Abstract
BackgroundAllergen specific IgG4 levels have been monitored as a surrogate marker for the tolerance inducing effect of subcutaneous immunotherapy (SCIT) in many studies. Its accuracy at group level has been well established, but IgG4 has not yet found its place in the daily care of immunotherapy patients.MethodsIntralymphatic immunotherapy (ILIT) is a novel route for allergy vaccination against pollen allergy, where an ultrasound-guided injection of 1000 SQ-U Alutard is given directly into a groin lymph node. The suggested standard dosing so far has been one injection with 4 weeks in-between. In total 3000 SQ-U with the treatment completed in 2 months. IgG4 was measured with Immulite technique and rhinoconjunctivitis symptoms were estimated with daily online questionnaires. Mann–Whitney U-test and Wilcoxon Signed Rank test were applied for comparisons between groups and within groups, respectively.ResultsThe present study demonstrates that a single, preseason ILIT booster of 1000 SQ-U Alutard 5-grasses®, re-increases the allergen specific timothy-IgG4 levels, in patients already treated with ILIT before the previous pollen season. It also shows the feasibility of the ILIT-route for allergy vaccination of rhinitis patients, with or without concomitant asthma, with low degree of side effects and reconfirms high and sustained patient satisfaction.ConclusionsIt is tempting to suggest that the allergen specific IgG4 levels can be used to build an intuitive algorithm for future clinical guidance of ILIT patients.Trial registration Is Intralymphatic Allergen Immunotherapy Effective and Safe?, ClinicalTrials.gov Identifier NCT04210193. Registered 24 December 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04210193?term=NCT04210193&draw=2&rank=1
Highlights
Allergen specific IgG4 levels have been monitored as a surrogate marker for the tolerance inducing effect of subcutaneous immunotherapy (SCIT) in many studies
No dose finding intralymphatic immunotherapy (ILIT)-study has yet been published for pollen allergy, but escalated ILIT doses have been evaluated from a safety aspect both in individuals who previously were treated with 3 years of pollen SCIT- and in allergen specific immunotherapy (AIT)-naive individuals [18]
Since the ILIT treatment period is relatively short, 2 months compared with at least 3 years for SCIT and sublingual immunotherapy (SLIT), there has been a discussion about the potential beneficial effects of a single extra intralymphatic dose, given as a pre-seasonal booster
Summary
Allergen specific IgG4 levels have been monitored as a surrogate marker for the tolerance inducing effect of subcutaneous immunotherapy (SCIT) in many studies. The alternative mode in routine care is sublingual immunotherapy (SLIT), where tablets or solutions are taken daily at home during at least 3 years. This approach is burdened by high cost of the medication and problems with compliance. In this context intralymphatic immunotherapy (ILIT) has emerged as an alternative form of AIT, both for pollen allergies [6,7,8,9,10,11,12] and indoor allergies [13,14,15] and was recently reviewed [16, 17]. This makes it hard to evaluate the add-on effects, in real time, of a successful booster, without the use of a reliable biomarker
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