Allergy has been linked to otologic pathologies of the external, middle, and inner ear with distinct clinical presentations. The external ear may be affected by contact dermatitis or a dermatophytid reaction, necessitating clinical differentiation from other etiologies of chronic otitis externa and treatment of the offending agent. The eustachian tube can become dysfunctional by mechanical obstruction or failure of dynamic clearance in the setting of allergic rhinitis. This may lead to otitis media with effusion. The middle ear may be a primary site of independent allergic activity. Eosinophilic otitis media represents a distinct subset of otitis media with effusion related to bronchial asthma and nasal polyposis, but with a postulated etiology of patulous eustachian tube and a potential target of monoclonal antibodies. Meniere’s disease is also associated with allergy, but the underlying pathophysiologic link remains uncertain, and the recommendations for immunotherapy are relatively weak.