Allergic rhinitis may seem like a “minor illness”, but once it is causally linked to asthma, it becomes a “major problem”. The article “Don’t let a small problem become a big problem” systematically introduces three types of drugs combined with allergic rhinitis to effectively control nasal symptoms. However, these treatments can only be symptomatic, and once the patient stops taking the medication, the allergic symptoms will return once they are exposed to the allergen again. So, is it possible to solve the problem of allergic rhinitis treatment with long-term medication once and for all? In this issue, ENT experts introduce another new treatment method, which is “immunotherapy”. A female patient in her 40s has been suffering from allergic rhinitis for more than 10 years. When her nose itched, it was like ants crawling; her runny nose was like a faucet that could not be stopped; severe nasal congestion led to snoring, breath-holding and even sleep apnea at night. At first she had been receiving medication, and as time lengthened, the treatment became less and less effective. The patient was in great pain as a result, her mood was severely affected and she even became depressed, and her relationship with her family became very bad. After examination the patient was allergic to mites, so the doctor recommended that she receive standardized mite desensitization treatment (immunotherapy). Soon, the female patient’s symptoms were effectively controlled. As her symptoms improved and her quality of life improved, her emotions were relieved, her psychological state changed, and her relationship with her family became cordial. She said, “If I could have received immunotherapy earlier, I would have lived a much better life in these 10 years.” What works Wang F. said the treatment of allergic rhinitis (also called allergic rhinitis) mainly includes patient education, allergen avoidance, medication, and immunotherapy. Medication is currently the common tool. The first-line drugs are antihistamines, nasal hormones, and leukotriene receptor antagonists, which can work quickly and completely relieve symptoms. The problem, however, is that once the medication is stopped clinically, the symptoms return immediately and do not prevent allergic rhinitis from evolving into asthma. Immunotherapy can not only significantly reduce nasal symptoms such as itching, sneezing, runny nose and nasal congestion and improve the quality of life of patients, but it can also reduce or stop medication and be effective in the long term; prevent the occurrence of new allergen sensitization; and prevent allergic rhinitis from developing into asthma. “Thus, immunotherapy is currently the only treatment that can alter the natural course of allergic diseases.” Wang F. emphasized. The medical community’s understanding of immunotherapy is constantly evolving. 1998 World Health Organization (WHO) opinion states that immunotherapy is indicated when drug therapy for allergic rhinitis is ineffective or intolerable; 2001 guidelines on “Allergic rhinitis and its impact on asthma” (ARIA) recommend that immunotherapy The European Academy of Allergy and Clinical Immunology (EAACI) standard of 2006 states that immunotherapy is an allopathic treatment that modifies the course of the disease and should be used as early as possible to prevent irreversible damage to the mucosa of the affected organs. In recent years, some experts have even suggested, “Upgrading immunotherapy as a first-line option for the treatment of allergic rhinitis.” Who can use it Wang F. introduced that some patients are triggered by exposure to allergens and also have a single or fewer types of allergens, and they have poor efficacy or some adverse reactions to medication. At this time, if patients no longer want to receive long-term medication, they can receive immunotherapy with a full understanding of the risks and limitations of immunotherapy. In fact, not only allergic rhinitis, but also allergic diseases mediated by IgE, such as asthma and atopic dermatitis, can be treated with immunotherapy. However, immunotherapy is not suitable for all patients. Wang F. emphasized that patients with asthma that cannot be controlled by medications, patients who are using beta-blockers, patients with other immune diseases in combination, psychological dysfunction, malignant tumors, severe cardiovascular disorders, as well as children under 5 years old and those with poor treatment compliance are not suitable for immunotherapy. How to treat Immunotherapy is administered by finding the antigen to which the patient is allergic, and then administering the antigen in increasing doses, starting with a dose that the patient can tolerate. When it comes to the key to successful treatment, F. Wang emphasized that the first thing is to find the proper antigen (standardized vaccine), followed by a reasonable method of administration, and finally the total course of treatment should generally be no less than three years. The so-called standardized vaccine requires that it should contain all relevant allergenic proteins, consistent content of major allergenic proteins between vaccine batches, and consistent total potency between batches. Due to the difficulty of vaccine preparation, only one vaccine against one allergen, dust mite, is currently available in clinical practice. The routes of administration of immunotherapy include subcutaneous immunotherapy and non-injectable immunotherapy, the latter of which includes sublingual immunotherapy, oral immunotherapy, intranasal immunotherapy, and tracheal immunotherapy. Currently, subcutaneous immunotherapy is commonly used in clinical practice. The dose of subcutaneous vaccine injection is gradually increased. The initial treatment starts with the lowest concentration and the smallest dose in increments of 7-14 days; if interrupted for 2-4 weeks, it is restarted at no more than half of the last dose; after reaching the maximum dose, the injection interval is gradually extended to 4-6 weeks. What to watch out for As with any drug treatment, immunotherapy can have adverse effects. Wang F introduced that some people will have strong local reactions, such as injection site mound diameter > 4 cm, redness, itching, pseudopod, at this time, measures can be taken to repeat the previous tolerated dose of injection; for minor systemic reactions, such as complications of rhinitis, conjunctivitis, asthma, rash, at this time, the injection dose can be adjusted back 2~3 steps; if there is a serious systemic reaction, such as minor systemic reaction in addition to vertigo, severe asthma, and alert symptoms including burning, itching, and heat on the upper and lower tongue, pharynx, palms, and feet, then the doctor needs to evaluate with the patient whether to continue the treatment, and if so, restart the injection from the minimum dose. The rescue drugs for serious adverse reactions to immunotherapy are antihistamines, beta2 agonists, steroids and epinephrine, and the clinic will take appropriate management countermeasures according to the different grades of adverse reactions.