New treatment: Vaccines against hay fever could be injected directly into your tonsils

More than one million Norwegians suffer from pollen allergy, often referred to as hay fever. Around 20 per cent of the global population is afflicted by sneezing, swelling throats and worse when pollen fills the air.

The treatment for the ailment consists of tablets or vaccine injections.

The vaccines contain small doses of the allergen you are reacting to, so-called allergen extracts. You get the jab in your arm.

But the methods used today are less efficient and more expensive than they need to be, says Sverre Karmhus Steinsvåg.

He proposes administering the jab straight into the tonsils.

• Related: Asthma seems to start before birth

Terribly wasteful

“When we give the shot into the skin, less than five percent of the allergen extracts actually reach the immune system,” Steinsvåg says. He is a professor and ear-nose-throat specialist at Sørlandet Hospital in southern Norway.

Allergen extracts are expensive.

“When so much of the treatment disappears into nothingness, it’s terribly wasteful,” Steinsvåg says.

The vaccine programme could work twelve times as fast if all the allergen extracts were absorbed by the body,.

Researchers from the Karolinska Institute in Sweden came up with one solution. They propose injecting the vaccine directly into a lymph node in the groin and believe it would ensure that all the allergen extracts end up in the immune system.

Traditional treatment methods involve 90 injections over three years, or one tablet daily for three years. The new method requires only four jabs over three months.

Trials on twelve patients

Steinvåg is researching a new method for vaccinating against pollen allergy. He wouldn’t put the vaccine in the groin.

“Our immune system divides the body into different sections. The lymph nodes in the groin aren’t part of the immune system that takes care of the pollen. That’s why our project involves injecting the allergen extracts into the tonsils,” says Steinsvåg.

The tonsils are part of the immune system that handles pollen, animal and mite allergies.

“We ran a project with twelve patients where we put injections of grass pollen extract directly into their tonsils,” says Steinsvåg.

He and his colleagues followed the same protocol as used for the groin vaccination. The same dose was given in four injections over a three-month period.

“The dose we used was probably a little high. Some of the patients experienced side effects in the form of a slight rash and heavy breathing. The side effects went away on their own after a couple of hours, and they were hospitalized with us so we could deal with all sorts of side effects. No one became seriously ill,” he says.

The next step will be to run the project again, with a much lower dose. Steinsvåg emphasizes that they are still in the research phase.

“But we’re obviously onto something here. The effect of this type of vaccination method is just as effective as a three-year injection treatment,” says Steinsvåg.

Method assumes you have tonsils

Steinsvåg reassures folks that getting an injection in the tonsils doesn’t hurt.

“There’s no pain associated with injections in the tonsils, because the tonsils have no pain fibres,” says Steinsvåg.

He says that the twelve trial subjects are very happy.

But the method is not an option for people who have had their tonsils removed.

“This particular technique presupposes that people have tonsils. And most people do,” says Steinsvåg.

“We’ve become much more restrictive when it comes to removing the tonsils, because it’s the most dangerous thing we do in the ear-nose-throat industry. In Norway, an average of one person a year dies in connection with a tonsillectomy,” he says.

Tonsils are still removed when they become acutely or chronically inflamed. But the decision to do it is only made after careful consideration. Steinsvåg's vaccine method is then no longer relevant.

Can be used for all respiratory allergens

The tonsils are the shock organ for pollen allergy, according to Steinsvåg. He calls the new method groundbreaking and believes it significantly simplifies allergy vaccination.

“In addition, the method can be used on all respiratory allergens. In other words, different types of pollen, animals, house dust mites and so on,” he says.

The pilot project was completed a couple of years ago. Steinsvåg and colleagues took blood samples from the subjects, which they have frozen. Immunologists from Karolinska University Hospital in Stockholm will examine the samples in greater detail.

“The research article is almost finished. We’ll be sending it to a magazine during the spring,” says Steinsvåg.

However, it will take several years before allergy sufferers receive the vaccine in their tonsils.

“Drug testing consists of multiple phases, so it’s a time-consuming process. This is the just first round,” says Steinsvåg.

Unknown concept

Shuo-Wang Qiao is an associate professor in the Institute of Clinical Medicine at the University of Oslo.

She has not heard of this technique before but finds it an interesting idea.

Qiao notes that the tonsils are a type of lymph node that is an important part of the immune system.

She believes shortening the current long treatment with vaccines in the arm to four jabs over three months would be a great advantage.

“The treatment could be fantastic once it’s been tested on enough people and if the effect lasts. The long treatment time is exactly the problem when it comes to sticking with the regimen. No question that managing to shorten it down and having fewer injections would be a huge advantage,” Qiao says.

Anaphylactic shock?

Qiao points out some challenges.

Quite a few people have had their tonsils removed, and for them this treatment isn’t an option, she says.

Also, we have to be careful when injecting allergens into a person who is allergic.

"An allergic reaction of anaphylactic shock is a real and feared complication," Qiao said.

One of the most serious forms of allergic reaction is a swelling of the throat with the risk of suffocation.

"Injecting the vaccine straight into the tonsils of the throat sounds like an extra daring operation given this serious complication," Qiao said.

———

Translated by Ingrid Nuse

Read the Norwegian version of this article at forskning.no

You might also want to read:

Does being outside when it's really cold make you more exhausted — even if you don’t do anything tiring?