新报道的一项临床试验提示,直接向患者的淋巴结而不是皮肤注射过敏原可以极大地加快花粉过敏症的治疗。一个为期3年、进行54次注射的疗程是目前可以长期缓解花粉过敏患者症状的唯一的疗法。许多患者没有坚持做完疗程,而且其他一些患者常常遇到该疗法的副作用。
Thomas Kündig及其同事如今提出了一个替代方法:直接向淋巴结注射。淋巴结里聚集了免疫系统细胞。这组科学家比较了两组人类自愿参与者的淋巴和静脉注射疗法治疗花粉过敏的效果。第一组接受了标准疗法,而第二组在8周时间里等间隔地接受了3次淋巴注射。根据这组作者,在实验阶段结束的时候,两种方法带来的保护是类似的,但是淋巴注射组的不良反应的频率和严重程度均更小。接受淋巴注射的患者也报告该疗法痛苦程度更低,这组作者说,再加上注射次数的减少,这种方法应该可以增加完成该疗法的患者数量。(生物谷Bioon.com)
生物谷推荐原始出处:
PNAS published November 10, 2008, doi:10.1073/pnas.0803725105
Intralymphatic allergen administration renders specific immunotherapy faster and safer: A randomized controlled trial
Gabriela Senti, Bettina M. Prinz Vavricka, Iris Erdmann, Mella I. Diaz, Richard Markus, Stephen J. McCormack, John J. Simard, Brunello Wüthrich, Reto Crameri, Nicole Graf, P?l Johansen, and Thomas M. Kündig
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.