Intratonsillar Immunotherapy found efficacious in Allergic Rhinitis

A lower adherence rate existed in patients received allergen specific immunotherapy (AIT) due to its lengthy period and side effects even though it is the only curative treatment for IgE-mediated allergies. Therefore, exploring innovative AIT routes are necessary.

This study was designed to explore the efficacy and safety of the intratonsillar injection of house dust mite (HDM) extract in patients with HDM-induced allergic rhinitis.

A randomized double-blind placebo-controlled clinical trial was conducted. Eighty patients with HDM-induced AR were randomized to receive 6 intratonsillar injections with HDM extract or placebo over 3 months. The total nasal symptom score (TNSS), Visual Analogue Scale (VAS) of nasal symptoms, combined symptom and medication score (CSMS), Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), and serum allergen-specific IgG4 to D. pteronyssinus were all monitored at baseline, 3, 6, and 12 months after the treatment finished. The intent-to-treat (ITT) and per protocol set (PPS) are both analyzed.

Results:

The primary endpoints TNSS and ΔTNSS were improved significantly at 3 months after AR patients finished a 3-month 6-injection intratonsillar immunotherapy (ITIT) by comparing to the placebo treatment in both ITT and PPS. VAS, CSMS and MiniRQLQ were also improved significantly at 3 months after treatment in PPS. However, the improvement effect of ITIT at 6 and 12 months was limited and uncertain based on the data. The increase of serum Der p IgG4 in the active group was significantly higher than that in the placebo group at 3, 6, and 12 months after the treatment finished. Adverse events were monitored, and no systemic adverse reactions were observed.

The clinical trial showed that intratonsillar injection with HDM extract was safe and effective in patients with AR. Optimizing the protocol and allergen formulations is expected to increase and maintain the efficacy of this novel approach.

Reference:

Zhang J, Yang X, Chen G, Hu J, He Y, Ma J, Ma Z, Chen H, Huang Y, Wu Q, Liu Y, Yu L, Zhang H, Lai H, Zhang J, Zhai J, Huang M, Zou Z, Tao A. Efficacy and Safety of Intratonsillar Immunotherapy for Allergic Rhinitis: A Randomized, Double-blind, Placebo-Controlled Clinical Trial. Ann Allergy Asthma Immunol. 2023 Oct 30:S1081-1206(23)01392-3. doi: 10.1016/j.anai.2023.10.029. Epub ahead of print. PMID: 37913839.

Keywords:

Intratonsillar, Immunotherapy, found, efficacious, Allergic Rhinitis, latest trial, Zhang J, Yang X, Chen G, Hu J, He Y, Ma J, Ma Z, Chen H, Huang Y, Wu Q, Liu Y, Yu L, Zhang H, Lai H, Zhang J, Zhai J, Huang M, Zou Z, Tao, Annals of Allergy, Asthma & Immunology, allergic rhinitis; house dust mite; intratonsillar immunotherapy; randomized controlled trial; specific immunotherapy.