsen. In contrast to all other successful trials, the interval between injections in that trial by Witten et al [15] was shorter than in other trials, i.e., 2 instead of 4 weeks. This may explain the missing clinical effect as time intervals shorter than 2 weeks are known to compromise memory B cell formation and affinity maturation [18, 19].…”

Section: Ilit Updatedmentioning

confidence: 65%

“…In 2015, Senti et al [11] reviewed the accumulated experience in ILIT up to 2014. They reviewed all 4 clinical trials on ILIT in humans published until mid-2014 [12-15]. Their conclusion from the 4 trials was that they indicate ILIT against grass pollen and bee venom to not only be safe and efficient, but also associated with a lower risk of systemic adverse effects (e.g., anaphylaxis and lethal consequences).…”

Section: Ilit Updatedmentioning

confidence: 99%

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Intralymphatic Immunotherapy: Update and Unmet Needs

Senti

Freiburghaus

Larenas‐Linnemann

et al. 2018

Int Arch Allergy Immunol

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Allergen-specific immunotherapy (AIT) is the only allergy treatment that confers long-term symptom amelioration for patients suffering from allergy. The most frequently used allergen application route is subcutaneous injection (SCIT), commonly taken as the gold standard, followed by sublingual (SLIT) or oral (OIT) application of allergen preparations. This is an up-to-date review of the clinical evidence for a novel route of allergen application, i.e., directly into lymph nodes – intralymphatic immunotherapy (ILIT). The major advantages of ILIT over the current AIT approaches are its short duration and the low allergen doses administered. The whole treatment consists of merely 3 ultrasound-guided injections into inguinal lymph nodes 1 month apart. While the number of patients included in randomised controlled trials is still limited, the clinical results for ILIT are encouraging, but more clinical trials are needed, as well as more preclinical work for optimising formulations.

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“…The 3-year outcomes were similar and the safety of intralymphatic was superior to conventional SCIT [9]. However, a randomized, placebo-controlled study of this approach failed to confirm the efficacy of intralymphatic immunotherapy [12], but the results were challenged because the injections were given at 2-week rather than 4-week intervals. ClinicalTrials.gov lists two ongoing studies of intralymphatic immunotherapy that may settle the controversy.…”

mentioning

confidence: 98%

Allergen immunotherapy: what’s new, what’s next?

Nelson

2015

Expert Review of Clinical Immunology

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Is intralymphatic immunotherapy ready for clinical use in patients with grass pollen allergy?

Cited by 91 publications

References 16 publications

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Intralymphatic Immunotherapy: Update and Unmet Needs

Allergen immunotherapy: what’s new, what’s next?

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