Current place of allergen-specific immunotherapy in asthma and rhinitis

Summary Immunotherapy is considered a controversial treatment of allergic diseases in spite of a documented clinical relevant efficacy in controlled studies investigating Hymenoptera allergy, allergic rhinitis and asthma. The guidelines as to the use of immunotherapy have been provided in several international position papers. Immunotherapy is recommended in patients with an unequivocal IgE-mediated disease not responding adequately to allergen avoidance and with a need for prophylactic topical corticosteroids for longer periods (season or perennially). The clinical benefit in relation to reducing the need for drugs, and potential preventive aspects of immunotherapy should be carefully weighted against the risk of the disease and therapeutic injections. Immunotherapy should only be initiated with allergens that in controlled studies have documented both clinical efficacy and safety. Immunotherapy is recommended as a supplement to pharmacotherapy to interfere broadly in the pathophysiological mechanisms of the allergic inflammation by a multifactorial treatment approach.