Breakthrough Treatment for Allergic Rhinitis: Intratonsillar Injection Shows Promising Results in Clinical Trial

In a groundbreaking clinical trial, researchers have discovered a novel approach to treating house dust mite (HDM)-induced allergic rhinitis (AR) that could revolutionize allergen-specific immunotherapy. The study found that Intratonsillar injection with HDM extract was deemed safe and effective in patients with AR. The study results were pulished in the journal Annals of Allergy, Asthma, & Immunology. 

In the quest for improved allergy treatment, researchers are investigating innovative routes for allergen-specific immunotherapy. The current challenges of lengthy treatment periods and adverse effects hinder patient adherence to this essential, albeit demanding, cure for IgE-mediated allergies. Hence, the study, a randomized, double-blind, placebo-controlled trial involving 80 patients, explored the efficacy and safety of intratonsillar injection with HDM extract—a treatment aimed at addressing the challenges of lengthy periods and adverse effects associated with traditional immunotherapy. 

Patients with HDM-induced AR were randomly assigned to receive either six intratonsillar injections with HDM extract or a placebo over three months. The research team closely monitored various parameters, including the total nasal symptom score (TNSS), the visual analog scale of nasal symptoms, combined symptom and medication score, mini rhinoconjunctivitis quality of life questionnaire, and serum allergen-specific IgG4 to Dermatophagoides pteronyssinus at baseline and 3 months, 6 months. The intent-to-treat and per-protocol set (PPS) are both analyzed.

Findings: 

• The results of the trial revealed promising outcomes.
• Primary endpoints, including TNSS and ΔTNSS, showed a significant improvement at the three-month mark in patients who underwent the intratonsillar immunotherapy compared to those in the placebo group. This improvement was evident in both the intent-to-treat and per-protocol set analyses.
• Moreover, secondary endpoints, such as the visual analog scale, combined symptom and medication score, and mini rhinoconjunctivitis quality of life questionnaire, demonstrated a significant positive impact at the three-month assessment in the per-protocol set. However, the study noted that the efficacy of the intratonsillar immunotherapy at the six- and twelve-month follow-ups was limited and uncertain based on the available data.
• One key finding that supports the effectiveness of the treatment was the significant increase in serum Der p IgG4 levels in the active group at three, six, and twelve months after completing the treatment.
• Importantly, the researchers observed no systemic adverse reactions, highlighting the safety profile of the intratonsillar injection with HDM extract.

The study's conclusion suggests that this innovative approach is not only safe but also effective in treating patients with AR. The researchers emphasized the importance of further optimization of the protocol and allergen formulations to enhance and sustain the efficacy of this pioneering treatment. This breakthrough could potentially address the lower adherence rates observed in traditional allergen-specific immunotherapy, offering a more appealing alternative for patients suffering from HDM-induced AR. As the research progresses, future investigations will likely focus on refining the treatment protocol and assessing its long-term effectiveness, bringing hope to individuals seeking relief from the burdens of allergic rhinitis.

Further reading: Efficacy and safety of intratonsillar immunotherapy for allergic rhinitis: A randomized, double-blind, placebo-controlled clinical trial. https://doi.org/10.1016/j.anai.2023.10.029