RE: Intralymphatic therapy

susan paterson — Tue, 12 Feb 2019 20:54:56 GMT

Most dogs will tolerate the injection into a popliteal lymph node if they are gently restrained. Many people use ultrasound guided injection.

It can be used on any or all of the cases you have suggested.

Sue

RE: Intralymphatic therapy

HELENA MANN — Tue, 12 Feb 2019 07:32:56 GMT

Thank you so much!

When used do you know if the dogs need to be sedated or is local anaethetic used?

What patients is the best to try on, in your opinion? the ones already on subcuaneous administration or new patients just starting up with ASIT?

Mvh

RE: Intralymphatic therapy

susan paterson — Mon, 11 Feb 2019 23:06:11 GMT

Hi Helena

Intralymphatic therapy is starting to be used more and more. It is currently mostly being used by Veterinary Dermatologists. There are no vaccines made up specifically for intralymphatic use. Many dermatologists make up their own vaccine from concentrated allergens. I know many vets in the UK use the ARTU vaccines and use 0.2ml of the vaccine into the popliteal lymph node. This is done once monthly for 3 - 6 applications. It is of course an off license use. It will depend on your country as to whether it is considered experimental. In the UK I would expect vets to need to get ethical approval before using it but in dogs I would not consider it experimental as there are at least two papers in the literature describing its use in dogs.

Intralymphatic immunotherapy: An effective and safe alternative route for canine atopic dermatitis].

[Article in German; Abstract available in German from the publisher]

Fischer N¹, Rostaher A¹, Favrot C¹.

Abstract

in English, French, German, Italian

Allergen-specific immunotherapy (ASIT) is the only etiologic treatment of atopic dermatitis in dogs. In humans it has been shown that intralymphatic immunotherapy (ILIT) enhanced efficacy and patient compliance and reduced treatment time from 3 years to 8 weeks. As only safety data have been published yet, the aim of this study was to evaluate the clinical efficacy of ILIT in dogs. 20 atopic dogs underwent ILIT with alum-precipitated allergens administered every 4 weeks for 3 to 7 times in the popliteal lymph node. Pruritus (Hill score), CADESI (canine atopic dermatitis severety index), concurrent medications and adverse reactions were recorded initially and every 4 weeks for a total period of 24 weeks. The observed clinical response was good in 12/20 (60%) patients and improvement could be seen in some dogs already after 4 weeks. The median number of injections was 5.6. All dogs tolerated the procedure well and no adverse effects were recognized during or after ILIT. Therefore ILIT should be regarded as a safe alternative to subucaneous ASIT, enabling a faster clinical improvement with the same response rate.

Vet Dermatol. 2018 Apr;29(2):123-e49. doi: 10.1111/vde.12517. Epub 2018 Jan 12.

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

Timm K¹, Mueller RS², Nett-Mettler CS¹.

Abstract

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.

Hope this answers your question.

Sue Paterson