Apart from allergen avoidance and pharmaceutical medication, specific immunotherapy (SIT) represents the third most important mainstay in a balanced therapeutic concept for the treatment of allergic rhinitis. For subcutaneous immunotherapy (SCIT) there is evidence for therapeutic clinical effectiveness, duration of the therapeutic result, prevention of bronchial asthma, reduced generation of additional co-sensitization and safety of the procedure. The present guidelines on allergen-specific immunotherapy (SIT) were established by the German allergy societies in 2006. Another option for specific immunotherapy in future is the sublingual route (SLIT). This method might play an important role as in-vitro studies indicated that oral Langerhans cells are potential target cells involved in the tolerance-induction of SLIT. However, questions concerning SLIT and prevention of bronchial asthma, reduced generation of co-sensitization and long-term effects have not yet been fully clarified. Furthermore, this paper gives an overview on recent innovative strategies in SCIT and SLIT, such as cluster and rush schemes, pre-seasonal therapy, recombinant allergen extracts and additive therapy with adjuvants or IgE-specific antibodies, high-dosis SLIT preparation or allergen tablets.