Efficacy and Safety of Intralymphatic Immunotherapy for Allergic Rhinitis: An Overview of Systematic Reviews and Meta Analyses

Zhuang Wang¹Xiaofei Xie^1,2Zhikai Qiu¹Dongze Li¹yongfu Song²Na Wang¹Bing Tian¹Yongji Wang^1,2*

• ¹Changchun University of Chinese Medicine, Changchun, China
• ²Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China

Objective: Conduct an overview of systematic reviews and meta-analyses on intralymphatic immunotherapy for allergic rhinitis, providing systematic evidence to optimize clinical practice and evidence-based decision-making. Methods: A computer-based retrieval system was used to comprehensively search databases such as PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, WANFANG, and CBM. The retrieval time limit was set from the inception date of each database to August 14, 2025, aiming to obtain systematic review/Meta-analysis literatures on lymph node intralymphatic immunotherapy for the treatment of allergic rhinitis. Use evaluation tools such as ROBIS, AMSTAR-2, PRISMA 2020, and GRADE to perform quality re-evaluations on the systematic reviews/Meta-analyses of included studies from the aspects of bias risk, methodology, reporting, and evidence level, and conduct comprehensive re-evaluations on the outcome indicators of the included studies. Results: A total of 7 systematic reviews/meta-analyses were included. Risk of bias assessment indicated all studies had low risk. Methodological quality evaluation revealed 6 studies were of low quality and 1 was of very low quality. In terms of reporting quality, all included studies demonstrated high quality, with PRISMA scores ranging from 33 to 40. For outcome measures, evidence quality assessment identified 6 high-quality, 13 moderate-quality, 18 low-quality, and 27 very low-quality results. Quantitative analysis showed that intralymphatic immunotherapy not only improved subjective symptom scores in allergic rhinitis patients but also effectively induced immune tolerance. Qualitative analysis further confirmed that this targeted approach significantly enhanced allergen tolerance and reduced nasal symptom severity. The therapy demonstrated a favorable safety profile, primarily characterized by mild local adverse events, with substantially fewer systemic reactions compared to conventional subcutaneous immunotherapy. Conclusions: Intralymphatic immunotherapy demonstrates efficacy in improving symptoms and objective indicators of allergic rhinitis, particularly for grass pollen and mixed allergens, with acceptable short-to-medium term outcomes despite limited long-term effectiveness. The treatment exhibits a favorable safety profile dominated by mild local reactions. However, these findings are constrained by low evidence quality. Future studies should adhere to established guidelines to produce higher-quality evidence through systematic reviews and meta-analyses.