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Skröder C, Hellkvist L, Dahl Å, Westin U, Bjermer L, Karlsson A, Cardell LO. Limited beneficial effects of systemic steroids when added to standard of care treatment of seasonal allergic rhinitis. Sci Rep 2023; 13:19649. [PMID: 37950032 PMCID: PMC10638382 DOI: 10.1038/s41598-023-46869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Intramuscular injections with methylprednisolone treating allergic rhinitis (AR) have a long history. Modern guidelines are designed to dissuade this treatment, but it´s frequently used, especially in primary care. This despite of concern for side effects and lack of modern placebo-controlled studies. This study was designed to evaluate if methylprednisolone, could significantly improve symptoms of birch pollen induced AR and reduce the concomitant use of standard of care medication. Forty-two patients with birch pollen induced AR were randomized to treatment with methylprednisolone (80 mg) or placebo (NaCl 0.9%). Daily symptom- and medication scores was registered for 3 weeks. Quality of life questionnaires Sino-nasal Outcome Test-22 (SNOT-22) and Juniper Rhinoconjunctivitis Quality of Life Questionaire (Juniper RQLQ) were registered at trial start and at the end of the 3 weeks period. The combined symptom- and medication scores indicate that the methylprednisolone treated group [mean Area Under the Curve (AUC) 37.1 (SD 16.2 (95% CI 29.9-44.6))] was significantly better off than the placebo group [mean AUC 49.1 (SD 10.1 (95% CI 44.5-53.7))], p = 0.008. No significant difference between the groups were found in the SNOT-22 and Juniper RQLQ analysis. Registered side effects were few and mild. The limited beneficial effects of systemic steroids when added to standard of care in combination of its potential risk for side effects, speaks against its use for treatment of severe seasonal allergic rhinitis. The lack of difference in quality-of-life further underscores this result.
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Affiliation(s)
- Carl Skröder
- Department of Otorhinolaryngology, Head and Neck Surgery, Skane University Hospital, Lund, Sweden.
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Laila Hellkvist
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Åslög Dahl
- Departments of Biological and Environmental Sciences, Gothenburg University, Gothenburg, Sweden
| | - Ulla Westin
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Skane University Hospital, Lund, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Skane University Hospital, Lund, Sweden
| | - Agneta Karlsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
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Kourie M, Bogdanovic D, Mahmutyazicioglu K, Ghazi S, Panic N, Fjellgren E, Hellkvist L, Thiel T, Kjellman A, Kartalis N, Danielsson O, Dani L, Löhr JM, Vujasinovic M. Autoimmune Pancreatitis Type 1 with Biliary, Nasal, Testicular, and Pulmonary Involvement: A Case Report and a Systematic Review. J Clin Med 2023; 12:6340. [PMID: 37834983 PMCID: PMC10573784 DOI: 10.3390/jcm12196340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition associated with fibroinflammatory lesions that can occur at almost any anatomical site. It often presents as a multiorgan disease that may mimic malignancy, infection, or other immune-mediated conditions. Autoimmune pancreatitis (AIP) type 1 is the most prominent manifestation of IgG4-RD in the digestive tract, with common extra-pancreatic inflammation. We present the first patient with AIP and involvement of the testicles and nasal cavity. PATIENT AND METHODS A case of a patient with AIP type 1 and other organ involvement (bile ducts, testicles, nasal polyps, and lungs) is described. Additionally, a systematic review of AIP type 1 with testicular and nasal involvement was conducted. RESULTS The systematic review found two cases of AIP type 1 with testicular involvement and 143 cases with AIP type 1 with nasal cavity involvement. None of them had both testicular and nasal involvement. CONCLUSIONS This is the first case of AIP type 1 with other organ involvement, including testicular and nasal involvement, to be described. The number of patients with nasal and testicular involvement described in the literature is low. Creating awareness of this rare clinical condition is necessary, especially due to the very effective available treatment with corticosteroids and rituximab.
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Affiliation(s)
- Mourad Kourie
- Department of Medicine, Vrinnevisjukhuset, 603 79 Norrköping, Sweden;
| | - Darko Bogdanovic
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
| | - Kamran Mahmutyazicioglu
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (K.M.); (N.K.)
| | - Sam Ghazi
- Department of Pathology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (S.G.); (O.D.)
| | - Nikola Panic
- Digestive Endoscopy Unit, University Clinic “Dr Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia;
| | - Eva Fjellgren
- Medical Library, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Laila Hellkvist
- Department of Ear, Nose and Throat, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Tomas Thiel
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (D.B.); (T.T.); (A.K.)
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
| | - Nikolaos Kartalis
- Department of Radiology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (K.M.); (N.K.)
| | - Olof Danielsson
- Department of Pathology, Karolinska University Hospital, 141 86 Stockholm, Sweden; (S.G.); (O.D.)
| | - Lara Dani
- Department of Rheumatology, Karolinska University Hospital, 141 86 Stockholm, Sweden;
| | - J.-Matthias Löhr
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden;
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institute, 141 86 Stockholm, Sweden
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Hjalmarsson E, Hellkvist L, Karlsson A, Winquist O, Kumlien Georén S, Westin U, Cardell LO. A 5-Year Open-Label Follow-up of a Randomized Double-Blind Placebo-Controlled Trial of Intralymphatic Immunotherapy for Birch and Grass Allergy Reveals Long-term Beneficial Effects. J Investig Allergol Clin Immunol 2023; 33:362-372. [PMID: 37843385 DOI: 10.18176/jiaci.0832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intralymphatic immunotherapy (ILIT) is a novel, faster alternative to conventional allergen immunotherapy (AIT). Few previous studies have evaluated its long-term effects. The objective of the present study was to complete a 5-year follow-up of a randomized double-blind placebo-controlled trial of ILIT for a combination of birch and grass allergens. METHODS Fifty-eight patients with allergic rhinitis were treated with either placebo or a combination of ALK Alutard Birch and Grass 1000 SQ-U administered in 3 intralymphatic injections at 1-month intervals. A year after the vaccination, the symptoms induced by nasal provocation were significantly reduced. After 5-6 years, 20 out of 26 actively treated patients were followed up with a nasal provocation test (NPT) and seasonal registration of the combined symptom and medications score (CSMS), IgE and IgG4 levels in blood, and immunological markers in blood and lymph nodes and compared with 13 unvaccinated controls. RESULTS The reduction in the NPT response with ILIT at year 1 could not be convincingly reproduced at year 5. The new CSMS scores were markedly lower among the previously treated patients than among the control group. Furthermore, grass-specific IgG4 was increased, grass-specific IgE decreased, FcεR1 on basophils was reduced, and the fraction of memory T-cells in lymph nodes increased. CONCLUSION The combination of seasonal clinical data and immunological parameters supports the notion of a long-lasting effect of ILIT. These data support the concept of ILIT as a good alternative to traditional AIT in pollen-induced allergic rhinitis.
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Affiliation(s)
- E Hjalmarsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - L Hellkvist
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Karlsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - S Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - U Westin
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - L O Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
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Hellkvist L, Hjalmarsson E, Weinfeld D, Dahl Å, Karlsson A, Westman M, Lundkvist K, Winqvist O, Georén SK, Westin U, Cardell LO. High-dose pollen intralymphatic immunotherapy: Two RDBPC trials question the benefit of dose increase. Allergy 2022; 77:883-896. [PMID: 34379802 DOI: 10.1111/all.15042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. METHODS Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000-3000-10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. RESULTS Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000-3000-3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study. CONCLUSION Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.
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Affiliation(s)
- Laila Hellkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Eric Hjalmarsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (adults) Department of Internal Medicine South Alvsborgs Central Hospital Boras Sweden
| | - Åslög Dahl
- Departments of Biological and Environmental Sciences Gothenburg University Gothenburg Sweden
| | - Agneta Karlsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Marit Westman
- Immunology and Allergy Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Karin Lundkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | | | - Susanna Kumlien Georén
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ulla Westin
- Laboratory of Clinical and Experimental Allergy Research Department of Otorhinolaryngology Malmö Lund University Skåne University Hospital Malmö Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
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Weinfeld D, Westin U, Hellkvist L, Mellqvist UH, Jacobsson I, Cardell LO. A preseason booster prolongs the increase of allergen specific IgG4 levels, after basic allergen intralymphatic immunotherapy, against grass pollen seasonal allergy. Allergy Asthma Clin Immunol 2020; 16:31. [PMID: 32368217 PMCID: PMC7189556 DOI: 10.1186/s13223-020-00427-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Allergen specific IgG4 levels have been monitored as a surrogate marker for the tolerance inducing effect of subcutaneous immunotherapy (SCIT) in many studies. Its accuracy at group level has been well established, but IgG4 has not yet found its place in the daily care of immunotherapy patients. METHODS Intralymphatic immunotherapy (ILIT) is a novel route for allergy vaccination against pollen allergy, where an ultrasound-guided injection of 1000 SQ-U Alutard is given directly into a groin lymph node. The suggested standard dosing so far has been one injection with 4 weeks in-between. In total 3000 SQ-U with the treatment completed in 2 months. IgG4 was measured with Immulite technique and rhinoconjunctivitis symptoms were estimated with daily online questionnaires. Mann-Whitney U-test and Wilcoxon Signed Rank test were applied for comparisons between groups and within groups, respectively. RESULTS The present study demonstrates that a single, preseason ILIT booster of 1000 SQ-U Alutard 5-grasses®, re-increases the allergen specific timothy-IgG4 levels, in patients already treated with ILIT before the previous pollen season. It also shows the feasibility of the ILIT-route for allergy vaccination of rhinitis patients, with or without concomitant asthma, with low degree of side effects and reconfirms high and sustained patient satisfaction. CONCLUSIONS It is tempting to suggest that the allergen specific IgG4 levels can be used to build an intuitive algorithm for future clinical guidance of ILIT patients.Trial registration Is Intralymphatic Allergen Immunotherapy Effective and Safe?, ClinicalTrials.gov Identifier NCT04210193. Registered 24 December 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04210193?term=NCT04210193&draw=2&rank=1.
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Affiliation(s)
- Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, 50182 Boras, Sweden
| | - Ulla Westin
- Division of Ear, Nose and Throat Diseases, Head and Neck Surgery, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Laila Hellkvist
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf-Henrik Mellqvist
- Section of Hematology, Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Ingvar Jacobsson
- Clinical Chemistry, Department of Medical Imaging and Laboratory Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Lars-Olaf Cardell
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
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Konradsen JR, Grundström J, Hellkvist L, Tran TAT, Andersson N, Gafvelin G, Kiewiet MBG, Hamsten C, Tang J, Parkin RV, Shamji MH, Hedlin G, Cardell LO, van Hage M. Intralymphatic immunotherapy in pollen-allergic young adults with rhinoconjunctivitis and mild asthma: A randomized trial. J Allergy Clin Immunol 2019; 145:1005-1007.e7. [PMID: 31775016 DOI: 10.1016/j.jaci.2019.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/04/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jon R Konradsen
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Grundström
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Laila Hellkvist
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Thi Anh Thu Tran
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Guro Gafvelin
- Therapeutic Immune Design Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M B Gea Kiewiet
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Carl Hamsten
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jiaqian Tang
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Rebecca V Parkin
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Mohamed H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and University Hospital, Stockholm, Sweden.
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Abstract
INTRODUCTION Allergic rhinitis (AR) affects over 20% of the population of Europe and the United States. Allergen immunotherapy (AIT) is currently the only form of treatment that affects symptoms and modifies the progression of disease. Established forms of AIT include subcutaneous (SCIT) and sublingual (SLIT) immunotherapy and are widely effective, yet only 2-9% of eligible patients undergo therapy, likely due to the long duration of treatment. As a result, novel, faster forms of AIT are currently under development. AREAS COVERED This article provides an overview of AR and summarises the efficacy and mechanisms of established forms of AIT, highlighting the current drawbacks. We discuss novel strategies of AIT that have been developed in an attempt to tackle these limitations, including epicutaneous, intradermal and intralymphatic immunotherapy (ILIT), focusing on ILIT, the treatment that has been most comprehensively assessed. EXPERT OPINION Current strategies to treat AR suffer from a poor safety profile and, importantly, lack of adherence. ILIT is a faster and safer form of AIT, with a treatment regime of only 12 weeks. Further validation is required, but ILIT, with its short and comparatively inexpensive protocol, has the potential to offer disease-modifying therapy to a larger number of patients.
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Affiliation(s)
- Olivia Larsson
- a Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Laila Hellkvist
- a Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Ulla Peterson-Westin
- b Laboratory of Clinical Experimental Allergy Research, Department of Otorhinolaryngology Malmö , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Lars Olaf Cardell
- a Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.,c Department of ENT Diseases , Karolinska University Hospital , Stockholm , Sweden
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Hellkvist L, Hjalmarsson E, Kumlien SG, Winqvist O, Westin UP, Cardell LO. Intralymphatic Immunotherapy (ILIT) with both grass and birch allergen‐ a randomized controlled trial. Clin Transl Allergy 2015. [PMCID: PMC4493501 DOI: 10.1186/2045-7022-5-s4-p29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Eric Hjalmarsson
- Karolinska InstitutetClinical SciencesIntervention and TechnologyStockholmSweden
| | | | - Ola Winqvist
- Karolinska InstitutetDepartment of MedicineStockholmSweden
| | - Ulla Petersson Westin
- Department of OtorhinolaryngologyLund UniversitySkåne University HospitalMalmöMalmöSweden
| | - Lars Olaf Cardell
- Karolinska InstitutetClinical SciencesIntervention and TechnologyStockholmSweden
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