Respiratory allergies in horses are a common health problem and can vary from mild discomfort easily managed with husbandry changes to severe, performance-limiting effects with animals unable to participate in their routine training programs. Classic allergies are primarily Type 1 hypersensitivity reactions, in which the body produces immunoglobulin E (IgE) against normally innocuous environmental molecules. Other changes seen with Type 1 reactions include T-cell dysregulation, hyper-reactive responses of various organs (usually lungs and skin), and changes in the secretion of various cell-to-cell mediators. Allergies are generally suspected via history and clinical signs, but advanced tools such as upper airway endoscopy or bronchioalveolar lavage may be needed for confirmation. The key to allergy treatment is environmental changes, but this takes time and may be impossible based on a horse’s lifestyle. Conventional medications to treat allergies have focused on anti-inflammatory and bronchodilator administration, which provide rapid relief, while the environment is modified if possible. Integrating traditional Chinese veterinary medicine (TCVM) provides an additional approach to medical treatment that may reduce the need and/or dose of conventional medications, particularly during long-term disease management. It offers a variety of modalities such as acupuncture, Chinese herbal medicine, and food therapy that can be targeted to patient need and temperament. Significant improvement in quality of life may be seen with the individualized patient management that integrating TCVM treatment provides. This paper reviews immune mediated mechanisms associated with allergic respiratory disease and explores both conventional and TCVM based treatment protocols used to treat affected horses.