Chenchulakshmi Vasudevan*

Department of Otorhinolaryngology, KJ Somaiya Medical College, and Research Centre, Somaiya Ayurvihar, Sion, Mumbai, India

*Corresponding Author: Chenchulakshmi Vasudevan, Department of Otorhinolaryngology, KJ Somaiya Medical College, and Research Centre, Somaiya Ayurvihar, Sion, Mumbai, India.

Received: September 30, 2025; Published: October 24, 2025

Abstract

Background: Allergic rhinitis (AR) is prevalent in otorhinolaryngology, impacting quality of life and often leading to complications like recurrent rhinoconjuctivitis, sinusitis, nasal polyps or otitis media. Recent advances in allergy testing, allergen immunotherapy (AIT), and the use of monoclonal antibodies have transformed diagnostic and therapeutic approaches to allergy management, offering precision medicine tailored to ENT practice.

Objective: To review recent developments in allergy testing, use of AIT, and the role of biologics, focusing on their application in otorhinolaryngology for improved diagnosis and management of allergic upper airway diseases.

Methods: This article is review of literature that, synthesizes evidence from recent literature (2023–2025), including systematic reviews, randomized controlled trials, and real-world studies. Key advancements in skin prick testing (SPT), molecular diagnostics, subcutaneous and sublingual Immunotherapy and role of biologics such as dupilumab, omalizumab, and mepolizumab and their relevance to ENT practice is elaborated.

Conclusion: Innovations in SPT, such as skin prick tape, enhance patient comfort and diagnostic consistency, making it ideal for ENT clinics. Molecular testing improves precision in identifying allergen components for AR and CRS. AIT, via subcutaneous or sublingual routes, induces long-term tolerance, reducing reliance on pharmacotherapy and preventing disease progression. Biologics, in the form of monoclonal antibodies targeting IL-4/IL-13, IgE, and IL-5 pathways demonstrate efficacy in severe CRSwNP (Chronic rhinosinusitis with nasal polyps) and AR (Allergic Rhinitis), decreasing nasal polyp size, improving symptoms, and reducing the need for surgery. Advances in allergy evaluation and treatment provide otorhinolaryngologists with effective tools to manage allergic upper airway diseases. Integrating these innovations into routine practice enhances diagnostic accuracy, optimizes treatment outcomes, and improves patient quality of life, with ongoing research promising further personalization.

Keywords: Allergic Rhinitis; Chronic Rhinosinusitis; Skin Prick Testing; Allergen Immunotherapy; Biologics; Otorhinolaryngology

References

1. Licari A., et al. “Epidemiology of allergic rhinitis in children: a systematic review and meta-analysis”. Allergy, Asthma, and Clinical Immunology1 (2023): 84.
2. Wise SK., et al. “International consensus statement on allergy and rhinology: Allergic rhinitis – 2023”. International Forum of Allergy and Rhinology4 (2023): 293-859.
3. Chong AC., et al. “Skin prick testing: A review of clinical utility and limitations”. International Forum of Allergy and Rhinology2 (2024): 258-265.
4. Kamatou GPP and Viljoen AM. “A review of the application and evolution of skin prick testing in allergy diagnostics”. Clinical Reviews in Allergy and Immunology2 (2023): 123-135.
5. Bernstein IL., et al. “Allergy diagnostic testing: an updated practice parameter”. Annals of Allergy Asthma and Immunology3 (2024): 275-291.
6. Matricardi PM., et al. “Molecular allergology: precision diagnostics in allergic diseases”. The Journal of Allergy and Clinical Immunology6 (2023): 1423-1432.
7. Wise SK., et al. “International consensus statement on allergy and rhinology: Allergic rhinitis – 2023”. International Forum of Allergy and Rhinology4 (2023): 293-859.
8. Tosca MA., et al. “In-office allergy testing in otorhinolaryngology: techniques and outcomes”. Rhinology 5 (2023): 412-420.
9. Durham SR and Penagos M. “Sublingual or subcutaneous immunotherapy for allergic rhinitis?”. The Journal of Allergy and Clinical Immunology2 (2023): 345-352.
10. Alvaro-Lozano M., et al. “Allergen immunotherapy in children: current evidence and future perspectives”. Pediatric Allergy Immunology1 (2024): e14012.
11. Cox L., et al. “Allergen immunotherapy: a practice parameter third update”. The Journal of Allergy and Clinical Immunology1 (2023): 1-39.
12. Ciprandi G., et al. “Allergen immunotherapy in allergic rhinitis: practical considerations for otorhinolaryngologists”. European Archives of Otorhinolaryngology4 (2024): 1675-1683.
13. Nolte H., et al. “Efficacy and safety of sublingual immunotherapy in allergic rhinitis: a 2024 update”. Allergy6 (2024): 1456-67.
14. Shamji MH., et al. “Novel monoclonal antibodies in seasonal allergic rhinitis: clinical outcomes with stapokibart”. The Journal of Allergy and Clinical Immunology5 (2024): 1234-1242.
15. Hellings PW., et al. “EUFOREA consensus on biologics and immunotherapy in allergic diseases”. Allergy 7 (2023): 1742-1757.
16. Rondón C., et al. “Local allergic rhinitis: implications for management in ENT practice”. Rhinology3 (2023): 201-210.
17. Pfaar O., et al. “Advances in allergen immunotherapy: focus on personalized approaches”. Allergy2 (2024): 315-328.
18. Wise SK., et al. “Innovations in immunotherapy for allergic rhinitis and chronic rhinosinusitis”. International Forum of Allergy and Rhinology3 (2024): 498-507.
19. Zuberbier T., et al. “Advances in the management of allergic rhinitis: a 2023 perspective”. Clinical and Experimental Allergy10 (2023): 987-996.
20. Roberts G., et al. “Long-term outcomes of allergen immunotherapy in allergic rhinitis”. Allergy 4 (2024): 876-889.
21. Bachert C., et al. “Efficacy and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps: pooled analysis of SINUS-24 and SINUS-52 trials”. Lancet Respiratory Medicine1 (2023): 25-34.
22. Mullol J., et al. “Real-world effectiveness of dupilumab in chronic rhinosinusitis with nasal polyps: a 2024 update”. The Journal of Allergy and Clinical Immunology Practice5 (2024): 1123-1131.
23. Kariyawasam HH., et al. “Dupilumab for otologic symptoms in chronic rhinosinusitis with nasal polyps and asthma”. Rhinology 6 (2023): 543-550.
24. Gevaert P., et al. “Omalizumab in chronic rhinosinusitis with nasal polyps: real-world evidence”. The Journal of Allergy and Clinical Immunology4 (2023): 879-887.
25. Bachert C., et al. “Omalizumab as an alternative to surgery in recurrent nasal polyps: a real-world study”. International Forum of Allergy and Rhinology1 (2024): 45-53.
26. Han JK., et al. “Mepolizumab for eosinophilic chronic rhinosinusitis with nasal polyps: a randomized controlled trial”. The Journal of Allergy and Clinical Immunology5 (2023): 1289-1297.
27. Chupp GL., et al. “Combination biologic therapy in severe asthma and chronic rhinosinusitis: real-world outcomes”. Allergy and Asthma Proceedings 2 (2024): 89-97.
28. Fokkens WJ., et al. “Biologics reduce the need for surgery in chronic rhinosinusitis with nasal polyps: a systematic review”. Rhinology4 (2023): 301-312.
29. Bachert C., et al. “Biologics versus endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: a 2024 cost-effectiveness analysis”. International Forum of Allergy and Rhinology6 (2024): 789-798.
30. Tsabouri S., et al. “Omalizumab in moderate-to-severe allergic rhinitis: a meta-analysis”. Clinical and Experimental Allergy8 (2023): 789-801.
31. Corren J., et al. “Dupilumab in allergic rhinitis: a randomized controlled trial”. The Journal of Allergy and Clinical Immunology Practice4 (2024): 876-884.
32. Bacharier LB., et al. “Dupilumab in severe allergic asthma after omalizumab failure: real-world evidence”. The Journal of Allergy and Clinical Immunology6 (2023): 1498-1505.
33. Hellings PW., et al. “Safety profile of biologics in allergic diseases: a 2024 update”. Allergy 5 (2024): 1123-1134.
34. Maurer M., et al. “Dupilumab reduces IgE levels in patients with severe allergic diseases: implications for treatment sequencing”. Clinical and Experimental Allergy11 (2023): 1156-1164.

Citation

Citation: Chenchulakshmi Vasudevan. “Advances in Allergy Testing, Evaluation, and treatment: For an Otorhinolaryngologist's Practice".Acta Scientific Otolaryngology 7.11 (2025): 15-19.

Copyright

Copyright: © 2025 Chenchulakshmi Vasudevan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.