The development of new vaccines remains an attractive goal for disease prevention and therapy, in combination or alternative to drug-based treatment. In parallel, a growing awareness of the importance of early diagnosis in successful disease management is driving the demand for new reliable diagnostic tools. As a consequence, over the last decades an impressive amount of work has been directed toward the search for new solutions to address vaccine design and biomarker discovery. In this context, peptides have generated considerable interest thanks to their general accessibility and ease of manipulation. The aim of this review is to provide the reader a general picture of the traditional peptide-based strategies adopted in immunology and to report on recent advances made in this field, highlighting advantages and limitations of classic versus innovative approaches. Case studies are described to provide illustrative examples, and cross references to more topic-focused and exhaustive reviews are proposed throughout the text.