OBJECTIVES: Allergic rhinoconjuntivitis is a global health problem, and many studies have shown an important increase in the disease prevalence in the last 20 years. Allergen specific immunotherapy (SIT) is the only available treatment for the underlying cause of the disease. At present, few economic evaluations are available for Italy. The present study is focused on the cost effectiveness of SIT in Italy, considering the fragmented reimbursement policies in different Regions of the Country. METHODS: A review of the literature on the pharmaco-economy of immunotherapy for allergic rhinoconjuntivitis with a special focus on Italy (costs taken from Italian formularies, tariffs and Diagnosis Related Groups, or DRG). Reimbursement values were taken from official regional resolutions RESULTS: Treatment with SIT reduced by 38% symptomatic drugs consumption (whose costs are ranging from € 0.1 to € 0.5 per unit). Moreover, SIT reduced by 30% symptoms intensity (impacting on GPs and specialists visits, whose cost are ranging from € 13 to  € 18, respectively) and by 20% the development of allergic asthma (which implies € 190 for one day of hospitalization). There are wide differences in SIT reimbursement across Italian Regions, ranging from 100% in 3, to various level of copayment in 7, down to no reimbursement in 10. CONCLUSIONS: Overall, these data support the favorable impact of SIT on the medium-long term in front of a relative cost increase in the short term. This benefit is still not fully recognized in Italy where differences persist across regions in the access to SIT reimbursement