Abstract:Allergen-specific immunotherapy (AIT) is currently the only approach that can modify the natural course of immunoglobulin E (IgE)-mediated allergic diseases. However, conventional subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) require 3–5 years of continuous administration and are associated with poor adherence. The palatine tonsil, as a crucial secondary lymphoid organ in the oropharynx, is capable of inducing mucosal immune tolerance. Intratonsillar immunotherapy (ITIT), which delivers allergens directly into the tonsil, combines rapid onset of action with a favorable safety profile. Available evidence suggests that ITIT with 3–6 injections over 2–4 months can achieve clinical efficacy, with significant improvements in nasal symptoms, quality of life, and combined symptom?medication scores at 3 months. At 12 months, its overall efficacy is comparable to that of SCIT, while reducing the number of injections by more than 80%, although some patients may experience waning efficacy between 6 and 12 months. ITIT can increase allergen?specific immunoglobulin G4 (IgG4) levels and the proportion of regulatory T cells, and is generally well tolerated, with transient systemic reactions occasionally observed in high?dose regimens; patients aged ≤14 years derive greater benefit. In summary, ITIT is a convenient, safe, and effective novel immunotherapy for allergic rhinitis, particularly suitable for children and adolescents, although its long?term efficacy, optimal dosage, and booster strategies still require high?quality studies for further validation.
