Allergen Immunotherapy: An Updated Review of Safety

Christine James; David I. Bernstein


Curr Opin Allergy Clin Immunol. 2017;17(1):55-59. 

In This Article

Abstract and Introduction


Purpose of review Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy.

Recent findings Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon.

Summary Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.


Allergic rhinitis is one of the most prevalent chronic illnesses, ranking fifth in the United States, and accounting for significant estimated costs (6.1–11.2 billion dollars).[1,2] Allergic rhinitis is also a major predictor and risk factor for asthma, further expanding its potential economic impact.

Allergen immunotherapy (AIT) is the only modality that can modify TH2-directed immune responses and reduce allergic nasal and ocular symptoms upon exposure to aeroallergens. The two major AIT modalities used in clinical practice are subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT). Although both approaches have been found to be efficacious in reducing both symptoms and the need for rescue medications, risk of rare systemic reactions following administration is a significant patient safety concern.