Allergy has evolved significantly since its early twentieth-century origins, with pivotal contributions from Carl Prausnitz and Heinz Küstner’s groundbreaking work in 1921. The field has seen rapid advancements, from the introduction of antigen-specific immunotherapy in 1914 to the identification of IgE in the 1960s. Despite the broadening scope of medical specialties, Otolaryngology has maintained a critical role in allergy management. Early pioneers like French Hansel integrated allergy into Otolaryngology, establishing practices that remain foundational today. The official recognition of allergy as fundamental component of Otolaryngology by organizations such as the American Board of Otolaryngology—Head and Neck Surgery and the Accreditation Council for Graduate Medical Education (ACGME) underscores the importance of this field. Contemporary Otolaryngology practices routinely address allergic conditions affecting the upper airway, and understanding the pathophysiology of IgE-mediated responses is crucial for accurate diagnosis and management. Food allergies, characterized by immediate and delayed reactions, present unique challenges, while the relationship between allergy and chronic rhinosinusitis (CRS) remains complex and evolving. Allergic responses may overlap with symptoms of laryngeal and esophageal disorders, complicating clinical presentations. In otology, allergy’s impact ranges from chronic otitis externa to potential associations with middle ear and inner ear diseases, though high-level evidence supporting allergy treatment for these conditions is limited. A comprehensive grasp of allergy enhances the Otolaryngologist’s ability to manage a diverse array of head and neck disorders, integrating both surgical and non-surgical approaches for optimal patient care.