BackgroundIntralymphatic immunotherapy (ILIT) represents a promising novel approach treating allergic diseases. However, no standardized procedures or recommendations have been established or reported, despite the recognized fact that treatment efficacy relies on the ability to inject the allergen intranodally.ObjectiveWe aim to provide a critical appraisal of ILIT as a method of allergen immunotherapy and to deliver practical recommendations for accurate ILIT.MethodsOne hundred and seventy‐three ILIT injections were performed in 28 (47%) women and 32 (53%) men with median age of 29 years (21–59). The injections were ultrasound‐guided and recorded for retrospective analysis with respect to injection location, needle visibility, medication release, and patient characteristics.ResultsThe results show that the correct positioning of the needle within the lymph node (LN) was most critical. If the whole length of the needle bevel was not inserted into the LN, substance backflush into the interstitium was observed. Selecting a more superficial LN and inserting the needle at a smaller angle towards the LN significantly improved needle visibility in the ultrasound. Longitudinal results showed that continuous practice significantly correlated with improved needle visibility and more accurate ILIT injections.ConclusionBased on our results and practical experience, we propose several recommendations for LN selection and the correct handling of ultrasound probe and needle. We are confident that ILIT standardization and training will be important as to meet the goals of good safety and efficacy of ILIT.

中文翻译：

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如何达到过敏目标：对淋巴内免疫疗法的严格评估以及超声引导注射的实用建议

背景淋巴内免疫疗法（ILIT）代表了一种有前途的治疗过敏性疾病的新方法。然而，尽管公认的事实是治疗效果依赖于节内注射过敏原的能力，但尚未建立或报告标准化程序或建议。 目的我们的目标是对 ILIT 作为过敏原免疫治疗方法进行严格评估，并提供实用建议方法 28 名 (47%) 女性和 32 名 (53%) 男性进行了 173 次 ILIT 注射，中位年龄为 29 岁 (21-59)。注射是在超声引导下进行的，并记录下来，以便对注射位置、针头可见性、药物释放和患者特征进行回顾性分析。结果结果表明，针头在淋巴结 (LN) 内的正确定位最为关键。如果针头斜面的整个长度没有插入 LN，则会观察到物质反冲到间质中。选择更表层的淋巴结并以较小的角度向淋巴结插入针可显着提高超声中针的可见度。纵向结果表明，持续练习与改善针头可见度和更准确的 ILIT 注射显着相关。结论根据我们的结果和实践经验，我们提出了有关 LN 选择以及超声探头和针头正确处理的几项建议。我们相信，ILIT 标准化和培训对于实现 ILIT 良好安全性和有效性的目标非常重要。