Asia Pac Allergy.  2017 Jul;7(3):131-137. 10.5415/apallergy.2017.7.3.131.

Allergen-specific intralymphatic immunotherapy in human and animal studies

• Kim ST
• Park SH
• Lee SM
• Lee SP

• KMID: 2396936
• DOI: http://doi.org/10.5415/apallergy.2017.7.3.131

Abstract

Clinical trials of intralymphatic immunotherapy (ILIT) have been performed to overcome the limitations of long-term therapy and the local or systemic hypersensitivity reactions in conventional allergen-specific immunotherapy, including subcutaneous or sublingual immunotherapy. Additionally, several animal studies of ILIT have been conducted in the form of translational or veterinary research. We conducted a literature review to examine the treatment efficacy and adverse effects of ILIT.

Keyword

Immunotherapy; Injections, intralymphatic; Treatment efficacy; Adverse effects

MeSH Terms

Animals*
Humans*
Hypersensitivity
Immunotherapy*
Injections, Intralymphatic
Sublingual Immunotherapy
Treatment Outcome

Figure

• 

  Fig. 1 Possible mechanism of immune modulation in intralymphatic immunotherapy. After entering the lymph node through an afferent lymphatic vessel, a naïve B-cell undergoes clonal expansion and somatic hypermutation within the dark zone of the germinal center. Allergens injected into a lymph node are phagocytosed by follicular dendritic cells, and their peptides are presented on major histocompatibility complex (MHC) class II molecules to B cells within the light zone of the germinal center. These activated B cells differentiate into plasmablasts, plasma cells, and memory B cells. They then exit the lymph node through the medulla and efferent lymphatic vessels. The circulating B cells, with or without enhanced affinity, may secrete allergen-specific IgE, IgG4, or other antibody isotype.

• 

  Fig. 2 Possible mechanism underlying the development of a hypersensitivity reaction in intralymphatic immunotherapy. Although we performed ultrasound-guided intralymphatic injection after confirming the targeted lymph node, small amount of allergens can be leaked from lymph node during the procedure and this may lead to systemic hypersensitivity reaction. In addition, the lymph node is not isolated but connected to the systemic circulation through the medulla, arteries, veins, and the lymphatic vessels. Therefore, allergens injected into a lymph node can use this route to reach the systemic circulation and provoke a hypersensitivity reaction.

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