Kasemsuk Navarat, Ngaotepprutaram Premyot, Kanjanawasee Dichapong, Suwanwech Triphoom, Durham Stephen R, Canonica Giorgio Walter, Tantilipikorn Pongsakorn
Faculty of Medicine Siriraj Hospital, Division of Rhinology and Allergy, Department of Otorhinolaryngology, Mahidol University, Bangkok, Thailand.
Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok, Thailand.
Int Forum Allergy Rhinol. 2022 Dec;12(12):1503-1516. doi: 10.1002/alr.23011. Epub 2022 May 23.
Local nasal immunotherapy (LNIT), an alternative noninjection immunotherapy method, is theoretically an efficient method for inducing immunotolerance directly in the affected organ. LNIT is more convenient and less invasive than injection immunotherapy, with fewer systemic reactions. The development of adjuvants to overcome LNIT's limitations raises the possibility of it being an alternative allergen immunotherapy.
To evaluate the clinical and immunological efficacy and safety of LNIT for patients with allergic rhinitis.
A systematic search for randomized controlled trials comparing LNIT and placebo was performed using OVID Medline and Embase. Outcomes were total nasal symptom score (TNSS), symptom-medication score (SMS), medication score, immunological assessment, and nasal provocation threshold. Data were pooled for meta-analysis.
A total of 20 studies with 698 participants were included. The LNIT group had greater posttreatment improvement in TNSS, SMS, and medication score than control (TNSS: standardized mean difference [SMD], -1.37 [95% confidence interval [CI], -2.04 to -0.69]; SMS: SMD, -1.55 [95% CI, -2.83 to -0.28]; and medication score: SMD, -1.09 [95% CI, -1.35 to -0.83]). Immunological assessments showed no significant differences in serum-specific IgE (mean difference [MD], 6.35; 95% CI, -4.62 to 17.31), nasal IgE (MD, -0.59; 95% CI, -1.99 to 0.81), or nasal eosinophil cationic protein (MD, 7.63; 95% CI, -18.65 to 33.91). Only serum IgG significantly increased with LNIT (MD, 0.45; 95% CI, 0.20, 0.70). Posttreatment, nasal provocation threshold was higher with LNIT (MD, 27.30; 95% CI, 10.13-44.46). No significant adverse events were reported.
LNIT is a safe alternative allergen immunotherapy route without significant adverse events. It improves clinical symptoms, reduces medication usage, and increases the nasal provocation threshold.
局部鼻内免疫疗法（LNIT）是一种非注射免疫疗法的替代方法，理论上是一种在受影响器官直接诱导免疫耐受的有效方法。与注射免疫疗法相比，LNIT更方便且侵入性更小，全身反应更少。克服LNIT局限性的佐剂的开发增加了其成为替代变应原免疫疗法的可能性。
评估LNIT治疗变应性鼻炎患者的临床和免疫疗效及安全性。
使用OVID Medline和Embase系统检索比较LNIT与安慰剂的随机对照试验。结局指标为总鼻症状评分（TNSS）、症状-药物评分（SMS）、药物评分、免疫评估和鼻激发阈值。汇总数据进行荟萃分析。
共纳入20项研究，698名参与者。LNIT组治疗后TNSS、SMS和药物评分的改善程度高于对照组（TNSS：标准化均数差[SMD]，-1.37[95%置信区间[CI]，-2.04至-0.69]；SMS：SMD，-1.55[95%CI，-2.83至-0.28]；药物评分：SMD，-1.09[95%CI，-1.35至-0.83]）。免疫评估显示血清特异性IgE（均数差[MD]，6.35；95%CI，-4.62至17.31）、鼻内IgE（MD，-0.59；95%CI，-1.99至0.81）或鼻嗜酸性粒细胞阳离子蛋白（MD，7.63；95%CI，-18.65至33.91）无显著差异。仅血清IgG随LNIT显著增加（MD，0.45；95%CI，0.20，0.70）。治疗后，LNIT的鼻激发阈值更高（MD，27.30；95%CI，10.13 - 44.46）。未报告显著不良事件。
LNIT是一种安全的变应原免疫疗法替代途径，无显著不良事件。它可改善临床症状，减少药物使用，并提高鼻激发阈值。
