Clinical Efficacy and Possible Mechanism of Endoscopic Vidian Neurectomy for House Dust Mite-Sensitive Allergic Rhinitis

Abstract

<b><i>Background/Aims:</i></b> Endoscopic vidian neurectomy (EVN) for allergic rhinitis (AR) has good clinical effects. However, the pathophysiological basis of the effect of EVN on AR is still poorly understood. This study aimed to investigate the efficacy of EVN on house dust mite (HDM)-sensitive AR and the dynamic changes of serum immunoglobulin E and some immune regulatory factors. <b><i>Methods:</i></b> Twenty HDM-sensitive AR patients were treated with bilateral EVN (EVN group), 15 HDM-sensitive AR patients were treated with subcutaneous immunotherapy (SCIT group), and 15 healthy subjects served as healthy controls. Quality of daily life was assessed by the scores of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQs). The visual analog scale was used to assess clinical efficacy. Serum molecules were measured by ELISA and the UNICAP system. <b><i>Results:</i></b> Compared with the SCIT group, the RQLQs in the EVN group were lower 12 months after treatment (both <i>p</i> < 0.05). There was no significant difference in improving nasal itching and sneezing (both <i>p</i> > 0.05), but the clinical efficacy of bilateral EVN was greater than SCIT in improving nasal obstruction, rhinorrhea, eye itching, and lachrymation 12 months after treatment (all <i>p</i> < 0.05). Compared with before treatment, the serum levels of total immunoglobulin E (tIgE), <i>Dermatophagoides pteronyssinus</i>- and <i>Dermatophagoides farinae</i>-specific immunoglobulin E (sIgE), and tumor necrosis factor (TNF)-α in the EVN group and the serum levels of TNF-α and interleukin-4 in the SCIT group were lower 12 months after treatment (all <i>p</i> < 0.05). <b><i>Conclusion:</i></b> The short-term efficacy of bilateral EVN is more effective than SCIT in treating HDM-sensitive AR. This may be because the surgery reduced the tIgE and sIgE levels. TNF-α may be involved in the therapeutic mechanism.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Evidence published from 2011 onwards provides support regarding its use in AR patients. Observational studies and a non‐randomized controlled trial found that AR patients experienced improvements in sneezing, nasal discharge, obstruction, itching, and QOL 2375,2387–2390 . An RCT and another non‐randomized controlled trial of patients with both AR and CRSwNP found similar results, as well as improvement on pulmonary functions tests 2391,2392 .…”