title: Intralymphatic immunotherapy of pollen-induced rhinoconjunctivitis: a double-blind placebo-controlled trial.
abstract: BACKGROUND
  Allergen-specific immunotherapy represents the only disease-modifying treatment for allergic diseases. We and others have previously demonstrated that intralymphatic immunotherapy (ILIT), a less time-consuming alternative to conventional subcutaneous immunotherapy (SCIT), is safe and effective. However, this has recently been disputed. The aim of this study was therefore to expand our previous trial, further assessing the safety and efficacy of ILIT.
  
  
  METHODS
  Thirty-six patients with pollen-induced rhinoconjunctivitis were randomised to receive three intralymphatic inguinal injections of active allergen (1000 SQ-U birch- or grass-pollen) or placebo. Clinical effects, safety and circulating immunological markers were assessed before, 4 weeks after treatment and at the end of the consecutive pollen season.
  
  
  RESULTS
  No moderate or severe reactions were recorded following ILIT. Patients receiving active ILIT experienced a significant improvement in self-recorded seasonal allergic symptoms, as compared to placebo (p = 0.05). In a subgroup of these patients ("improved"), a reduction in nasal symptoms following nasal allergen provocation was also demonstrated. No changes in total IgE or IgG4 were found. However, the affinity of allergen specific IgG4 following active treatment was significantly increased, as compared to non-improved patients (p = 0.04). This could be correlated with clinical improvement, on an individual level.
  
  
  CONCLUSIONS
  This double-blinded placebo-controlled study confirms that ILIT is a safe and effective treatment for pollen-induced rhinoconjunctivitis, markedly reducing seasonal allergic symptoms.
  
  
  BACKGROUND
  EudraCT: 2009-016815-39.
authors.affiliation: Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. terese.hylander@ki.se.
authors.forename: Terese
authors.initials: T
authors.lastname: Hylander
authors.affiliation: Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. olivia.larsson@ki.se.
authors.forename: Olivia
authors.initials: O
authors.lastname: Larsson
authors.affiliation: Laboratoy of Clinical Experimental Allergy Research, Department of Otorhinolaryngology Malmö, Lund University, Skåne University Hospital, Malmö, Sweden. ulla.westin@med.lu.se.
authors.forename: Ulla
authors.initials: U
authors.lastname: Petersson-Westin
authors.affiliation: Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. mia.eriksson19@gmail.com.
authors.forename: Mia
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. susanna.georen@ki.se.
authors.forename: Susanna
authors.initials: S
authors.lastname: Kumlien Georén
authors.affiliation: Department of Medicine Solna, Translational Immunology Unit, Karolinska University Hospital Solna, Stockholm, Sweden. ola.winqvist@ki.se.
authors.forename: Ola
authors.initials: O
authors.lastname: Winqvist
authors.affiliation: Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. lars-olaf.cardell@ki.se.|Laboratoy of Clinical Experimental Allergy Research, Department of Otorhinolaryngology Malmö, Lund University, Skåne University Hospital, Malmö, Sweden. lars-olaf.cardell@ki.se.|Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden. lars-olaf.cardell@ki.se.
authors.forename: Lars-Olaf
authors.initials: LO
authors.lastname: Cardell
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D003231:Conjunctivitis / Q000276:immunology* / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007272:Injections, Intralymphatic / Q000379:methods; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000485:Allergens
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