Christopher Brooks, MD, an allergy and immunology physician at The Ohio State University.

Christopher Brooks, MD

treatment research is increasingly focused not only on improving efficacy but also on reducing the burden that existing therapies place on patients and families. Although oral immunotherapy and biologic therapies such as omalizumab have expanded the range of management options available in recent years, investigators continue to explore alternative approaches that could make immunotherapy more accessible, efficient, and potentially safer for broader patient populations.

One area drawing early interest is intralymphatic immunotherapy (ILIT), a delivery strategy already being studied and used in environmental allergies that involves targeted injections into lymph nodes rather than the prolonged schedules required with conventional allergy shots. While research in food allergies remains in its earliest stages, investigators are beginning to examine whether ILIT could eventually offer a shorter, more flexible treatment pathway for patients with food allergies.

In recognition of Food Allergy Awareness Month, 

 spoke with Christopher Brooks, MD, an allergy and immunology physician at The Ohio State University, about the emerging role of ILIT in food allergy research. Brooks discussed the current focus on safety, why the approach has gained attention among investigators seeking alternatives to traditional immunotherapy models, and what hurdles remain before ILIT could become a viable clinical option for food allergy management.

You're actively researching intralymphatic immunotherapy—a delivery route most clinicians probably haven't heard much about. Can you explain the concept and why it excites you? Where does it stand right now, and what would need to happen for it to become a real clinical option?

We're [at] the very start of using ILIT for food allergies. There was one group in California that started to do it for a short period of time, and they didn't continue their research in that area. We're essentially at a place [where] we are using ILIT right now for treatment of environmental allergies. Based on our knowledge, [it] potentially could be used to treat food allergies. We're very early on that.

We want to make sure that it's not going to cause an excessive number of food allergic reactions because, of course, the ultimate goal is to decrease the number of reactions that people have and help treat food allergies. We're at a place [where] we're trying to determine safety right now. Once we determine it [is] safe, then the next step is going to be making sure that it has enough effectiveness [to be] a good treatment option for patients.

What drew you specifically to intralymphatic immunotherapy as a research focus? It's not the dominant modality getting attention right now. What do you see in it that others might be underestimating?

What I saw when I was really stuck with just using conventional allergy shots for treatment of environmental allergies was that there wasn't much flexibility. For normal allergy shots for environmental allergies, patients have to come in initially weekly. It takes three months to 12 months of coming weekly. Then I have to do [it] monthly for a long period of time. There were a lot of patients [who] just couldn't do that, so [ILIT] was giving patients options. [It] started to become more important to me.

Currently, for environmental allergies, [I] offer normal allergy shots or subcutaneous immunotherapy, sublingual immunotherapy… and now ILIT.

With being involved in the ILIT world for environmental allergies and [being] approached from one of the leaders about… [whether we] would want to be involved in a clinical trial, potentially for the treatment of food allergies, that's how I got into that role. ILIT wasn't something that I had really [learned] back in training.

Read the first part of the Q&A focusing on personalized food allergy management here: 

Personalized Food Allergy Care Gains Momentum, With Christopher Brooks, MD

Articles

In this Q&A, Christopher Brooks, MD, discusses advancing research on intralymphatic immunotherapy for environmental and, more recently, food allergies.

How Close Is Intralymphatic Immunotherapy for Food Allergies?

 care is evolving rapidly, with increasing recognition that management extends beyond strict avoidance and emergency preparedness to include proactive, individualized strategies. A more personalized approach to risk reduction is reshaping conversations between clinicians and patients. At the same time, misconceptions about food allergy testing and diagnosis continue to create challenges across specialties, particularly as more patients seek answers about suspected reactions and long-term management strategies.

 spoke with Christopher Brooks, MD, an allergy and immunology physician at The Ohio State University, about how advances in food allergy research are translating into clinical practice and where gaps in care remain. Brooks discussed the importance of individualized treatment decisions, the expanding role of omalizumab, and why food challenges remain an underused but critical tool in confirming true food allergy diagnoses.

Drawing from both academic research and day-to-day patient care, Brooks also highlighted differences between pediatric and adult food allergy management, including the ongoing effort to make emerging therapies safer and more effective for adults. He emphasized the need for greater education across primary care and other specialties, particularly around the limitations of blood testing and the importance of avoiding unnecessary dietary restrictions or treatment burden in patients who may not actually have a food allergy.

How does practicing at an academic medical center and your involvement in research shape the way you approach food allergy management compared to what community-based allergists might be doing day-to-day? What do you wish were translated more quickly into general practice?

One big area is being involved with fellows and…their education and working with a lot of different people that are on that cutting edge of [research].

From a food allergy standpoint, there's been a lot of avoidance of the food…and not really thinking about some of the nuances of it. Because I'm working with a lot of people [who] have a lot of cutting-edge knowledge in that area, [it] helps us to have a more personalized approach.

Food allergy prevalence has been climbing for decades.

From your vantage point in both the clinic and research, do you think clinicians across specialties, such as primary care, GI, and pediatrics, are equipped to have the right conversations with patients today?

Some primary care providers are, and some aren't. Primary care providers are well-equipped to have conversations with patients if they have…really good knowledge of what testing can do for [patients], like blood testing. If a patient has a concern for a food allergy, but there's a positive but low positive blood test, that doesn't necessarily mean they have a food allergy. Really, we need to do a food challenge. Some primary care doctors understand that, and some don't.

Omalizumab is now FDA-approved as a risk-reduction therapy for food allergy, and there's growing interest in combining it with OIT. How are you thinking about sequencing these therapies in your practice? Who is the right candidate for combination versus monotherapy?

[It] is really helpful to meet [patients] where they are. There are some patients that the best management for them is avoidance of a food [if] they don't want to take an injection. There's others [whose] biggest…goal is to prevent severe reactions or decrease the risk of cross-contamination. [Other patients] do want to have the food in their diet…that's where combining or doing oral immunotherapy for them could be a good option. There might be patients [who] are at higher risk of allergic reactions based on the history and maybe you might combine the two [treatments]. There can be a limitation of combining therapies, as you might not get coverage for [the] patient, and that might be...why you can't do both.

In the adult world, we do a lot of omalizumab, but oral immunotherapy is much safer and more effective in kids.

What does the pipeline look like for patients managing four or five allergens at once, and what's still a major unmet need?

Omalizumab is one we would probably jump to earlier for patients’ multiple food allergies because [this drug] often [has] more an impact on their quality of life. They might have a greater risk of cross-contamination just because there's more allergens there.

As far as oral immunotherapy goes, or other types of immunotherapies for food allergy…sometimes you're just figuring out which food is the most impactful for them. For example, if someone has an allergy to peanuts and to multiple tree nuts, but they're never going to eat tree nuts, you might just treat for peanut for example, and…do classical avoidance for tree nuts if it's not an important part of their diet.

Beyond what's already approved or in late-stage trials, what data or research direction are you watching most closely right now that does not get a lot of attention?

As a mainly adult allergist, I think there's amazing work being done in pediatric food allergy and a lot of advancements like epicutaneous patches on the skin [and] oral immunotherapy. We even found a way to make it as safe or as effective [in] an adult, so I think what I'm really looking forward to is more advancements in allowing these great advancements for pediatric food allergy care to then be moved toward the adult world, whether that's with combining omalizumab with some of these treatments or different protocols.

 If you had to name one thing you do in your clinic that you think more allergists or even primary care providers should adopt, what would it be?

Doing food challenges [in the clinic]. There's no test that tells us 100% someone has a food allergy.

Something really interesting [came out of work at] Nationwide Children's [Hospital]. When they were enrolling [children] for immunotherapies, [about] half of them were passing the food challenge. They actually weren't food-allergic to start with.

I think making sure that patients truly are allergic before they go into these time-consuming treatments [is important] because many may not have a food allergy.

In recognition of Food Allergy Awareness Month, Brooks discusses food challenges, omalizumab, oral immunotherapy, and persistent gaps in food allergy management.