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Lee, Jung, Lee, Joe, Kang, Kim, Lee, Park, and Choi: Intralymphatic Immunotherapy Alleviates Allergic Symptoms During Allergen Exposure in Daily Life
Letter to the Editor

Allergy, Asthma & Immunology Research 2018; 10(2): 180-181.

Published online: 7 November 2017

DOI: https://doi.org/10.4168/aair.2018.10.2.180

Intralymphatic Immunotherapy Alleviates Allergic Symptoms During Allergen Exposure in Daily Life

Sang Pyo Lee1, , Joo Hyun Jung2, , Sang Min Lee1, Eugene Joe3, Il Gyu Kang2, Seon Tae Kim2, Min Woo Lee4, So Hyun Park5, Seung Joon Choi5

1Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

2Department of Otolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea.

3Department of Radiology, Seoul Medical Center, Seoul, Korea.

4Gachon University Graduate School of Medicine, Incheon, Korea.

5Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.

Corresponding author: Prof. Sang Min Lee, MD, PhD, Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-2634; Fax: +82-32-469-4320; sangminlee77@naver.com

Equal contributor:

Sang Pyo Lee and Joo Hyun Jung contributed equally to this work.

Received 8 June 2017       Revised 11 August 2017       Accepted 16 September 2017

Copyright © 2018 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Previously, we reported that intralymphatic immunotherapy (ILIT) can cause serious local or systemic hypersensitivity reactions.1 However, patients who experienced those reactions in our study were eager to receive additional injections because they experienced alleviation of allergic symptoms, especially during exposure to causal allergens in daily life.
We asked 11 patients with allergic rhinitis who were allergic to Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), dog or cat to score their allergic symptoms during exposure to house dust, dogs, or cats in daily life using a visual analogue scale (VAS) ranging from 0 to 100 mm. We regarded patients as being exposed to house dust when they were cleaning rooms or making beds, or when they were in bed.23 Patients were also requested to rate their level of agreement with the statements “allergen-specific immunotherapy can reduce allergic symptoms,” as well as their willingness to pay for allergen-specific immunotherapy (AIT) using a VAS ranging from 0 to 100 mm before, and 4 months and 1 year after ILIT.
As a result, rhinorrhea, sneezing, itchy nose, itchy eyes, nasal obstruction, and postnasal drip during exposure to house dust, dogs and/or cats in daily life were alleviated 4 months and 1 year after the first day of ILIT (Figure).
Patients also showed a greater level of agreement with the statement “allergen-specific immunotherapy can reduce allergic symptoms” (P<0.05 compared to baseline; Suppl. Fig. 1), and they were more willing to pay for AIT after skin prick tests, nasal allergen provocation tests (NAPTs), and ILIT (P<0.05 compared to baseline; Suppl. Fig. 2) than before they received those tests and ILIT.
In conclusion, ILIT alleviates allergic symptoms during allergen exposure in daily life, helps patients become more aware of AIT, and increases their willingness to pay for AIT. ILIT as a new AIT modality may satisfy unmet needs of patients with allergic diseases. However, ILIT was also found to provoke serious hypersensitivity reactions in our previous report; thus, investigators should seek to develop new immunomodulatory methods with a low risk of serious adverse reactions and improved therapeutic efficacy.

Figures and Tables

Figure

Changes in degrees of allergic symptoms provoked by exposures to the causal allergen in daily life. VAS ranges from 0 to 100 mm. Data are shown as mean±SD. (A) rhinorrhea, (B) sneezing, (C) itchy nose, (D) itchy eyes, (E) nasal obstruction, and (F) postnasal drip. VAS, visual analogue scale; Pt, patient.

aair-10-180-g001

ACKNOWLEDGMENTS

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A1A02061943).

Notes

There are no financial or other issues that might lead to conflict of interest.

References

1. Lee SP, Choi SJ, Joe E, Lee SM, Lee MW, Shim JW, et al. A Pilot Study of Intralymphatic Immunotherapy for House Dust Mite, Cat, and Dog Allergies. Allergy Asthma Immunol Res. 2017; 9:272–277.
crossref
2. Linneberg A, Nielsen NH, Madsen F, Frølund L, Dirksen A, Jørgensen T. Increasing prevalence of allergic rhinitis symptoms in an adult Danish population. Allergy. 1999; 54:1194–1198.
crossref
3. Linneberg A, Jørgensen T, Nielsen NH, Madsen F, Frølund L, Dirksen A. The prevalence of skin-test-positive allergic rhinitis in Danish adults: two cross-sectional surveys 8 years apart. The Copenhagen Allergy Study. Allergy. 2000; 55:767–772.

SUPPLEMENTARY MATERIALS

Supplementary Fig. 1

Patients' agreement with the statement “allergen-specific immunotherapy can reduce allergic symptoms” before and after a SPT, NAPT and ILIT. VAS ranges from 0 to 100 mm. Data are shown as mean±SD. ILIT, intralymphatic immunotherapy; NAPT, nasal allergen provocation test; SPT, skin prick test; VAS, visual analogue scale. *P<0.05 compared to baseline.

Supplementary Fig. 2

Patients' willingness to pay for AIT before and after a SPT, NAPT and ILIT. VAS ranges from 0 to 100 mm. Data are shown as mean±SD. AIT, allergen-specific immunotherapy; ILIT, intralymphatic immunotherapy; KRW, Korean won; NAPT, nasal allergen provocation test; SPT, skin prick test; VAS, visual analogue scale. *P<0.05 compared to baseline.
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