Update on allergen immunotherapy for asthma

PURPOSE OF REVIEW: The usefulness of allergen-specific immunotherapy for asthma is controversial. Publications from 2024 and 2025 on allergen immunotherapy for asthma will be reviewed. RECENT FINDINGS: A trial of house dust mite for asthma was strikingly positive for a subset of patients with variant alleles in chromosome 17q12-21. A trail of cockroach immunotherapy for asthma was negative based on nasal challenge. However, there were promising effects on T cells. New allergen-specific vaccines using allergoids and adjuvants are being developed in Europe and look promising for reducing the number of injections and improving safety. Small clinical trials have shown that trained immunity vaccines containing bacterial lysates can reduce wheezing in young children and animal models suggest these vaccines can affect allergen sensitization and asthma. Recent reviews of multiple clinical trials have shown allergen-specific immunotherapy can reduce symptoms and medications in asthmatic individuals but not objective measures of lung fucntion. Recent reviews of combining biologics with allergen-immunotherapy suggest improved safety. SUMMARY: Allergen-specific immunotherapy remains an important treatment for allergic rhinitis and conjunctivitis and can be used safely in patients with mild or moderate well controlled asthma. Several new approaches look promising but need a lot more work.