Local nasal immunotherapy for allergic rhinitis: A systematic review and meta-analysis

Introduction: 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. Objectives: To evaluate the clinical and immunological efficacy and safety of LNIT for patients with allergic rhinitis. Methods: 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. Results: 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. Conclusions: 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.