Allergen immunotherapy and avoidance

Since its introduction almost a century ago, immunotherapy continues to be an effective method of managing allergic rhinitis, allergic asthma, and insect anaphylaxis. Confusion and misinformation on the part of physicians and the public lead to the inappropriate use of this treatment. Before immunotherapy is started, appropriate avoidance techniques and pharmacotherapy should be instituted (except for insect anaphylaxis, where immunotherapy is a part of the initial treatment.) When these measures fail, or significant side effects are encountered, immunotherapy can be beneficial. This article eliminates as much as possible the ambiguity surrounding immunotherapy to help the clinician understand more clearly the appropriate use of immunotherapy and the treatment of allergic diseases.