The use of immunotherapy in grass pollen allergic rhinitis has been proven in the short- and long-term (Durham et al., 1999). However, if there is cross-reactivity to a range of inhaled allergens, then im-munotherapy directed at one allergen is less effective. Similarly, the evidence to support allergen avoidance is mixed. The results of house dust mite desensitiza-tion have been equivocal. Fungal immunotherapy following surgery for allergic fungal sinusitis has helped prevent recurrence and it has been postulated that this may help patients with eosinophilic mucin rhi-nosinusitis (Ferguson, 2000). The benefits of allergen avoidance are contentious. When there is a marked single allergen, for example, to house dust mite, then going to great lengths to avoid this allergen has been shown to help. However, it is debatable how well these studies can be extrapolated into day-to-day practice, and whether patients are ready to comply with these measures. It appears that half-measures to reduce exposure to such allergens have little effect on the allergen load and are likely to be of little benefit.

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