Oral immunotherapy in children with allergic diseases: past, present and future

Allergen immunotherapy (AIT) is the only treatment capable of modifying the natural history of allergic diseases by promoting immune tolerance. Initially developed for respiratory allergies, AIT has expanded to include food allergies, particularly through oral immunotherapy (OIT). This review explores the historical evolution, current applications, and future directions of AIT in pediatric patients. Subcutaneous and sublingual immunotherapy (SCIT and SLIT) remain well-established approaches for allergic rhinitis, asthma, and hymenoptera venom allergy, demonstrating long-term benefits. Additionally, OIT has gained attention for food allergies, aiming to increase the threshold for allergic reactions and reduce the risk of severe reactions upon accidental exposure. Despite promising results, challenges remain, including safety concerns, adherence, and the durability of induced tolerance. Research continues to refine treatment protocols, improve safety profiles, and identify biomarkers to predict patient response. Advancements in immunology and personalized medicine continue to influence the future of AIT, with novel administration routes, adjuvants, and biologic therapies being explored to enhance efficacy and reduce adverse effects. While AIT has transformed the management of allergic diseases, optimizing patient selection, standardizing protocols, and ensuring broader accessibility remain key priorities. A deeper understanding of immune mechanisms will further improve individualized treatment approaches, maximizing long-term benefits for pediatric patients.