Every treatment I prescribe for a child with asthma, from the daily preventer inhaler to antileukotriene tablets, works by suppressing or managing the symptoms of the disease. Inhaled corticosteroids reduce airway inflammation. Bronchodilators relax airway muscle. These treatments are effective and essential, but they share a fundamental characteristic: when they stop, the disease returns. Allergen immunotherapy is different in a way that matters. It is the only treatment that addresses the underlying immune dysregulation driving the allergic disease, and its effects persist for years after the treatment course is completed. As the Director of Vatsalya Superspeciality Children Hospital's dedicated paediatric allergy and asthma centre in Varanasi, where I offer both subcutaneous and sublingual immunotherapy, I want to explain what allergen immunotherapy actually does, who benefits, and what the treatment journey looks like for families considering it.
Why immunotherapy is fundamentally different from other asthma treatments
The immune system of an allergic child has learned to treat a harmless substance, whether house dust mite, cockroach, or pollen, as a threat. When it encounters that allergen, it mounts an IgE-mediated inflammatory response that drives airway inflammation in asthma, nasal inflammation in allergic rhinitis, and skin inflammation in eczema. Allergen immunotherapy works by re-educating this response. Small, increasing doses of the specific allergen are introduced over time, initially at very short intervals during the build-up phase, then monthly during the maintenance phase. Over the course of treatment, the immune system shifts from an allergic Th2-type response toward a tolerant response, producing regulatory T cells and allergen-specific blocking antibodies that reduce reactivity. The clinical evidence for this approach is strong. In children with confirmed allergen sensitisation and persistent asthma, immunotherapy reduces symptom scores, reduces medication requirements, and improves lung function. Critically, it reduces the risk of developing new allergen sensitivities - a meaningful benefit in a child whose allergic march is still evolving.
SCIT vs SLIT: which route is right for which child?
I offer both subcutaneous immunotherapy, SCIT, administered as injections in clinic, and sublingual immunotherapy, SLIT, administered as drops or tablets at home. My training at Sir Ganga Ram Hospital and the University of Colorado specifically included both routes, and the choice between them is made on clinical and practical grounds for each family.
SCIT involves regular clinic visits during the build-up phase, typically weekly or fortnightly injections over several months, followed by monthly maintenance injections for two to three years. It has the strongest evidence base and is suitable for a wider range of allergens. SLIT involves daily doses taken at home under the tongue, with less frequent clinic review. It is more convenient for families with school-going children or those who live at a distance, and it is well established for house dust mite, which is the most common sensitising allergen in children with asthma in Varanasi. The full course for either route is typically three to five years, and the benefits of immunotherapy persist for several years after the course is completed, which distinguishes it from every other treatment in asthma management.
Who is a candidate and when to start
Allergen immunotherapy is considered for children who have confirmed allergen sensitisation on skin prick testing or specific IgE testing, whose asthma and associated allergic rhinitis are not adequately controlled with appropriate pharmacotherapy, and who are old enough to cooperate reliably with the treatment schedule. In practice, I consider immunotherapy from around age five for SLIT and from around age six to seven for SCIT, though this varies with the individual child. I do not offer immunotherapy during an acute asthma exacerbation or in children with very poorly controlled severe asthma until their lung function and symptom control are stabilised. The decision to start is always made after a thorough allergy assessment, a clear discussion with the family about the time commitment involved, and confirmation that the family has the capacity to engage with a multi-year treatment course. Immunotherapy is not a short-term intervention. It is a commitment, and the families who complete the full course consistently report outcomes that justify it.
To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111.
Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.
Related reading
Childhood Asthma: A Complete Guide to Diagnosis, Treatment, and Long-Term Control
Pediatric Allergy and Asthma: Symptoms, Causes, and Care Tips
Pediatric and Neonatal Pulmonology: Breathing Life into Healthy Childhood
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