Allergy specific immunotherapy (SIT) has been established as an effective treatment in patients with allergic asthma and rhinitis. Although its efficacy has been relatively controversial in patients with atopic dermatitis, recent controlled trials and meta-analyses have reported significant improvement in subjective symptoms in some patients with moderate-to-severe atopic dermatitis. There are a few limitations with SIT safety and patient compliance. Efforts are being made to overcome these limitations, including using recombinant allergens and adjuvants, as well as different routes of administration, such as transdermal delivery. Herein, we review the mechanism of SIT in patients with atopic dermatitis, clinical trial results, its use in clinical practice, limitations, and future direction. (Korean J Dermatol 2018;56(2):91∼98)