Bridging Innovation and Access: Advancing Allergen Immunotherapy (AIT) in India

Background: In recent years, we have seen allergen immunotherapy (AIT) gain recognition as a disease-modifying option in allergic asthma. However, its use in day-to-day care remains limited due to concerns about safety, variable diagnostic standards, availability of allergen extracts, and trained specialists. The 2025 update by the Global Initiative for Asthma (GINA) offers important clarifications on where allergen AIT fits into asthma care. Objective: Through this article, we aim to summarize key updates from the GINA 2025 strategy report regarding the role of AIT in asthma care. Drawing on our clinical experience and published literature, we critically examine how international guidelines align with the real-world context in India and similar resource-limited settings. Methods: A narrative synthesis of the GINA 2025 strategy report, a recent Indian review on allergy practice, and a global textbook on diagnostic and therapeutic allergy procedures was undertaken. Emphasis was placed on immunologic mechanisms, biomarker integration, safety protocols, and regional implementation strategies. Results: AIT, including subcutaneous (SCIT) and sublingual (SLIT) forms, is endorsed for individuals with well-controlled allergic asthma and confirmed sensitization, particularly when allergic rhinitis coexists. GINA 2025 discourages initiation in uncontrolled or severe asthma. Advances in component-resolved diagnostics and type 2 biomarker profiling now support more personalized AIT protocols. In India and similar settings, implementation remains constrained by infrastructural, regulatory, and socioeconomic barriers, although emerging innovations such as telehealth-enabled SLIT and indigenous allergen panels offer pathways forward. Conclusion: GINA 2025 brings a major change in how we view AIT for asthma. It is increasingly recognized not merely as a symptomatic treatment, but as a disease-modifying intervention. But to truly make AIT work for more people worldwide, we need to close the gaps in access, safety, and accurate diagnosis.