Long-term effects of intralymphatic immunotherapy (ILIT) on canine atopic dermatitis.

BACKGROUND: Subcutaneous allergen immunotherapy (SCIT) is an established and efficacious therapy for canine atopic dermatitis (AD). In humans, intralymphatic immunotherapy (ILIT) was reported to be associated with fewer and less severe adverse effects than subcutaneous allergen immunotherapy and to be efficacious for several years after three intralymphatic injections. OBJECTIVE: To evaluate safety and effects of ILIT in a case series of dogs with (AD). ANIMALS: Fifty one privately owned dogs with AD. METHODS: Dogs received injections of 0.2 mL alum-precipitated allergen extract into the popliteal lymph nodes at monthly intervals for 3-5 months. Lesion scores, pruritus and medication scores were determined before and at three and 12 months after beginning immunotherapy, and compared in a per protocol analysis (PP) and an intention-to-treat analysis (ITT). RESULTS: Twenty two dogs completed the study and 29 dogs did not fulfil study completion criteria due to lack of a final study visit (21 of 29) or due to insufficient improvement (14 of 29). All scores improved during the study with both analyses. For pruritus and Quality of Life scores this improvement was significant with both analyses; for Canine Atopic Dermatitis Extent and Severity Index (CADESI)-03 values and medication scores only with PP. The only rare adverse effects observed included mild swelling of the lymph node post-injection and increased pruritus. CONCLUSION AND CLINICAL RELEVANCE: ILIT is safe and feasible, and provides long-lasting relief in some atopic dogs with a limited number of injections.

Intralymphatic allergen administration renders specific immunotherapy faster and safer: a randomized controlled trial.

The only causative treatment for IgE-mediated allergies is allergen-specific immunotherapy. However, fewer than 5% of allergy patients receive immunotherapy because of its long duration and risk of allergic side effects. We aimed at enhancing s.c. immunotherapy by direct administration of allergen into s.c. lymph nodes. The objective was to evaluate safety and efficacy compared with conventional s.c. immunotherapy. In a monocentric open-label trial, 165 patients with grass pollen-induced rhinoconjunctivitis were randomized to receive either 54 s.c. injections with pollen extract over 3 years [cumulative allergen dose 4,031,540 standardized quality units (SQ-U)] or 3 intralymphatic injections over 2 months (cumulative allergen dose 3,000 SQ-U). Patients were evaluated after 4 months, 1 year, and 3 years by nasal provocation, skin prick testing, IgE measurements, and symptom scores. Three low-dose intralymphatic allergen administrations increased tolerance to nasal provocation with pollen already within 4 months (P < 0.001). Tolerance was long lasting and equivalent to that achievable after standard s.c. immunotherapy (P = 0.291 after 3 years). Intralymphatic immunotherapy ameliorated hay fever symptoms (P < 0.001), reduced skin prick test reactivity (P < 0.001), decreased specific serum IgE (P < 0.001), caused fewer adverse events than s.c. immunotherapy (P = 0.001), enhanced compliance (P < 0.001), and was less painful than venous puncture (P = 0.018). In conclusion, intralymphatic allergen administration enhanced safety and efficacy of immunotherapy and reduced treatment time from 3 years to 8 weeks.

[Complications of indirect lymphotropic therapy in patients with suppurative wounds]. / Oslozhneniia nepriamoi limfotropnoi terapii u bol'nykh s gnoinymi ranami.

With the aim to reveal the frequency of complications in indirect lymphotropic therapy, retrospective analysis of 2136 case records of patients with festering wounds was carried out. In 1.59% of patients the following complications in the area of introduction of preparation were detected: protracted oedemas of hands and feet, severe painful syndrome, infiltration, necroses of soft tissues and the areas of atrophy and aseptic inflammation. Most commonly the complications arose in patients with peripheral circulation disturbances. The authors suggested this method of treatment to be contraindicated in peripheral blood flow disturbances and before its application the additional examination for revealing vascular disturbances is obligatory. In cases of painful syndrome, oedema, infiltration, hyperemia in the area of introduction of the drugs one day after the injection, indirect lymphotropic therapy should be discontinued.

[Lymphography and the possibility of tumor cell dissemination]. / Limfografiia i vozmozhnost' disseminatsii opukholevykh kletok.

It is concluded that endolymphatic infusion of X-ray contrast substance in the presence of migrating tumor cells in lymphatic routes is inherent in a potential danger of tumor dissemination. Although getting of tumor cells in blood does not always result in metastases, nevertheless, a due account should be taken of the fact that lymphography is frequently performed in poor immunological resistance patients, preliminarily subjected to chemo- and radiotherapy. The decrease of immune resistance of the organism, in which the lymphatic system is of primary importance, is known to contribute per se to generalization of the tumor process. Another important conclusion is that the principal mass of tumor cells is ejected in the immediate period after endolymphatic injection of X-ray contrast substance. Thus, the cannulation of the thoracic duct during this period may prevent or reduce getting of massive amounts of tumor cells into the total blood flow.

[Intralymphatic B.C.G. infusions. Preliminary results (40 cases)]. / Les infusions intra-lymphatiques de B.C.G. Résultats préliminaires (40 cas)

A new route of administration for BCG aimed at stimulating immunity in cancer patients is presented. 40 patients received an intra-lymphatic infusion of BCG and in 20 lymphnode dissection was carried out for bacteriological and histological study. Details of technique and the results are given with regard to the effects of BCG on pelvic and pre-vertebral nodes after injection via a foot vessel.