Amber: Love the idea of allergy shots, but just don't have time? Tired of frequent appointments for getting your injections? Well, maybe there's a faster, more convenient way to get you that relief from hay fever and allergic asthma. Get ready for allergy shots 2.0 as we dive into ILIT, Intralymphatic Immunotherapy and help figure out if it's right for you.

Why ILIT is a Game-Changer for Patient Adherence

Amber: Ladies, you're both expert allergy shot allergists. You offer Interlymphatic Immunotherapy, ILIT, sublingual, SLIT, subcutaneous, SCIT, traditional shots. Tell me when you first heard about ILIT, what was it about it that you thought, "Wow, this could be a game changer for my patients?"

Meagan: We were both lucky enough to be in training whenever we heard about I, well, I was, you know, we had talked before about how we all happened to be there whenever you were doing the research. And Dr. Kundig came over to give the talk about ILIT. And so I was fascinated. I had always thought, and this is, I can't remember if I was a first or second year fellow, but I remember thinking, I'd always just thought allergy shots were so much time. People just don't have time for that.

Kara: Yeah.

Meagan: We're busy and shots that if you're ever told, "Hey, you can do these shots at home", they're not going to be well say they, they probably even shouldn't be as effective as a shot in the office because, you need to be able to deal with the reaction. So you really need to be in the doctor's office, it's a ton of time and being able to reduce it like that is an amazing thing.

Kara: I think I came from a similar adjacent frame of mind. One of the things you learn early in medical school is about, well, at the time we called it "compliance," but adherence. How hard it is for us as humans because human behavior, it's hard to show up time and time again. And and I think, through my experience wealth of experience with sublingual immunotherapy, my initial thought was, "Gosh, if someone could do this at home, that might be more convenient," but we know it's still really hard for people to remember to take a medicine or a treatment every single day.

I was talking to a patient yesterday who, their eczema would be so much better controlled if if he could incorporate putting lotion on after every shower, but it's hard to do that, right? And and so, gosh, we know like the, the simpler things are, the, the less often or the the less frequent we need to show up, the less total number of times we need to show up, the higher likelihood it is that someone will follow through to completion. And so, I mean that on its own was like, wow, this is a huge game changer.

Meagan: I was just gonna say that it took so, It was faster to see a result. That's the other issue with allergy shots is they work, but they just work over a long period of time, and I'm very impatient and yet I know that they're going to work. And I can't imagine how that feels as a patient too, as sort of kind of doubtful. And it sucks to come for these shots each week and that thought, like, "wow, seeing something that works really quickly is probably the best way we can get people on board".

Amber: Yeah, I agree. It's like when we're thinking about any treatment, first, is it safe? Second, is it actually gonna help the patient? But third, are, are they going to use it? And when we look at adherence data for SCIT, traditional shots and SLIT, I mean, it's all over the board. There are some studies that show upwards of 80% adherence, but some 16%, and on average about 50%.

With ILIT, we get close to a 100% adherence, and I think a lot of that has to do with the schedule, like you guys said.

What is ILIT? The 3-Injection Protocol Explained

Amber: ILIT, for those of you who haven't heard of it, it's a off-label, it's not FDA approved, but using FDA approved extracts for administering allergy shots, ultrasound guided directly into a lymph node, and it's a more efficient process of delivery.

So, in terms of biomolecular logistics, we're going right to the source of where that antigen needs to go. So we can do one injection every four weeks. After the third injection, or eight weeks you're done and you're seeing improvement within a month of finishing that treatment. So it's quick. And the other thing currently not covered by insurance, but for a lot of people, you're out of pocket for a three to five year course of SCIT is, is gonna be around the same or even more potentially. So ILIT can be a cost savings for a lot of people. With that in mind too, I think that helps with the motivation for adhering to your treatment. If you know you only have to get to the office three times and you're paying for it, you're gonna do it.

Meagan: So as far as the off-label thing, by the way, I've had a patient who was hesitant and ended up not wanting to do ILIT because of that. And of the things that I tell people now after I've thought a lot about it, is that, like Amber said, the extracts that we're using are the same extracts that we use for regular shots.

And when you actually get into the nitty gritty of immunotherapy, there are actually only, is it 13 extracts that are standardized by the FDA. So, in other words, most of those and a lot, a lot of those are venom. So there are very few extracts that we use that are technically standardized. And I feel that, that for ILIT is just something to think about that for whenever you have regular allergy shots, there are things that are not it's not that it's not closely looked at, it's just that the, the FDA approval, I think for that is not something that would, would put, put me off for that.

The Key Safety Advantages of ILIT (Bypassing Mast Cells)

Amber: Mm-hmm. How do you approach explaining the safety aspect of ILIT? You know, compared, if you're explaining this compared to maybe SCIT?

Kara: So I talk a lot about mast cells since I see a lot of people with some, some pretty irritable mast cells. Taking care of a lot of people with mast cell activation. Mast cells on the whole are primarily found in our connective tissue, kind of, and, and there are very few to none found within our lymph nodes.

Mast cells are the cells that are primarily responsible for causing those whole body allergic reactions, so those anaphylactic reactions. And so, when we are directing this allergen directly into a space that is, has fewer mast cells than the place we normally would put it that's, that's one advantage.

Now, certainly you are going through the skin, you're going through a little connective tissue on your way to the lymph node but we, you know, do our best to prevent any kind of leakage of that allergen out of the, the syringe. And the other aspect is we're actually using a smaller amount of allergen compared to what we would put in that connective tissue directly with those mast cells. And so when I think of it for, especially my patient population, who on the whole, I tend to see some very sensitive, folks who kind of are the canary in the coal mine, individuals. And in my mind I feel so much safer, more controlled. We only have those three visits that we have to worry about compared to dozens, if not hundreds. And gosh, that's, those are two really huge advantages.

Meagan: That's another thing I tell patients too, is if I have a lot of patients who will say, "Well, I tried allergy shots, but I couldn't tolerate it because I kept having these large local reactions." Or an honest, another another example would be people who are scared of needles, and I'll say, well, the advantage of ILIT is, you may actually, you can have a, a, a large local reaction in the area.

It's, it's a lot less common, but you can, but this would happen three times instead of, a hundred or more times over the course of the next five years. And so doing that is much easier whenever, you're just gonna do it three times.

Amber: Yeah. And, I'm not a statistician by any means, but when you think about the cumulative risk for the number of injections over time, you're reducing that significantly. So definitely something.

Kara: Almost an order, What, a couple orders of magnitude?

Meagan: Mm-hmm.

Amber: We need a statistician to comment to help us with that. What'd you say, Meagan?

Meagan: It's overwhelmingly better tolerated by than than SCIT in general, most patients really have very little side effect. I'm sorry, I got distracted because my dog started barking and the kids came in with a soccer ball.

Amber: That's our lives, right?

Kara: Yeah, I, I had my 6-year-old like waving to me earlier. I was like, "Oh, go talk to your dad."

Amber: Aw. 

The Science & Effectiveness of ILIT

Amber: So efficacy of course, is another thing that we think about when we're choosing treatments for our patients. And we can look at data and say, okay, there're these studies with this many patient that show that, you know, like one of the pivotal studies about ILIT was that first study out of the University of Zurich that Dr. Kundig and Dr. Senti and Dr. Johansen, their group put out that was so eloquently written where they compared a group of patients allergic to grass pollen treated with ILIT versus SCIT over a three year period and they tracked all those patients and then they followed them up 19 years later. And to be able to show that what we're doing with ILIT is similar to what we can see with SCIT in terms of effectiveness and, and length of benefit of treatment I think gives some confidence.

But then actually treating your patients with a new therapy is kind of a next level of, when you're using something for the first time, sometimes as a physician, it's hard to know, like, gosh, is it really gonna work for my patients? Tell me about, like, have you either of you gone through that mentally, like when you first started to maybe now where you've treated patients with this and seen how the, they get benefit from it?

The "Off-Label" Status & Cost Discussion

Meagan: I struggled a lot in the beginning because it is something that as of now in the United States, insurance won't cover. And so I live in West Virginia and as far as median state income and things like that, we're always near the lowest. And so I did not want this to be something that a lot of patients had to miss out on.

And I, I've initially felt guilty sort of trying to, I don't wanna say sell it, but talk people into doing it because it is so beneficial. And what I ended up realizing was I saw patients getting better. And again, I saw SCIT patients get better, but it was, after five years of therapy. But seeing ILIT patients get better and get better so quickly, very, it was, it was very soon that I realized that it was life changing. And it wasn't something you really had to wait on to happen, that it was such a life changing invention, I guess, that I felt like it was worth it for everybody to try to have it.

Amber: Mm-hmm. I had a patient one time similar thing like early on when I was first offering it clinically, that was on Medicaid that I did not suggest ILIT as an option for, and she heard out, heard about it kind of through the grapevine, and came back to me and said, "Why didn't you offer this to me? I wanna do ILIT."

And I said, "Well, I guess, to be honest, I, I didn't want to give you something that I knew your insurance wouldn't cover. And I didn't, I mean, I just didn't think that would be an option." And she said, " First of all, how about you worry about your finances. I'll worry about mine. I have a family member that's well off and wants to gift this procedure to me and I wanna do it."

And I thought, wow, that was a really eye-opening experience for me because we make assumptions about things and I think, especially in the medical world, we have this ethical dilemma like you mentioned, Meagan, of we want, we wanna be able to offer things that everybody can have access to. And so, I guess we shouldn't take cash-based procedures off the table in that regard.

Meagan: Yeah, that's a good point because, the, the way the system is in the United States getting something to go before the FDA, like we talked about, it doesn't behoove extract companies as well to use to advocate for something that uses so much less of their product.

Amber: Mm-hmm.

Meagan: Is it, do we ever think that it will actually go before the FDA and then become, something that insurance will cover? It, it may not, but, I still, but I agree that it's something everybody should have access to. And so at least for us, we have, and I think all of you guys have done this, we have different payment plans and things like that.

Amber: Yep.

Meagan: You can use your FSA, HSA to make it more affordable for everybody. 

Amber: Well, thank you guys for sharing your experience about ILIT and being with us today on, on the show. Leave comments about what you think about ILIT and if what you wanna know more about it, how it works, anything like that. Subscribe. Hit that bell and,

Kara: To find, and to find a qualified allergist through your area, you can check us out at the AUNI ILIT Learning Network.

Amber: Good point, Dr. Wada.

Kara: Dr. Patterson has put together this amazing network of, these true, these folks have really invested in learning and becoming experts in this area. Really staying right in step with the science helping contribute to the science.

And so, those are the folks you wanna connect with who are going to be your go-tos if you're interested in seeing if you're a candidate for this therapy.

Meagan: And we've learned from the best because I would like to point out again that Dr. Amber Patterson was the first in the world to do ILIT research in children and adolescent. So, she is the head of the AUNI ILIT Learning Network and got all of this started for all of us. So we are very thankful to have been given the chance to learn with her. So

Amber: Thank you guys.

Meagan: Everybody should know what a big deal you are to us.

Finding a Provider: The Auni ILIT Learning Network

Amber: I appreciate that. So check out ILIT Learning Network and see all of our expert physician ILIT providers like Doctors Shepherd and Wada and others, and we'll see you next time on ​ 

Kara: Allergy, Actually.

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