Knowledge of the mechanisms of
immunotherapy has increased substantially in recent years. The development of better extracts for both injection
immunotherapy and local
immunotherapy continues, and techniques for the production of recombinant
allergens and
peptides will be important for future
vaccines.
Immunotherapy with conventional commercially available extracts is best documented in childhood
pollen allergy and is useful in children with severe
hay fever symptoms or seasonal
asthma.
Immunotherapy for perennial
allergy has so far been most beneficial in dust mite- and cat-allergic children with
asthma. Dust mite
therapy is most efficacious in children with isolated
dust mite allergy. Appropriate environmental measures should, however, precede
immunotherapy when possible. Recent data indicate that
immunotherapy has no additional benefit in children with multiple
allergies and
asthma who receive optimal
pharmacotherapy. It is therefore preferable that
immunotherapy be combined with anti-inflammatory
drug therapy in most children with
asthma. For safety reasons, it is important that
immunotherapy be administered by physicians well acquainted with standardized extracts in a clinic or hospital where treatment for systemic reactions is available. Long-term treatment for 3 to 5 years results in a more sustained effect than short-term
therapy.