A Study on the Efficacy and Safety of Intratonsillar Immunotherapy for Allergic Rhinitis
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 120
- 试验地点
- 1
- 主要终点
- Number of Participants with Local or Systemic Adverse Reactions
研究概览
简要总结
This is a prospective, open-label, positive parallel controlled, blinded endpoint clinical study designed to compare the safety and efficacy of "Intratonsillar Immunotherapy of Standardized Dust Mite Allergen Extracts (Novo Helisen-Depot, Allergopharma, Merck, Germany)" with Subcutaneous Immunotherapy in patients with "Dust Mite Allergic Rhinitis."
Participants will be evaluated for safety and efficacy throughout the entire three-year period.
详细描述
Background:
Allergic Rhinitis (AR) presents both nasal and non-nasal symptoms. The global incidence of AR is rising, causing a significant burden. Seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR) are the two related clinical divisions of AR. Allergen immunotherapy (AIT) is a treatment involving the injection of specific allergens into the body. Studies have evaluated the effectiveness and safety of subcutaneous (SCIT), sublingual (SLIT), and intra-lymphatic immunotherapy (ILIT). The mechanisms underlying AIT involve both innate and acquired immunity. AIT modulates the activity of various immune cells, including dendritic cells, innate lymphoid cells (ILCs), and regulatory T cells (Tregs).
Intra-lymphatic inoculation (ILIT) has been studied in animals for its ability to improve T cell response to antigens. Studies have found that direct injection of antigens into lymph nodes can lead to improved T cell response and more efficient delivery of the antigen to subcutaneous lymph nodes. ILIT has been effective in treating atopic dermatitis, producing targeted IgG antibodies, enhancing lymphocyte responses, and treating viral and tumor challenges. It has also been effective in treating allergies and reducing symptoms of allergic rhinitis in mice. Studies have found ILIT to be effective in treating atopic dermatitis in dogs caused by common allergens and insect bite hypersensitivity in horses caused by biting midges. In general, animal studies support the use of ILIT as a safe and effective means to induce IgG and T cell responses with fewer treatments and lower doses compared to subcutaneous injection across a range of species.
Objectives:
The primary objective is to explore the efficacy, clinical value, and possible mechanism of action of Intratonsillar Immunotherapy (ITIT) by recording and analyzing the questionnaire scores after ITIT versus SCIT, while comparing the trend of bio-indicator changes in these two treatments.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
盲法说明
This experiment is a comparative study of two treatment methods, and there are obvious differences between the treatment methods of the experimental group and the control group, so it is difficult to blind the subjects, researchers and evaluators, and only the experiment design without blindness can be adopted.
入排标准
- 年龄范围
- 5 Years 至 65 Years（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Voluntarily sign informed consent.
- •Commitment to follow the research procedures and cooperate with the implementation of the entire research process.
- •Diagnosis in accordance with ARIA guidelines, based on:
- •① Symptoms: Two or more symptoms such as paroxysmal sneezing, watery nose, nasal itching, and nasal congestion, with symptoms lasting or accumulating for more than 1 hour per day. May be accompanied by eye symptoms such as tearing, eye itching, and eye redness.
- •② Signs: Common nasal mucosa pale, edema, nasal watery secretions.
- •Allergen test: Positive for skin prick test (SPT) and/or serum-specific IgE for at least one allergen, or positive for nasal provocation test.
- •Have a history of allergic rhinitis caused by atopic allergens and one of the following:
- •① No significant relief after drug treatment.
- •② Do not want to continue taking medication for a long time.
- •③ Long-term drug treatment can produce adverse side effects.
- •Allergens cannot be effectively avoided in daily life.
- •Women of childbearing age must ensure that they do not become pregnant during the treatment cycle.
- •Must be between 5 and 65 years old.
排除标准
- •Allergic to the excipient (aluminum hydroxide) of Allergopharma or the rescue medication epinephrine.
- •Respiratory disease other than stable asthma.
- •Pulmonary insufficiency (NYHA grade II and above or FEV1 < 80%) or irreversible changes in the responding organs such as emphysema and bronchiectasis.
- •Severe acute or chronic diseases (including malignant diseases), inflammation, and fever.
- •Multiple sclerosis.
- •Immune system diseases (autoimmune diseases, immune diseases caused by antigen and antibody complexes, immune deficiencies, etc.).
- •Active tuberculosis.
- •Severe mental disorder.
- •Obvious cardiac insufficiency.
- •A history of severe recurrent acute sinusitis (defined as two episodes per year within the past 2 years, each requiring antibiotic treatment).
- •A history of chronic sinusitis, including at least two of the following symptoms (at least one of which should be nasal congestion or runny nose):
- •① Nasal congestion, runny nose, facial pressure, or pain.
- •② Having a diminished or lost sense of smell.
- •③ Endoscopic or CT examination showed signs of sinusitis.
- •Severe liver and renal impairment, including but not limited to abnormal liver function (such as ALT, AST elevation more than 2 times the normal range), abnormal kidney function (such as creatinine clearance less than 60 mL/min), etc.
- •Smokers averaging more than 5 cigarettes per day in the 3 months prior to the trial or unable to give up smoking during the entire hospital stay.
- •Regular drinkers in the 3 months prior to the trial, i.e., more than 2 units of alcohol per day on average (1 unit = 360ml beer or 45ml spirits with 40% alcohol or 150ml wine).
- •Received immunotherapy within the last 3 years (subcutaneous injection or sublingual allergen-specific immunotherapy, etc.).
- •Patients who used experimental drugs or participated in other clinical studies within 30 days prior to treatment.
- •Patients treated with IgE monoclonal antibodies within the last 4 months.
- •Patients who are taking beta blockers.
- •Patients who do not have sufficient knowledge about the trial.
- •Not between the ages of 5 and
- •Patients who are pregnant or nursing during the study period, or who plan to become pregnant.
- •Patients who are unable to have tonsil injections due to chronic tonsillitis, small tonsils, prior tonsillectomy, etc.
研究组 & 干预措施
Intratonsillar Immunotherapy (ITIT) group
The intervention of ITIT will be a series of 3 injections of a commercially-available standardized dust mite allergen extracts (Novo Helisen-Depot, Allergopharma, Merck, Germany) given every four weeks into tonsil through guidance using a 1-mL hypodermic syringe with a 25-gauge or smaller needle. The specific doses are 5 TU (0.1 ml, the first injection), 50 TU (0.1 ml, the second injection), and 50 TU (0.1 ml, the third injection).
Before each injection, patients will take one tablet of antihistamine.
干预措施: Intratonsillar immunotherapy (ITIT) (Procedure)
Subcutaneous Immunotherapy (SCIT) group
The same drugs will be used in active comparator. SCIT consists of two stages: the accumulation stage and the maintenance stage. During the initial 14 weeks, patients will receive sequential subcutaneous injections as follows: (1) 1st vial: 0.1 mL, 0.2 mL, 0.4 mL, and 0.8 mL; (2) 2nd vial: 0.1 mL, 0.2 mL, 0.4 mL, and 0.8 mL; (3) 3rd vial: 0.1 mL, 0.2 mL, 0.4 mL, 0.6 mL, 0.8 mL, and 1.0 mL of allergen, achieving a maintenance dose of 5000 TU. Subsequently, maintenance therapy involves subcutaneous injections of 5000 TU (1.0 mL, 3rd vial) every 4-6 weeks. The intervention process before and after each injection is similar to that of the ITIT group.
干预措施: Subcutaneous immunotherapy (SCIT) (Procedure)
结局指标
主要结局
Number of Participants with Local or Systemic Adverse Reactions
时间窗: After each treatment. Up to 36 months
Participants will be observed for 30 minutes post-injection and encouraged to report any adverse events during follow-up. Adverse reactions are classified as local reaction (LR) or systemic reaction (SR) according to the World Allergy Organization Subcutaneous Immunotherapy Response Classification System. Detailed records include occurrence time, number of injections, clinical manifestations, and management measures.
Combined Symptom and Medication Score (CSMS)
时间窗: Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months
Combined Symptom and Medication Score (CSMS) serves as the primary efficacy endpoint, tracking changes in participant symptoms and assessing the sustainability and stability of treatment effects. It comprises: Allergen-induced symptom score: Scored from 0 (no symptoms) to 3 (most severe symptoms) for nasal congestion, rhinorrhea, nasal itching, sneezing, eye itching, and tearing, with the average yielding the symptom score (SS). Emergency medication use related to allergy symptoms: Assigned points based on antihistamine (1 point/day), nasal corticosteroid (2 points/day), and oral corticosteroid (3 points/day) usage, with the highest value determining the medication score (MS). CSMS (0-6) = SS (0-3) + MS (0-3). Recorded at baseline and 1, 2, 3, 6, 12, 24, and 36 months post-dust mite extract treatment.
次要结局
- Concentration of FeNO(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- Proportion of Blood T Cell Differentiation(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- RQLQ(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- Concentration of Serum Immune Globulins(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- Concentration of Key Serum Cytokines(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- Absolute Value and Percentage of Blood Leukocytes(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
- Visual Analog Scale (VAS)(Pre-intervention screening period; 3 months, 6 months, 12 months, 24 months, 36 months after the first intervention. Up to 36 months)
研究者
Xu Yu
Professor, Chief Physician
Renmin Hospital of Wuhan University