アレルギー性鼻炎におけるリンパ内免疫療法（ILIT）と標準治療またはプラセボ：ランダム化比較試験の系統的レビューとメタアナリシス

BACKGROUND: Subcutaneous immunotherapy (SCIT) is the gold standard for allergic rhinitis (AR) but is limited by long treatment duration and poor adherence.リンパ内免疫療法 (ILIT) は、時間効率の高い代替療法として登場しました。 目的: AR 患者における ILIT の有効性と安全性をプラセボまたは SCIT と比較して評価すること。 METHODS: We searched PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL up to February 2026 for randomized controlled trials (RCTs) comparing ILIT with placebo or SCIT.主要評価項目は、症状と投薬スコアを組み合わせたもの（CSMS）でした。二次アウトカムには、生活の質（RQLQ）、症状スコア、有害事象が含まれます。データは変量効果モデルを使用してプールされました。 結果: 606 人の患者を含む 16 件の RCT が含まれた。ILIT はプラセボと比較して CSMS を有意に減少させました (SMD=-0.51、95% CI: -0.82 ～ -0.20、p<0.001; MD=-1.32)。しかし、鼻結膜炎の生活の質アンケート（RQLQ）スコアには有意差は観察されませんでした（p=0.74）。In head-to-head comparisons with SCIT, ILIT showed similar efficacy at 3, 6, and 12 months for Total Symptom Score (TSS) and Total Nasal Symptom Score (TNSS).しかし、SCIT は 24 か月および 36 か月で優れた耐久性を示しました (p>0.05 で SCIT の傾向を支持)。Regarding safety, ILIT was associated with a higher risk of local swelling compared with placebo (RR = 4.25, p < 0.001) but had a 58% lower risk of total adverse events compared with SCIT (RR = 0.42, p = 0.01). CONCLUSION: ILIT is an effective short-course alternative that reduces symptoms and medication use compared with placebo, though it may not significantly improve quality of life.

BACKGROUND: Subcutaneous immunotherapy (SCIT) is the gold standard for allergic rhinitis (AR) but is limited by long treatment duration and poor adherence. Intralymphatic immunotherapy (ILIT) has emerged as a time-efficient alternative. OBJECTIVE: To evaluate the efficacy and safety of ILIT compared with placebo or SCIT in patients with AR. METHODS: We searched PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL up to February 2026 for randomized controlled trials (RCTs) comparing ILIT with placebo or SCIT. The primary outcome was the Combined Symptom and Medication Score (CSMS). Secondary outcomes included quality of life (RQLQ), symptom scores, and adverse events. Data were pooled using random-effects models. RESULTS: Sixteen RCTs involving 606 patients were included. ILIT significantly reduced CSMS compared with placebo (SMD = -0.51, 95% CI: -0.82 to -0.20, p < 0.001; MD = -1.32). However, no significant difference was observed in the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores (p = 0.74). In head-to-head comparisons with SCIT, ILIT showed similar efficacy at 3, 6, and 12 months for Total Symptom Score (TSS) and Total Nasal Symptom Score (TNSS). However, SCIT demonstrated superior durability at 24 and 36 months (p > 0.05 favoring SCIT trends). Regarding safety, ILIT was associated with a higher risk of local swelling compared with placebo (RR = 4.25, p < 0.001) but had a 58% lower risk of total adverse events compared with SCIT (RR = 0.42, p = 0.01). CONCLUSION: ILIT is an effective short-course alternative that reduces symptoms and medication use compared with placebo, though it may not significantly improve quality of life.