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.
This article is discussed on The Podcast by KevinMD: Intralymphatic immunotherapy and the future of allergy care.
Kara Wada is a quadruple board-certified pediatric and adult allergy and immunology, lifestyle, and functional medicine physician, a Sjögren’s disease specialist, and a Sjögren’s patient herself. She spent nine years on faculty at The Ohio State University Wexner Medical Center, where she served as associate program director of the allergy and immunology fellowship and led the Mast Cell Center of Excellence.
In 2025, she left academic medicine to build the kind of practice she could not find as a patient: the Immune Confident Institute, a national direct-care immunology practice licensed in 27 states. She treats the patients the health care system sends ping-ponging between specialists, people with complex, chronic, multisystem disease including mast cell activation syndrome (MCAS), dysautonomia, Sjögren’s disease, immune dysfunction, and the seronegative and “in-between” diagnoses that do not fit neatly into a single specialty.
Her premise is simple: These patients are not the problem. Fragmented care is. Medicine has become exceptionally good at looking through microscopes while losing sight of the telescope, the bigger picture of the person in front of us. Her work challenges a health care culture that demands compliance when it should assume competence, and aims to make strategic, compassionate immune-directed care the standard, and the exam room a place where patients are finally seen, heard, and believed.
Most of her reach is built outside the exam room. Her YouTube channel drew roughly two million views this past year, and more than 100,000 people follow her work across platforms, including a Sjögren’s community of about 6,600. She founded and hosts the Virtual Sjögren’s Summit, now in its sixth year and drawing some 4,300 registrants worldwide. She appears regularly on national television and in the health press, including Prevention, SELF, Good Housekeeping, WebMD, Medscape, and MedPage Today, and she writes for KevinMD on the diagnoses that live in the shadows and the medical gaslighting that surrounds them.
A TEDx speaker and sought-after keynote, Wada speaks to clinician and patient audiences about complex immune disease, the experience of being disbelieved, and what changes when the physician is also the patient. She is also an unlikely pageant titleholder, having served as Dr. Ohio America 2022 and Dr. Midwest America 2023, and has written about how pageantry sharpened skills medicine rewards but rarely teaches.
She earned her medical degree with honors from the University of Illinois College of Medicine at Peoria and completed internal medicine-pediatrics residency, allergy and immunology fellowship, and clinician educator fellowship at The Ohio State University and Nationwide Children’s Hospital. She lives in Columbus, Ohio, with her medical school sweetheart turned husband, Akira, and their three children.
Amber Patterson and Tiffany Owens are allergy and immunology physicians.
