High dose pollen intralymphatic immunotherapy : Two RDBPC trials question the benefit of dose increase
(2022) In Allergy: European Journal of Allergy and Clinical Immunology 77(3). p.883-896- Abstract
Background: The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. Methods: Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000–3000–10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. Results: Doses up to 10,000 SQ-U were... (More)
Background: The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. Methods: Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000–3000–10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. Results: Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000–3000–3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study. Conclusion: Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.
(Less)
- author
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- clinical immunology, immunotherapy and tolerance induction, pollen, rhinitis
- in
- Allergy: European Journal of Allergy and Clinical Immunology
- volume
- 77
- issue
- 3
- pages
- 883 - 896
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85113642990
- pmid:34379802
- ISSN
- 0105-4538
- DOI
- 10.1111/all.15042
- language
- English
- LU publication?
- yes
- id
- bee270cc-b15e-4217-b059-60b51189ea17
- date added to LUP
- 2021-09-09 08:40:58
- date last changed
- 2024-06-16 18:40:53
@article{bee270cc-b15e-4217-b059-60b51189ea17,
abstract = {{<p>Background: The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. Methods: Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000–3000–10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. Results: Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000–3000–3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study. Conclusion: Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.</p>}},
author = {{Hellkvist, Laila and Hjalmarsson, Eric and Weinfeld, Dan and Dahl, Åslög and Karlsson, Agneta and Westman, Marit and Lundkvist, Karin and Winqvist, Ola and Georén, Susanna Kumlien and Westin, Ulla and Cardell, Lars Olaf}},
issn = {{0105-4538}},
keywords = {{clinical immunology; immunotherapy and tolerance induction; pollen; rhinitis}},
language = {{eng}},
number = {{3}},
pages = {{883--896}},
publisher = {{Wiley-Blackwell}},
series = {{Allergy: European Journal of Allergy and Clinical Immunology}},
title = {{High dose pollen intralymphatic immunotherapy : Two RDBPC trials question the benefit of dose increase}},
url = {{http://dx.doi.org/10.1111/all.15042}},
doi = {{10.1111/all.15042}},
volume = {{77}},
year = {{2022}},
}