Abstract: Yong Lei, Gao Chunfang, Cheng Xiangduo, Li Huaxin, Li Xiaohong, Li Ke, Wang Junqi, Li Hongwen*. *Department of Dermatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Corresponding author: Li Hongwen, Email: yfylhw@sina.com 【Abstract】 Objective To evaluate the efficacy and safety of intralymphatic immunotherapy in adult patients with atopic dermatitis. Methods Eighty-five patients were enrolled into this study, and divided into intralymphatic injection group （n = 34） receiving ultrasound-guided injections of standardized house dust mite allergens into inguinal lymph nodes at week 0, 4, 8, 12, 16, and 20, and subcutaneous injection group （n = 51） receiving subcutaneous injections of the same standardized allergens for 68 weeks. The dose of house dust mite allergens in the intralymphatic injection group was 100 standardized quality units （SQ-U） on week 0, and 1 000 SQ-U at the following time points, while the standardized allergens were injected once weekly in the subcutaneous injection group during the dose-accumulative stage with the dose gradually increasing from 20 to 80 000 SQ-U at week 16, and once every 4 weeks during the following 52-week maintenance stage with the dose maintaining at 80 000 SQ-U. Scoring Atopic Dermatitis（SCORAD） index was determined at the baseline and week 16, 20, and 68 after starting treatment. The amount of other drugs （such as antihistamines, glucocorticosteroids, etc） used was scored, and serum levels of house dust mite-specific IgE （sIgE） and sIgG4 were measured at the baseline and after 68-week treatment. Adverse reactions were recorded. Results Thirty-two patients in the intralymphatic injection group and 31 patients in the subcutaneous injection group completed the study, with the compliance rate in the former group significantly higher than that in the latter group （P < 0.01）. SCORAD index was markedly decreased in both groups after treatment, but the intralymphatic injection group showed an earlier decrease at week 16, and repeated-measures analysis of variance revealed that the intralymphatic injection group was superior to the subcutaneous injection group in general improvement of SCORAD index. The score for amount of drugs used and serum levels of sIgE were both significantly decreased, while the serum levels of sIgG4 significantly increased in both groups at week 68 compared with those before starting treatment （all P < 0.01）. Five patients in the subcutaneous injection group reported systemic adverse reactions to 12 out of 1 024 injections, including 8 cases of grade I reactions and 4 cases of grade Ⅱ reactions, while no systemic adverse reaction was reported in the intralymphatic injection group who received a total of 198 injections. Conclusions Intralymphatic immunotherapy with house dust mite allergen can greatly shorten treatment duration, increase treatment compliance with marked efficacy and a good safety profile in patients with atopic dermatitis.

Key words: Dermatitis, atopic, Pyroglyphidae, Lymph nodes, Immunization, passive