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Intralymphatic immunotherapy: a 3-year randomized, double-blind study in 72 patients with allergic rhinitis due to birch and grass.
  • +11
  • Lars Ahlbeck,
  • Emelie Ahlberg,
  • Janne Björkander,
  • Caroline Aldén,
  • Georgia Papapavlou,
  • Laura Palmberg,
  • Ulla Nyström,
  • Pavlos Retsas,
  • Patrik Nordenfelt,
  • Totte Togö,
  • Pål Johansen,
  • Bo Rolander,
  • Maria Jenmalm,
  • Lennart Nilsson
Lars Ahlbeck
Linköping University Hospital
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Emelie Ahlberg
Linköping University
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Janne Björkander
Ryhov County Hospital
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Caroline Aldén
Linköping University
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Georgia Papapavlou
Linköping University
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Laura Palmberg
Linköping University
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Ulla Nyström
Linköping University Hospital
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Pavlos Retsas
Linköping University Hospital
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Patrik Nordenfelt
Ryhov County Hospital
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Totte Togö
Linköping University Hospital
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Pål Johansen
University Hospital Zurich
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Bo Rolander
Futurum Academy of Health and Care
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Maria Jenmalm
Linköping University
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Lennart Nilsson
Linköping University Hospital
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Abstract

Background: There is need for a fast, efficient, and safe way to induce tolerance in patients with allergic rhinitis. Methods: Patients with birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml, ALK-Abelló), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. Rhinoconjunctivitis Total Symptom Score, Medication Score and Rhinoconjunctivitis Quality of Life Questionnaire were evaluated before treatment and after each birch and grass pollen season during three subsequent years. Circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production were analyzed by flow cytometry and Luminex. Results: The three groups reported fewer symptoms, lower use of medication and improved quality of life during the birch and grass pollen seasons each year after treatment at an almost similar rate independently of treatment. Nine patients had severe adverse events which were judged to be unrelated to the therapy. Mild local pain was the most common adverse event. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased independently of treatment. IgG4 levels to birch and timothy and skin prick test reactivity remained mainly unchanged. Conjunctival challenge tests with timothy extract showed a higher threshold for allergen. In all three groups, regulatory T cell frequencies were increased three years after treatment. Conclusion: Intralymphatic immunotherapy against grass and birch pollen allergy was effective, safe and associated with bystander immune modulatory responses.