Are you or a loved one constantly battling the frustrating symptoms of seasonal or year-round allergies? You are not alone; millions around the globe are affected by sneezing, itchy, watery red eyes, stuffy, runny noses, and headaches. Avoidance of triggers and medications may provide temporary relief, but for those seeking a longer-lasting or more natural solution, immunotherapy (IT) can be life-changing. IT provides sustained benefits of decreased symptoms and medication use for years after treatment completion. Additionally, a full course of IT may prevent the development of future allergies and asthma. Despite these compelling benefits, most patients choose to use medications, even though studies have shown superior effects and cost savings from IT.

The reality is that traditional allergy shots (subcutaneous immunotherapy, or SCIT) are not a practical solution for many patients. A course of SCIT requires dozens of office visits (and injections) over 3 to 5 years. Alternatively, sublingual immunotherapy (SLIT) can be administered daily at home. When I first began offering this in my clinical practice around seven years ago, I thought that this would be the perfect fit for patients who lived far from the clinic or had needle phobias. Perhaps it’s not terribly surprising to learn that most people have a really hard time taking a daily allergy treatment. Studies have demonstrated similarly poor long-term adherence for both SCIT and SLIT. For years, allergists have been searching for the holy grail of treatments. Ideally, this option would be quick, easy, relatively painless, low risk, sustainable, and effective. We may finally be on the horizon with intralymphatic immunotherapy (ILIT).

Intralymphatic immunotherapy represents a significant advancement in allergy treatment. Unlike traditional allergy shots given under the skin, ILIT involves injecting small doses of allergens directly into the lymph nodes under ultrasound guidance. This approach aims to retrain the immune system more efficiently, reducing the allergic response in the long term. By targeting the lymph nodes, where a significant part of the immune response is coordinated, ILIT delivers allergens directly to the heart of the immune system. This direct approach leads to a fast and effective desensitization using small doses of the relevant allergens.

One of the most exciting aspects of ILIT is its potential benefits:

• Less time: ILIT treatment occurs over an 8-week period of time compared to the 3 to 5 years required by traditional allergy shots and drops/tablets.
• Fewer injections = less pain: ILIT typically involves ~3 injections compared to dozens, making it a much more convenient and an overall less painful option.
• Cost savings:  ILIT is calculated to have an overall lower cost of care compared to cost estimates for traditional allergy shots and multiple daily medications.
• Potential for long-term relief: Studies indicate that ILIT offers lasting relief from allergy symptoms similar to SCIT and SLIT.

The initial studies investigating ILIT began nearly 20 years ago in Europe, and since that time, we have seen a slow but growing body of clinical trial data supporting safety, tolerability, and effectiveness. The clinical adoption of ILIT has been slowed due to a number of factors within the insurance-driven U.S. health care system. That said, ILIT is beginning to become available outside research protocols for aeroallergies, including those to trees, grasses, weeds, molds, dust mites, and pets. When it comes to venom and food allergies, ILIT remains a promising treatment modality under investigation. Current studies are exploring its efficacy and safety, and while initial results are encouraging, more extensive clinical trials are needed. The future of ILIT could revolutionize how we approach allergy treatments.

Kara Wada is a board-certified academic adult and pediatric allergy, immunology, and lifestyle medicine physician, Sjogren’s patient, certified life coach, TEDx speaker, and Dr. Midwest 2023. She can be reached at Dr. Kara Wada and on Instagram, YouTube, Facebook, and LinkedIn. She is a national expert, sought-after speaker, advisor, and host of the Becoming Immune Confident Podcast. She is CEO and founder, The Crunchy Allergist and the Demystifying Inflammation Summit, and serves as the director of clinical content for Aila Health.

Amber Patterson and Tiffany Owens are allergy and immunology physicians.