ALLERGEN-SPECIFIC IMMUNOTHERAPY IN THE NEW ERA

Allergen-specific immunotherapy (AIT) is the only treatment for allergy disorders that changes the course of the allergic disease and has been used for over a century. This treatment, which initially used the traditional subcutaneous (SCIT) method, now includes new application routes. Sublingual immu-notherapy (SLIT) is a safer and practical method offered for asthma patients sensitized to house dust mites. Intralymphatic (ILIT) targets faster immune response with markedly fewer injections. Epicuta-neous (EPIT) is a non-invasive option, especially for peanut allergy. Oral immunotherapy (OIT) has encouraging results for food allergies. The immune modulation of both adaptive and innate immunity can provide relief from allergic rhinitis (AR) symptoms and help prevent the worsening of asthma, as well as avoid the development of new allergic sensitizations. Randomized controlled trials and long-term observational studies showed that successful treatment is expected to provide long-term, lasting effects. Nonetheless, the most important issue with AIT, particularly for food allergies, is the potential loss of enduring unresponsiveness and the significant probability of side effects. While recombinant al-lergens offer the benefit of tailored plans for diagnosis and treatment, the search for new biomarkers us-ing omics technologies aims to lay the foundation for personalized therapy. Peptide vaccines aim for a faster and more effective immune response. virus-like particles and nanoparticles are being researched as a new generation of adjuvants replacing traditional ones to enhance immunogenicity. Additionally, while immunotherapy seeks to bypass the side effects of AIT by using biologics such as omalizumab and dupilumab, the addition of toll-like receptor agonists also aims to induce immune deviation and the development of regulatory cells. Passive immunotherapy with monoclonal immunoglobulin (Ig)G can provide rapid symptom control. This section discusses this new era in AIT, where effectiveness is increased, personalized treatment plans are offered to patients, and fewer side effects with longer-last-ing clinical benefits are targeted.