Allergy Immunotherapy: State of the Art

Purpose of Review This paper is intended to review the current status of allergy immunotherapy (AIT), administered subcutaneously (SCIT) or sublingually (SLIT), for the treatment of allergic respiratory disease. Recent Findings Systematic reviews and meta-analyses confirm the efficacy of SCIT for allergic rhinitis (AR), allergic asthma (AA), and for Hymenoptera venom sensitivity, while SLIT is clearly effective for AR, but the data is marginal for AA. An exception is the house dust mite SLIT-tablet which has reduced inhaled steroid use and asthma exacerbations and improved asthma control in placebo-controlled trials. Children with only AR, treated with SLIT grass tablets for 3 years, had reduced risk of new onset of asthma that persisted for 2 years of follow-up compared to those receiving placebo. The reduced risk of developing asthma with AIT, in both children and adults, was also demonstrated with real-world data. Summary AIT is the only treatment for allergic respiratory disease that modifies the underlying immunologic abnormalities. Not only does it decrease the risk of allergic rhinitis progressing on to asthma, but it provides persisting improvement after a course of 3–5 years of treatment.