Allergen immunotherapy (AIT) is the only etiological treatment for allergic rhinitis (AR) patients, yet the impact of allergen sensitization patterns on AIT efficacy remains unclear. This study aimed to assess the effectiveness of subcutaneous immunotherapy (SCIT) using a native house dust mite (HDM) allergen extract in Chinese AR patients with diverse HDM sensitization patterns.

This prospective multicenter study across three allergy centers in China enrolled patients aged 5–65 diagnosed with HDM-induced AR. Serum-specific IgE testing for nine HDM components (Der p1, Der p2, Der p23, Der f1, Der f2, Der p5, Der p7, Der p10, Der p21) categorized patients into two groups: Group A with sensitization limited to major allergen components and Group B with sensitization to minor components with or without major components. Both groups underwent 1 year of HDM SCIT (Allergopharma, Germany), whose efficacy was assessed using the visual analogue scale (VAS) and combined symptom medication scores (CSMS). Serum IgE and IgG4 levels against the nine HDM components were measured pre- and post-treatment, and SCIT-related adverse reactions were recorded.

The study enrolled 168 patients, with 75 in Group A and 93 in Group B. Group B patients had higher asthma prevalence and elevated baseline HDM sIgE and total IgE levels. After 1 year, Group B showed significantly greater CSMS reduction (67.70% vs. 59.09%, p = 0.03) and VAS improvement (66.67% vs. 50.00%, p = 0.01) compared to Group A. Group A had increased new sensitization risk to minor allergens (Der p5, Der p7, Der p21). No significant difference in SCIT efficacy was observed between patients with and without new sensitization. Both groups exhibited increased sIgG4 levels against all nine HDM allergens, with a more pronounced elevation of sIgG4 levels to Der p21 observed in Group B compared to Group A (p = 0.02). SCIT-related adverse reactions were comparable (p > 0.05).

The native HDM allergen extract demonstrates efficacy in Chinese AR patients with varying sensitization patterns. It offers enhanced benefits for patients sensitized to minor allergens with or without major allergens of HDM, positioning it as the preferred option for individuals with AR. Trial registration: Chinese Clinical Trial Registry identifier: ChiCTR2300078642

Allergen immunotherapy (AIT) is an established treatment for mild to moderate allergic asthma. However, limited data are available regarding its safety and efficacy in patients with severe asthma. This study aimed to gather real-world evidence (RWE) on the safety and effectiveness of AIT in individuals with severe asthma caused by sensitization to at least one allergen, who were either currently undergoing AIT or had received it within the past five years.

A retrospective study was conducted in Spain, including patients aged ≥6 years with severe asthma (Spanish Guideline for Asthma Management [GEMA] steps 5–6 and Global Initiative for Asthma [GINA] step 5) sensitized to at least one allergen who had received AIT within the previous 5 years, to evaluate safety and effectiveness.

The study included 93 patients (54.8% female) with a median age of 40.3 years, including 5 under 14. A total of 16 systemic reactions (SRs) were reported in 8 patients (8.6%), mostly immediate (13/16) and occurring during the initiation phase (12/16), all in patients receiving subcutaneous immunotherapy. Most SRs were mild to moderate, except for 2 severe reactions in 1 patient. Only 3 patients discontinued treatment. Significant improvements in both FeNO and FEV1(%) were observed after 6 and 12 months of AIT, respectively. Quality of Life (through mini-AQLQ) scores improved at 1, 2, and 3 years after initiation of AIT compared to baseline. The number of patients who did not require rescue medication for asthma was significantly higher after starting AIT than before treatment. AIT was also associated with a 75.8% reduction in the number of emergency visits.

This study confirms the safety and effectiveness of AIT in patients with well-controlled severe asthma in routine clinical practice. Additional prospective real-world studies are needed to better understand the efficacy of AIT in severe asthma.

Recent advancements in genomics and “omic” technologies have ushered in a transformative era referred to as personalized or precision medicine. This innovative approach considers the unique genetic profiles of individuals, along with a range of variability factors, to devise tailored disease treatments and prevention strategies that cater to the distinct needs of each patient. Although the terms personalized medicine and precision medicine are frequently utilized interchangeably, it is essential to delineate the subtle distinctions between them. Personalized medicine concentrates on bespoke treatments and prevention strategies that are meticulously tailored for each individual. Conversely, precision medicine utilizes advanced gene sequencing and comprehensive data analytics to formulate specific treatments and prevention strategies for defined groups of individuals based on genetic, environmental, and lifestyle factors rather than focusing exclusively on individual patients. Therefore, precision medicine constitutes an extension of traditional personalized care, improving the accuracy of diagnosis, prognosis, and therapy estimations for each patient through the application of sophisticated molecular diagnostics and advanced imaging techniques enabled by recent technological innovations. The shift from personalized to precision medicine has gained considerable traction, particularly in the wake of the 2015 US Precision Medicine Initiative, which has further stimulated advancements in this domain. This review will explore multiomics approaches that have facilitated the evaluation of personalized biomarkers associated with allergen immunotherapy, particularly in the treatment of allergic diseases. By leveraging these innovative methodologies, we aspire to cultivate more effective and individualized patient care, ultimately enhancing health outcomes for individuals with allergies.

Subcutaneous allergen immunotherapy (SCIT) has a longstanding history as a safe and effective treatment. Nevertheless, to meet the European Medicines Agency’s regulatory requirements for continued market authorization, its efficacy and safety must be confirmed in a pivotal Phase III trial.

Based on a successful Phase II dose-finding study, the aim was to confirm the safety and efficacy of a subcutaneous house dust mite (HDM) preparation in a randomized controlled trial using an optimal higher dose than the current maintenance dose.

Seven hundred sixty-seven subjects were randomized in a 1:1 ratio to 1-year treatment with SCIT-product at a dose of 50,000 AUeq/mL or placebo. Out of these, 682 subjects completed the study. The primary endpoint was assessed using the combined symptom and medication score (CSMS(n)), which focuses on nasal symptoms, as specified by the European Academy of Allergy and Clinical Immunology (EAACI).

The primary endpoint showed a trend (p = 0.0767) with a mean treatment effect of -0.12 (95% CI, -0.3 to 0) toward a favorable change in mean CSMS(n) for active compared to placebo treatment. This treatment effect of 0.12 points did however not meet the prespecified minimal clinically relevant difference of 0.25 points. Among the 767 randomized patients, 539 had mild symptoms and 228 patients had moderate to severe HDM allergic symptoms, defined by a mean baseline daily symptom score (dSS(n)) of at least 2. Post hoc analysis of the clinical data, focusing on this subgroup of patients with moderate to severe symptoms, revealed a significant treatment effect for the primary endpoint, with a clinically meaningful reduction of -0.39 points (95% CI, -0.64 to -0.13; p = 0.0031), thereby surpassing the minimal prespecified difference of 0.25 points. No additional safety concerns were observed in the moderate to severe symptom group compared with the minor symptom group.

Treatment with the tested SCIT-product at a dose of 50,000 AUeq/mL was safe and well tolerated. The primary outcome was not met, with no significant difference observed between the active and placebo groups. A likely explanation might be the inclusion of mainly patients with mild symptoms of rhinoconjunctivitis (539 of a total 767 randomized subjects). Post hoc analysis, however, indicated that SCIT was effective in the subgroup of patients with moderate to severe disease, suggesting that the overall study outcome may have been influenced by the inclusion of a large proportion of patients with only mild symptoms of HDM-induced rhinoconjunctivitis. As a consequence, reconfirming efficacy requires adequate baseline symptom severity, especially in HDM allergic patients.

Reappraisal of systematic reviews and meta-analyses on sublingual immunotherapy (SLIT) for allergic rhinitis: evidence for clinical practice and decision-making.

A comprehensive computerized search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, WANFANG, and CBM databases from their inception to June 8, 2025, to systematically identify systematic reviews and meta-analyses on SLIT for allergic rhinitis. A citation overlap matrix was constructed to calculate the corrected covered area, assessing the degree of primary study overlap. The risk of bias, methodological quality, reporting quality, and certainty of evidence in the included systematic reviews/meta-analyses were evaluated using ROBIS, AMSTAR-2, PRISMA 2020, and GRADE tools, respectively. Both quantitative and qualitative analyses were performed on the primary outcomes to derive a more comprehensive and in-depth understanding.

A total of 20 systematic reviews/meta-analyses were included in this umbrella review. The corrected covered area of 6.391% derived from the citation matrix analysis indicated a modest degree of primary study overlap among the included literature. Risk of bias assessment demonstrated that all incorporated studies exhibited low bias risk. Methodological quality evaluation revealed 2 high-quality, 3 moderate-quality, 14 low-quality, and 1 extremely low-quality study. Reporting quality assessment yielded scores ranging from 22 to 41.5, with 7 studies classified as high-quality, 11 as moderate-quality, and 2 as low-quality reports. The evidence quality assessment revealed that among all evaluated outcomes, 7 were rated as high quality, 19 as moderate quality, 31 as low quality, and 14 as extremely low quality according to the GRADE framework.

Current evidence demonstrates that sublingual immunotherapy exhibits favorable efficacy in improving symptom scores and reducing medication use for allergic rhinitis, with a generally acceptable safety profile despite mild adverse reactions in some cases. Future research should focus on large-scale, real-world studies with diverse outcome measures, investigating variations in regional populations, allergen types, dosage regimens, and treatment durations to further optimize clinical application protocols for SLIT.

The efficacy of subcutaneous immunotherapy (SCIT) in allergic rhinitis (AR) patients varies. Component-resolved diagnostics (CRD) may serve as a useful tool to predict therapeutic responses.

Forty-three house dust mite (HDM)-sensitized AR patients undergoing SCIT were enrolled. Clinical data and serum samples were collected at baseline (V1), 15 weeks (V2), and 1 year (V3). The levels of specific immunoglobulin E (sIgE) and sIgG4 to nine HDM components were measured, and a predictive model was established. An independent prospective cohort of 23 patients was used for validation.

The most prevalent sensitizing components were Dermatophagoides pteronyssinus (Der p) 1, Dermatophagoides farinae (Der f) 1, Der p 2, Der f 2, and Der p 23. The responders had a significantly higher Combined Symptom and Medication Score (CSMS) at baseline than did the nonresponders. At V2, the responders showed a greater increase in serum levels of Der f 1 sIgE, higher levels of Der p 23 sIgG4, and greater incremental changes in Der p 23 sIgG4 levels. A composite model based on V1 CSMS, Δ15w Der f 1 sIgE, and Δ15w Der p 23 sIgG4 achieved an area under the receiver operating characteristic curve (AUC) of 0.896 (cutoff: 0.455), with 83.3% sensitivity and 84.0% specificity. In the validation cohort, the model showed a 75.0% positive predictive value, 86.7% negative predictive value, and 82.6% overall accuracy.

A composite biomarker model based on HDM component responses enabled early prediction of SCIT efficacy, supporting more personalized treatment strategies for AR management.

Moderate-to-severe allergic asthma caused by dust mite sensitization is challenging to treat. Allergen-specific immunotherapy (AIT) is the only disease-modifying option but is limited by delayed effects, allergic side reactions, and poor adherence. Omalizumab, an anti-IgE antibody, may improve AIT's safety and effectiveness.

To assess whether combining omalizumab with AIT is more effective and safer than AIT alone in patients with dust mite-induced moderate-to-severe asthma.

This prospective study involved 37 patients divided into two groups: AIT alone (n=18) and omalizumab + AIT (n=19). Over 48 weeks, asthma control (ACT, ACQ), lung function (FEV₁%, PEF%, FEV₁/FVC), and airway inflammation (FeNO) were measured. Secondary outcomes included IgE levels, eosinophil counts, quality of life (AQLQ), and safety.

Both groups improved, but the combination group showed significantly better asthma control, lung function, and quality of life at week 48. Only the combination group had significant reductions in FeNO and eosinophils, suggesting stronger anti-inflammatory effects. IgE levels followed expected trends with no major group differences. Fewer adverse reactions occurred in the combination group; severe systemic events were reported only in the AIT-alone group.

Adding omalizumab to AIT significantly enhances asthma control, lung function, and inflammation reduction while improving treatment safety. This supports its role as an effective adjunct in managing moderate-to-severe dust mite-allergic asthma in Chinese patients.

In recent years, it has been argued that eosinophilic esophagitis (EoE) seen in the early period of oral immunotherapy (OIT) may also exist before OIT.

We sought to evaluate the presence of EoE before initiating OIT and identify risk factors (during fetal development, infancy, and environmental exposures) for its development.

48 patients who underwent endoscopic evaluation before OIT were enrolled. Endoscopic findings were scored using the EoE Endoscopic Reference Score (EREFS) and histopathologic evaluation using the Eosinophilic Esophagitis Histologic Scoring System (EoEHSS). The Index of Severity for EoE (I-SEE) was used to evaluate disease activity.

There were pathologic endoscopic findings in 36 (75%) of the patients, and the median EREFS was 2 (min:0-max:7). Only 7 (14.5%) patients had normal histology, 16 (33.3%) had esophageal eosinophilia (EE), 5 (10.4%) had low-grade eosinophilia (5–15 eos/HPF). Although all children were asymptomatic, only 4 (8.3%) patients had normal endoscopic and histopathological findings. Furrows, total EREFS, and both inflammatory and fibrostenotic scores on I-SEE were statistically significantly higher in the EE group (p:0.013, p:0.008, p<0.01, p:0.005, respectively). An increased risk of EE of about 5 times (OR: 5.444, 95% CI: 1.290–22.976, p:0.021) was found if patients had any three of the early-life risk factors (maternal fever, cesarean delivery, formula feeding, antibiotic use, neonatal intensive care admission).

Given the significantly increased risk of EE in children with a combination of early-life risk factors, a risk-stratified approach to endoscopic evaluation may be warranted before OIT initiation.

Subcutaneous immunotherapy (SCIT) has been a cornerstone treatment for allergic rhinitis (AR) for over 50 years, consistently demonstrating symptom reduction and modulation of immune responses. Despite this, the underlying mechanisms responsible for the efficacy of SCIT remain incompletely understood, especially with regard to local immune responses in lymph nodes and nasal mucosa.

To determine the impact of SCIT treatment on immunoglobulin production in blood and nasal mucosa, as well as B cell class-switching in blood and lymph nodes.

Blood, nasal lavage (NAL), and fine-needle aspirates (FNA) of inguinal lymph nodes were collected from 23 patients with birch and/or timothy pollen-induced AR before and after SCIT updosing. General response to SCIT was evaluated with symptom and medication scores, as well as allergen-mediated activation of basophils. Allergen-specific IgE, IgA, IgG, and IgG4 were measured in blood and NAL via ELISA. B-cell class-switching was assessed in blood and FNAs by flow cytometry.

AR symptoms, medication use, and basophil sensitivity to allergens were reduced after SCIT updosing. Plasma levels of allergen-specific IgA, IgG, and IgG4 increased after SCIT updosing, while levels of allergen-specific IgE and IgA decreased in NAL. Moreover, there was an increase in conventional (IgD-CD27+) and unconventional (IgD-CD27-) memory B cells in blood and lymph nodes, respectively.

This study highlights the differential effects of SCIT on local and systemic immunity and identifies early immunological changes associated with treatment. The local decrease in allergen-specific IgA in NAL, alongside a systemic increase in allergen-specific IgA and IgG4, underscores the importance of assessing both mucosal and systemic responses when evaluating SCIT efficacy. Long-term tolerance confirmation will require extended follow-up, including in-season analyses.

This review evaluates the evidence on the effects of allergen immunotherapy (AIT) on lung function in asthma, with a focus on long-term outcomes. The topic is timely given the increasing interest in disease-modifying strategies that may alter asthma's natural course, particularly through interventions targeting type 2 inflammation.

Previous long-term observational and randomized studies suggest that sublingual immunotherapy (SLIT) can sustain clinical benefits and may positively impact lung function. However, while improvements in asthma control and exacerbation reduction are consistent, recent and robust evidence for lung function preservation remains limited. Real-world prospective studies from European and Chinese cohorts point to possible allergen-independent benefits on forced expiratory volume in one second.

While AIT is a proven disease-modifying intervention for allergic diseases, its role in preventing or slowing lung function decline in asthma is underexplored. Future research should prioritize longitudinal spirometry data across diverse allergens and patient populations to clarify AIT's potential to alter asthma progression.