Intralymphatic immunotherapy induces allergen specific plasmablasts and increases tolerance to skin prick testing in a pilot study.

Johannes Martin Schmid,Hans Jürgen Hoffmann,Alexander Schmitz,Homaira Nezam,Hans Henrik Torp Madsen

doi:10.1186/s13601-016-0107-x

Abstract

BackgroundAllergen Immunotherapy is a promising treatment of allergy. Seven patients with rhinoconjunctivitis to grass allergen were treated with intralymphatic immunotherapy (ILIT) to explore whether this treatment could be performed. Effect of treatment was assessed as change in symptom medication score, response in skin prick test and nasal allergen provocation. ILIT deposits allergen in an inguinal lymph node to elicit a strong immune stimulus. This allowed us to monitor appearance of allergen specific plasmablasts 7 days after allergen injection.FindingsIn an open trial of seven patients with a history of symptomatic allergic rhinoconjunctivitis due to grass pollen, three injections of allergen into inguinal lymph nodes were performed with monthly intervals. Allergen injections induced grass allergen specific plasmablasts expressing other isotypes than IgE after 7 days, induced a trend toward improvement in symptom and medication score and rhinoconjunctivitis-related quality of life during the grass pollen season 2013 and significantly raised the threshold in nasal allergen challenge and titrated skin prick testing. Mild side-effects were recorded after 3 of the 21 of injections (14 %).ConclusionsThis pilot study shows that ILIT may induce allergen specific plasmablasts, and confirms an effect on provocation of mast cells in skin and nasal mucosa during the ensuing winter.

Highlights

Allergen Immunotherapy is a promising treatment of allergy
This pilot study shows that intralymphatic immunotherapy (ILIT) may induce allergen specific plasmablasts, and confirms an effect on provocation of mast cells in skin and nasal mucosa during the ensuing winter
Seven patients with a history of symptomatic rhino-conjunctivitis due to grass pollen allergy recruited as open control group for a Subcutaneous immunotherapy (SCIT) study [9] accepted the option of ILIT as alternative to SCIT

Summary

Introduction

Seven patients with rhinoconjunctivitis to grass allergen were treated with intralymphatic immunotherapy (ILIT) to explore whether this treatment could be performed. ILIT deposits allergen in an inguinal lymph node to elicit a strong immune stimulus. This allowed us to monitor appearance of allergen specific plasmablasts 7 days after allergen injection. Subcutaneous immunotherapy (SCIT) is a time demanding and costly treatment, requiring 30–80 injections over. The efficacy of intralymphatic immunotherapy (ILIT), where allergen is injected into inguinal lymph nodes, has been assessed in recent studies [4–6]. We involved a radiologist to ascertain that we injected allergen into lymph nodes as this may be paramount to the success of this treatment [7] and adhered to the protocol of former, successful trials in which injections of 1000 SQU were given at more than 4-weekly intervals [4, 5, 8]

Methods

Results

Conclusion