What Do We Really Know About Intralymphatic Immunotherapy?

Purpose of review: Allergen-specific immunotherapy (AIT) is the only causal treatment method of IgE-mediated allergies that may lead to long-term symptom amelioration even after the end of treatment, positively interfere with the course of disease, and improve the immunological situation of the patient. While AIT in general requires treatment periods over 3 up to 5 years, intralymphatic immunotherapy (ILIT) needs only three ultrasound-guided injections of low allergen doses into inguinal lymph nodes with 4-week time interval making the entire treatment possible within 2 months. Recent findings: The number of published ILIT trials is continuously increasing and it has been mainly used for the indication of allergic rhinitis using commercially available grass pollen and birch extracts and Dermatophagoides farinae, Dermatophagoides pteronyssinus, dog or cat allergens, and moreover a recombinant MAT-Fel d 1 vaccine and autologous semen from a patient with post-orgasmic illness syndrome. Summary: ILIT is a very promising AIT technique that could widely improve patient treatment However, there is not enough convincing evidence for a routine use of ILIT and no authorized commercial allergen extracts exist for this approach, so far. Dose-escalation studies and prospective DBPC efficacy trials need to be performed in diverse allergens like insect venom. Moreover, pediatric populations have not been present in former ILIT studies. © 2018, Springer Nature Switzerland AG.