Abstract This review presents a general picture of the current trends and developments (2008–2013) related to electrochemiluminescence-based immunosensors. It briefly covers the milestones of qualitative changes in the field of electrochemiluminescent immunosensors; the peculiarities of the electrochemiluminescent immunoassay formats; the basic mechanisms of ECL detection, main features of early and ongoing approaches in electrochemiluminescent immunoassay commercial instruments, and the recent developments in fabrication of solid-state electrochemiluminescent immunosensors. Moreover, systematized data on biomarkers, immunoassay formats, and novel types of electrochemiluminescent label and immobilization support, such as semiconductor nanocrystals, porous noble metals, graphene, TiO2 nanotube arrays, metal–organic composites, multiwall carbon nanotubes, liposomes, photolummonescent carbone nanocrystals are presented as a table. Considerable efforts have also been devoted towards the following two key points: multiplexing analysis (multi-label, and the multianalyte strategies) and integration in microfluidic lab-on-paper devices with capabilities for point-to-care diagnostics. An immuno-like electrochemiluminescent sensor (based on synthetic receptors—molecularly imprinted polymers), as a new alternative to traditional electrochemiluminescent immunoassay is highlighted. Future perspectives and possible challenges in this rapidly developing area are also discussed.