title: Specific immunotherapy-indications and mode of action.
abstract: BACKGROUND
  It is estimated that up to 24% of the population in Germany suffers from allergic rhinoconjunctivitis and 5% from allergic asthma. Allergic rhinoconjunctivitis is closely related to other atopic diseases.
  
  
  METHODS
  This review is based on pertinent publications retrieved by a selective search of the Medline database, guidelines from Germany and abroad, and Cochrane meta-analyses.
  
  
  RESULTS
  Specific immunotherapy (SIT) is the only diseases-modifying treatment option for allergies. Meta-analysis reveals standardized mean differences in allergic rhinitis symptom scores of -0.73 for subcutaneous immunotherapy (SCIT) and -0.49 for sublingual immunotherapy (SLIT); the corresponding mean differences in medication scores are -0.57 and -0.32, respectively. The treatment should be carried out for at least three years. It is indicated when the symptoms are severe and allergen avoidance is not a realistic option. The efficacy of treatment depends on the allergen dose; thus, every allergen preparation should be evaluated individually, independent of route of administration. SCIT can cause systemic adverse effects, including anaphylaxis. SLIT is safer but often causes allergic symptoms of the oral mucosa at the beginning of treatment.
  
  
  CONCLUSIONS
  Even though the efficacy of SIT is well documented, it is still underused. SIT should be offered as standard treatment to patients suffering from allergic rhinitis.
authors.affiliation: Department of Dermatology, University Hospital of Münster.
authors.forename: Randolf
authors.initials: R
authors.lastname: Brehler
authors.forename: Ludger
authors.initials: L
authors.lastname: Klimek
authors.forename: Matthias Volkmar
authors.initials: MV
authors.lastname: Kopp
authors.forename: Johann
authors.initials: J
authors.lastname: Christian Virchow
mesh_terms: D003233:Conjunctivitis, Allergic / Q000276:immunology* / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D015995:Prevalence; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology* / Q000628:therapy*; D016896:Treatment Outcome