Innovative positioning of respiratory allergen immunotherapy: a focus on precision medicine

INTRODUCTION: Allergen immunotherapy (AIT) is the only treatment for IgE-mediated respiratory allergy that can modify disease progression. Historically, AIT has relied on empirical personalization, based on allergen selection and clinical judgment. However, AIT is now transitioning to a structured, precision-medicine framework to optimize patient selection and treatment strategies by aligning interventions with individual characteristics and response profiles. However, key methodological and implementation challenges must be addressed before precision AIT can be routinely operationalized. AREAS COVERED: This review addresses the evolution of AIT toward a precision medicine framework. Specifically, we discuss emerging strategies and associated challenges to refine the use of AIT, including improved patient characterization, assessment of response trajectories, and treatment optimization through molecular diagnostics, digital health tools, and adjunctive biologic therapies. EXPERT OPINION: AIT has the potential to be an individualized, disease-modifying intervention. To achieve this, the field needs to move beyond 'one size fits all' empirical approaches, toward structured, response-guided strategies supported by multivariable prediction models and patient-centered outcomes. While the current limitations in evidence, outcome measurement, and regulatory frameworks hamper the implementation into actionable pathways, the international community of allergy care should strive to address these challenges and promote a more nuanced evidence-based use of AIT.