Until recently, allergy treatment was largely based on average treatment schemes. A patient with pollen allergy would receive a similar therapy to others with the same diagnosis. Today, this model is beginning to change. The latest recommendations published by the European Academy of Allergy and Clinical Immunology in the journal Allergy show that allergen immunotherapy (AIT) is entering the era of precision medicine, and with it, the way we think about allergy itself is evolving.
From one diagnosis to multiple disease mechanisms
Allergy is increasingly perceived as less of a single disease entity. Contemporary allergy speaks rather of “endotypes,” meaning distinct biological mechanisms that lead to similar clinical symptoms. These are now becoming key to therapeutic decisions.
As explained by Prof. Marek Jutel from the Department and Clinic of Clinical Immunology, Wroclaw Medical University:
The role of allergen immunotherapy (AIT) is shifting from a standard approach toward targeted therapy. Thanks to precision medicine, AIT is increasingly selected based on the patient’s detailed allergy profile, including the identification of specific allergen components.
This shift is of fundamental importance, as immunotherapy is no longer merely a method of alleviating symptoms but is becoming a causal treatment tailored to the individual course of the disease.
Diagnostics
A key element of this transformation is the development of new diagnostic tools. Component-resolved diagnostics (CRD) now allow precise identification of the specific allergenic proteins to which a patient’s immune system reacts. In practice, this means the ability to distinguish true allergy from cross-reactivity and to better predict the effectiveness of immunotherapy.
As emphasized by Prof. Marek Jutel:
Modern diagnostic tools allow precise identification of the specific allergenic proteins to which a patient is sensitized. This makes it possible to distinguish true allergy from cross-reactivity, better predict the effectiveness of immunotherapy, and avoid unnecessary treatment.
Biomarkers are also gaining importance, from classical ones such as specific IgE or IgG4 to more advanced indicators of the immune response, including regulatory T cell (Treg) activity. Their role is not limited to diagnostics—they may also support patient qualification for therapy, assess treatment safety, and monitor its effects. At the same time, as the expert notes, many of these tools are still at the validation stage. The most important goal remains the ability to reliably identify which patients will truly benefit from immunotherapy.
Personalized treatment
As a result of these changes, allergen immunotherapy is becoming one of the most advanced examples of personalized medicine. Contemporary therapeutic strategies take into account not only the type of allergen but also the molecular profile of sensitization, disease severity, patient age, comorbidities, and, most importantly, the disease endotype.
The most important clinical benefits include greater treatment effectiveness, longer-lasting effects, fewer ineffective therapies, and improved safety. In selected cases, it is also possible to combine AIT with biological therapies, notes Prof. Marek Jutel.
Such an approach means not only better treatment outcomes but also more rational use of available therapeutic methods.
Between potential and practice
Despite its dynamic development, the implementation of precision medicine in allergology faces significant barriers. The most important include the lack of full standardization of biomarkers, the limited availability of advanced diagnostics, and the high costs of these diagnostics. Additionally, interpretation of results requires specialist expertise, and unified clinical guidelines are still under development.
Despite its great potential, precision medicine in allergology is still in an early stage of development, and its full implementation requires further research and systemic changes, concludes Prof. Marek Jutel.
The complexity of allergic diseases also remains significant, as they are influenced by genetic, environmental, and lifestyle factors.
Allergology of the future has already begun
The transformation currently taking place in allergen immunotherapy extends beyond allergology itself. It is an example of a broader trend in medicine: moving away from treating the “average patient” toward therapy tailored to a specific individual.
If the development of biomarkers, molecular diagnostics, and endotype classification continues at its current pace, allergen immunotherapy may become one of the most well-established models of causal treatment in precision medicine.
The material is based on the publication:
EAACI Guidelines on the Importance of Green Space in Urban Environments for Allergy and Asthma Prevention
https://doi.org/10.1111/all.70182