Intratonsillar Immunotherapy Safe and Effective for Allergic Rhinitis, suggests research

Traditional AIT involves subcutaneous or sublingual administration, necessitating frequent visits and increasing the risk of systemic adverse reactions. Intratonsillar injection, a novel approach, targets the tonsils, which play a crucial role in immune responses, potentially enhancing treatment efficacy and safety.

A recent randomized, double-blind, placebo-controlled clinical trial aimed to evaluate the efficacy and safety of intratonsillar injection with HDM extract in patients with HDM-induced AR. This study was published in the Annals of Allergy Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology. The study was conducted by Junyan Z. and colleagues.

Eighty patients with HDM-induced AR were randomly assigned to receive either intratonsillar injections of HDM extract or placebo over three months. Various outcome measures, including total nasal symptom score (TNSS), visual analogue scale, symptom and medication score, quality of life questionnaire, and serum allergen-specific IgG4 levels, were assessed at baseline and up to 12 months post-treatment.

The key findings of the study were:

• At 3 months post-treatment, TNSS and ΔTNSS significantly improved in the active group compared to placebo.

• Sustained improvements in visual analogue scale, combined symptom and medication score, and quality of life questionnaire in the per-protocol set.

• Patients receiving intratonsillar immunotherapy exhibited a significant increase in serum Der p IgG4 levels at 3, 6, and 12 months post-treatment.

• No systemic adverse reactions were observed, indicating the safety of intratonsillar injection with HDM extract.

The study demonstrates the potential of intratonsillar immunotherapy as a safe and effective treatment for HDM-induced AR. The observed improvements in symptoms and serum IgG4 levels highlight the promising role of this innovative approach in AIT.

Intratonsillar injection offers a convenient and well-tolerated alternative to traditional AIT methods, potentially enhancing patient adherence and treatment outcomes. Further optimization of protocols and allergen formulations may enhance the efficacy and durability of this novel approach.

Intratonsillar immunotherapy with HDM extract emerges as a promising therapeutic option for patients with AR, offering both efficacy and safety benefits. Continued research and refinement of this approach hold potential for significant advancements in AIT for allergic diseases.

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. (2024). Efficacy and safety of intratonsillar immunotherapy for allergic rhinitis: A randomized, double-blind, placebo-controlled clinical trial. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 132(3), 346-354.e1. https://doi.org/10.1016/j.anai.2023.10.029