Aeroallergen immunotherapy update: Developments since the third Practice Parameter

Background: Allergy immunotherapy is a proven treatment for allergic rhinitis and asthma with the potential to modify the natural history of these disorders. Considerable advances have been seen in the past 15 years since publication of the third update of the Allergen Immunotherapy Practice Parameter. Objective: The aim was to understand new developments that pertain to subcutaneous immunotherapy and sublingual immunotherapy (SLIT). Methods: New evidence related to advances related to efficacy and safety of allergy immunotherapy are presented as well as unmet needs and future directions. Results: Most new evidence has come from large double-blind placebo controlled trials of SLIT tablets, which better define efficacy and safety in patients with allergic rhinitis, allergic asthma, and atopic dermatitis. More evidence has emerged that identifies risk factors for anaphylaxis to subcutaneous injections and approaches to mitigate risk. Conclusion: Two modalities of allergy immunotherapy are available to allergy specialists. Both SLIT and subcutaneous immunotherapy have near equivalent efficacy, but SLIT has a superior safety profile, allowing self-administration.