Recent advances in allergen immunotherapy

ABSTRACT: Allergen immunotherapy (AIT) remains the only disease-modifying treatment for immunoglobulin (Ig) E-mediated allergic diseases, including allergic rhinitis (AR), asthma, food allergy, and atopic dermatitis (AD). This review provides a comprehensive update on recent advances in AIT, focusing on immunological mechanisms, novel vaccines, biomarkers, clinical outcomes across different diseases, and emerging combination strategies with biologics. We discussed the pivotal roles of regulatory T and B cells, innate lymphoid cells (ILCs), and blocking antibodies (immunoglobulin G4 [IgG4], immunoglobulin A [IgA]) in establishing long-term tolerance. Novel allergen vaccines-including recombinant and hypoallergenic derivatives, virus-like particle (VLP) conjugates, and transgenic peptide vaccines-aim to improve safety and efficacy. We critically evaluate current biomarkers for predicting and monitoring AIT response, such as the allergen-specific IgE (sIgE)/total immunoglobulin E (tIgE) ratio, basophil activation test, and cellular markers. Clinical evidence supports AIT efficacy in asthma, AR, and AD, with emerging applications in food allergies. Furthermore, combining AIT with biologics (e.g., anti-IgE and anti-interleukin [IL]-4/IL-4 receptor [IL-4R]) shows promise in enhancing safety and efficacy, particularly in severe asthma. Despite these advances, challenges remain in patient selection, treatment duration, and extract standardization. Future research should prioritize predictive biomarkers, short-course regimens, and synergistic biologic-AIT approaches.