PURPOSE: This expert point of view discusses why allergen-specific immunotherapy (AIT) should be considered earlier in the management of allergic rhinitis and asthma, highlighting a shift from its traditional use as a last-line add-on therapy toward a more proactive, disease-modifying intervention in carefully selected patients. RECENT FINDINGS: Large real-world datasets, including the REACT program and the EfficAPSI study, show that adding AIT to standard care in patients with allergic rhinitis, with or without mild-to-moderate asthma, is associated with sustained reductions in pharmacologic treatment needs, fewer severe asthma exacerbations, and lower healthcare utilization over long-term follow-up. Pediatric and adolescent analyses suggest that starting AIT earlier in life enhances these benefits, supporting the concept of a "window of opportunity" during which immune modulation may prevent or delay asthma onset and limit new sensitizations, in line with the notion of the allergic march. SUMMARY: The accumulating real-world evidence that early AIT can alter the natural history of allergic airway disease provides a strong rationale to reposition AIT within clinical algorithms, moving it from a rescue option for pharmacologic failures to an earlier, integrated disease-modifying strategy. Earlier use of AIT, alongside optimized pharmacotherapy, may improve long-term control, reduce progression to severe asthma, with important implications for patients and health-care systems.
Lombardi et al. (2026) studied this question.