Allergy is a systemic disease. It cuts across the entire system of the human organism but it generally affects the skin and mucous membrane of the respiratory and GIT systems. Since airborne allergens are abundantly present, easily find their way into the human respiratory system and chance of contact with them is the highest, respiratory allergy is the commonest of all types of allergy. Nose being the main door to the respiratory system, bears the brunt of allergic insult and so allergy affecting the nose or allergic rhinitis (AR) is the commonest allergic manifestation.Prevalence of AR is quite high especially in children and younger adults of productive age group. In North America, Settipane reports that up to 49% of total population suffers from mild to moderate to severe AR. In India, it is suspected that 20% - 30% of population especially in urban and semi urban areas, suffers from AR.If AR is mild and intermittent, it may not be taken serious and may be treated with or without medication. Once the disease is persistent, it has to be dealt with in a systematic way. Allergic inflammation has to be addressed adequately. Otherwise the continuity of unaddressed inflammation does cause a lot of morbidity and impact the quality of life of the sufferer. It can re-modulate the intranasal and surrounding tissue. Cascading inflammation can cause co-morbid allergic conditions in sinuses, eyes, ears, pharynx, larynx, trachea and ultimately cause asthma. Evidence shows that a very big majority of cases of AR become asthmatics over a course of time. Adequate management of AR will improve the quality of life of sufferer and may also impede the onset of asthma and other co-morbid conditions.Genetic predisposition has been an accepted factor for development of allergy. Recent findings show that early administration of antibiotics to infants and children, especially on speculated indications and in inappropriate doses damages the gut flora thereby increasing the susceptibility of a child to develop atopy. Evidence also shows that administration of antibiotics in third trimester of pregnancy ups the possibility of development of atopy in the growing fetus. Usage of germicidal and bactericidal products in dwelling places results in a sterile indoor atmosphere. Immune system of an infant growing in such a sterile atmosphere gets primed to develop allergy.Non-allergic triggers are irritants like smoke, fumes, smells, infections, infestations, emotional disturbances, chronic stress and endocrine disturbances. Air pollution of ambient air has been considered a major trigger.Allergens are protein in nature. They can be ingestants, injectants and inhalants. Any of the ingested food can cause an allergy but protein-rich foods are common allergens. Milk, Egg white, Wheat, Nuts, Legumes, Sea food, Preservatives, Food additives and Coloring agents are common food allergens. Drug injection, Honeybee sting, Ant bite are good examples of injectants. Inhalants are the commonest allergens in airway allergy. Indoor allergens can have their source from molds, pet animals, insects and house dust. House dust is a mixture of organic and inorganic substances. If you store the house dust, corresponding to the period of storage, its allergenicity increases thereby showing that there is a viable material in house dust. This viable material is a tiny little insect called house dust mite. Their dead or alive parts and tiny little fecal pellets become airborne and are virulent allergens. Moulds are also present outdoors but plant pollen are the predominant outdoor allergens.Specific diagnosis of allergy can be by in-vitro or by in-vivo test. Determining allergen specific IgE in an atopic individual must be the aim of an ‘allergy test’. Determination by doing Skin Prick Test (SPT) is the in-vivo technique. Determination by an enzyme test is the in-vitro test.In-vitro test is a good test but it is yet to be developed for our local allergens comprehensively. One sample of patient’s serum is enough to run the test for many allergens. It is non-invasive. It provides a quantitative analysis of circulating allergen specific antibodies but it does not provide a qualitative analysis. Comparatively it is a very expensive test. It may be applied for some universal allergens and as a confirmatory tool after SPT.Universally SPT is the gold standard allergy test as of now. This in-vivo test is a fairly simple test, is reliable and is quite cost-effective. It provides both quantitative and qualitative analysis. The results have been found to be well comparable to those of nasal challenge test and bronchial challenge test. Done properly and with good quality allergens, SPT is quite adequate and is valuable.Medical Management of allergy, especially when the disease is persistent is mandatory. It can control the disease and provide symptomatic relief. Anti-inflammatory drugs can control the symptoms and even suppress the allergic inflammation but cannot modify the disease for better. There is no medicine that can cure allergy. Complete avoidance of exposure to the causative allergen/s and or Allergen Specific Immunotherapy (AIT) are the only tools having curative advantage. Allergen avoidance is easy said than done in most of the case.For allergens that cannot be avoided, AIT provides a path of multiple benefits. AIT is the only curative tool we have, if at all. AIT can alter the course of allergic disease for good. AIT is capable of changing the Th2 status (allergic) to Th1 status (normal). AIT is capable of impeding the onset of asthma in cases of allergic rhinitis. AIT can impede poly-sensitization. AIT is capable of medication sparing effect. There is enough evidence that the benefit of AIT continues to be present for a long tenure even after concluding the therapy. AIT has the capacity to provide long-term protective benefit against development of various other allergic conditions.Subcutaneous AIT (SCIT) or Sublingual AIT (SLIT) as a choice is left to the clinician and the patient considering various angles of therapy and tenure. Evidence shows that currently SCIT has a slightly better benefit profile than SLIT. If the patient is under the care of the specialist, SCIT is a good option. If compliance is an issue even under the care of a specialist, SLIT is a better option. Patient and the family have to be impressed upon the necessity of maintaining the protocol of administration. Possibility of systemic reactions and anaphylaxis that is a major concern in SCIT, is almost eliminated in SLIT. SCIT or SLIT, whichever is the route of administration, proper diagnosis, good quality allergens, compatible and proper combination of allergens and compliance are crucial to successful treatment by AIT. Depending on the severity of symptoms, a careful dilution must be worked out and dose and or concentration have to be built up gradually to reach a high concentration so that the patient ultimately gets adequately high dose of allergen/s as maintenance to achieve therapeutic benefit. AIT will not be appreciable in its profile of benefit if it is administered in cases of mild allergy conditions. When the disease is persistent, moderate or moderate-severe, AIT would be a great option in addition to medical management.Successful AIT will initiate a marked enhancement of protective blocking IgG antibodies. AIT will blunt the blood concentration of specific IgE antibodies. There will be a down-regulation of inflammatory cell recruitment, activation and mediator release. These will modify the T-Lymphocyte response to the benefit of the patient. Th2 response will get down-regulated resulting in enhanced Th1 response.Simplest measure is the response to SPT before initiation of AIT and after a substantial period of AIT. Blunting of IgE is demonstrated on SPT with a marked reduction in skin response.Poly-sensitization is a common feature in patients. It happens over a course of period. Earlier the AIT administered, better it is so that poly-sensitization is prevented. Children are the best candidates. Intervention happens before re-modulation occurs. AIT will also provide cost-effective process.In adults and children alike, a judicious combination of AIT, medical management and correction of allergen-rich environment have become the hallmark of providing complete solution to the persistent suffering of allergy patients. Wherever necessary, an effort must be made to change the existing life style to suit the prevailing condition to achieve best results.