REVIEW Open Access Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report Giovanni Battista Pajno 1* , Roberto Bernardini 2 , Diego Peroni 3 , Stefania Arasi 1,4 , Alberto Martelli 5 , Massimo Landi 6,7 , Giovanni Passalacqua 8 , Antonella Muraro 9 , Stefania La Grutta 7 , Alessandro Fiocchi 10 , Luciana Indinnimeo 11 , Carlo Caffarelli 12 , Elisabetta Calamelli 13 , Pasquale Comberiati 14 , Marzia Duse 11 and Allergen-specific Immunotherapy panel of the Italian Society of Pediatric Allergy and Immunology (SIAIP) Abstract Allergen-specific immunotherapy (AIT) is currently recognized as a clinically effective treatment for allergic diseases, with a unique disease-modifying effect. AIT was introduced in clinical practice one century ago, and performed in the early years with allergenic extracts of poor quality and definition. After the mechanism of allergic reaction were recognized, the practice of AIT was refined, leading to remarkable improvement in the efficacy and safety profile of the treatment. Currently AIT is accepted and routinely prescribed worldwide for respiratory allergies and hymenoptera venom allergy. Both the subcutaneous (SCIT) and sublingual (SLIT) routes of administration are used in the pediatric population. AIT is recommended in allergic rhinitis/conjunctivitis with/without allergic asthma, with an evidence of specific IgE-sensitization towards clinically relevant inhalant allergens. Long-term studies provided evidence that AIT can also prevent the onset of asthma and of new sensitizations. The favorable response to AIT is strictly linked to adherence to treatment, that lasts 3–5 years. Therefore, several factors should be carefully evaluated before starting this intervention, including the severity of symptoms, pharmacotherapy requirements and children and caregivers’ preference and compliance. In recent years, there have been increasing interest in the role of AIT for the treatment of IgE-associated food allergy and extrinsic atopic dermatitis. A growing body of evidence shows that oral immunotherapy represents a promising treatment option for IgE-associated food allergy. On the contrary, there are still controversies on the effectiveness of AIT for patients with atopic dermatitis. This consensus document was promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP) to provide evidence-based recommendations on AIT in order to implement and optimize current prescription practices of this treatment for allergic children. Keywords: Allergy, Asthma, Atopic dermatitis, Children, Food allergy, Allergen-specific immunotherapy, Sub-lingual immunotherapy, Subcutaneous immunotherapy * Correspondence: giovanni.pajno@unime.it 1 Department of Pediatrics, Allergy Unit, University of Messina, Via Consolare Valeria-Gazzi, Messina 98124, Italy Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Pajno et al. Italian Journal of Pediatrics (2017) 43:13 DOI 10.1186/s13052-016-0315-y