Immunotherapy for allergic disease involves the gradual administration of increasing amounts of allergen to which the patient is sensitive, for the purpose of modulating the untoward immune response to that allergen and alleviating allergic symptoms. Immunotherapy is currently the only treatment that alters the abnormal immune response underlying allergic disease.
Subcutaneous injection immunotherapy (SCIT) is the established form of this treatment. Oral forms of immunotherapy are not discussed in this topic review. The indications and efficacy for SCIT will be reviewed here. The therapeutic mechanisms of SCIT and the preparation of allergen extracts are discussed elsewhere. (See "Subcutaneous immunotherapy for allergic disease: Therapeutic mechanisms" and "An overview of allergen extracts".)
The indications for SCIT with aeroallergens (ie, inhaled allergens, such as pollens, animal danders, etc) will be reviewed here. There are several questions that should be addressed to determine if SCIT is appropriate for a specific patient. The indications for venom immunotherapy for treatment of stinging insect hypersensitivity are discussed separately. (See "Hymenoptera venom immunotherapy: Efficacy, indications, and mechanism of action" and "Stings of imported fire ants: Clinical manifestations, diagnosis, and treatment", section on 'Venom immunotherapy'.)
Does the patient have a disorder that responds to immunotherapy? — Subcutaneous allergen immunotherapy (SCIT) using preparations of aeroallergens may be indicated in the management of the following disorders:
- Allergic rhinitis, with or without conjunctivitis, including: