As for SNOT-22 questionnaire contents, nose-ear-sinuses problems and sleep disorders were evaluated. There was a significant difference before and after immunotherapy, between before immunotherapy and the first pollination season. Considering the Mini RQLQ questionnaire, notably, a significant difference was reported in the quality of life between before and after treatment and also between before treatment and at the end of pollination. The serum level of IgE for Salsola was evaluated before and after the ILIT and also at the first pollination season. This rate had a significant difference.
Some side effects were revealed as lymph node enlargement, local itching, erythema, angioedema/ urticaria, the symptoms of which were seen during our study, while nasal, pulmonary, and abdominal symptoms were not appreciated in any of the cases. Pain at the injection site was completely tolerable regarding what the patients defined.
The first study for ILIT was done by Senti et al. They comprised ILIT in 58 cases versus subcutaneous immunotherapy in 54 cases by using grass pollen for the first time in 2008 .
Senti et al used ILIT over 3 injections to induce cat allergy tolerance in 2012 as a new idea . Similarly, to us, we also used 3 monthly injections of ILIT to induce allergic rhinitis for Salsola.
Our results would be comprised of their findings considering the relevant conclusions. All these studies reported that ILIT had no moderate to severe side effects, as same as ours, all side effects were mild and were resolved without any treatment.
Lee et al evaluated 11 cases of intralymphatic immunotherapy via using cat and dog allergens in an open pilot study. Exclusively, Lee and et al reported 2 cases of anaphylaxis and one case of severe local reaction but there was not any death report. We found lymph node enlargement as an early and late side effect in 6.7% and 26.7% of total respectively, which continued for one week and revealed without any treatment.
Hylander et al in a double-blind study on 21 patients, performed Intralymphatic allergen-specific immunotherapy for Birch pollen & grass pollen as a safe alternative treatment method for pollen-induced allergic rhinitis . A detailed of our findings considering the side effects of this method has been prepared in table 2. As it is seen in table-2 there is not any anaphylaxis, and also none of our cases were excluded because of side effects.
Several years later, again, Hylander et al during the controlled trial on 20 Active patients vs. 15 placebo cases, applied Intralymphatic allergen-specific immunotherapy for Birch pollen & grass pollen-induced rhinoconjunctivitis. Based on the VAS, the pain score was defined from zero to ten. The mean value for pain score was 1.15± 0.5 in our study in contrast to 0.4 regarding Hylander's result. While we used Salsola, using different allergen concentrate probably makes different pain severity.
As mentioned before, recently, most scientists believe that ILIT can improve quality of life and resolve the majority of allergic rhinoconjunctivitis problems. This idea has been proved in two studies using grass pollen by Patterson et al  on 8 patients and Lee.SP et al on 7 patients . While our sample volume was more than them (15 patients), considering Mini RQLQ the mean value for the quality of life was improved from 46.2 before the ILIT to 6.5 and 18.3 at the end of ILIT and pollination respectively. As a similar concept, Lee.SP et al also reported an improvement in the quality of life from 71.2 before injections to 52.3 after injections.
Witten et al in a double-blinded study on 12 cases of ILIT showed a significant difference in Mini RQLQ as a result of ILLT by grass pollen. As the same as our results, with a significant difference in Mini RQLQ, the quality of life got better in our study. It should be mentioned that the SNOT-22 questionnaire had not been used in any previous study and we creatively used this item for evaluating patients' satisfaction in a detailed view. We found a significant difference for each item between before and after immunotherapy, similarly, between before immunotherapy and at the pollination season. Our study highlighted two consecutive pollination seasons the first one after pollination season revealed an improvement and the next year was also patients experienced similar symptoms to pre ILIT. On the other hand, comparing to pre ILIT in first April, patients indicted alleviated symptoms in the next April. Comparing the second pollination season with the next April proved that ILIT can be helpful more in non-pollination seasons. These data were the same as quality of life as indicated in next April still ameliorating impacts of ILIT could be observed.
Although some immunologists recommend measuring IgG4, and specific IgE to assess the response of ILIT[16, 21], we couldn't do it according to our limitations.
In fact, because of our limited case number, it is suggested to design more studies with a larger sample volume on ILIT. On the other hand, we just focused on allergic rhinitis, while it is needed to evaluate ILIT as a safe and effective method for some diseases like asthma. This method does not need any premedication while safety, less and rare side effects, and also lower costs are interesting benefits that can motivate scientists to assess the ILIT long-term effectiveness on clinical improvement in a wide variety of allergic disorders which are resistant to conventional treatments.