Low Dose Allergen Therapy

What is an Allergy?

An allergy is an overreaction of the immune system to an antigen (a substance such as a pollen, mold, food, chemical or insect bite) which is usually not harmful to most people.

Some symptoms of allergies can include the following:

  • Itchy, runny nose or eyes
  • Repeated sinus infections
  • A feeling of fullness in the ears
  • Sneezing, coughing, wheezing and asthma
  • A closing up of the airway
  • Rashes such as hives and eczema
  • Joint aches
  • Gastrointestinal symptoms such as bloating, abdominal pain, diarrhea and vomiting
  • Changes in behavior, mood and hand writing

Low Dose Allergen Immunotherapy

We are using a new treatment for allergies at White Rock Naturopathic called LDA immunotherapy, short for Ultra Low Dose Enzyme Activated Immunotherapy, or Low Dose Allergen/Antigen Therapy. LDA immunotherapy is used to treat all types of allergies and immune/autoimmune system problems. This includes, but is not limited to sensitivity and intolerance to foods, allergies to airborne and environmental allergens (pollens, dust, mites, dander, and molds), and even various chemicals problematic in patients who have “multiple chemical sensitivities.” In addition, it has also been useful for many chronic diseases and auto-immune problems.

LDA is administered in the forearm by intradermal injection. LDA is given once every two to three months for the first six to eight treatments. Most patients receive a total of 11-15 treatments over three years. The effect of LDA can be almost immediate; however, the full benefit of LDA may be slow to appear. Generally, patients can notice some significant effect with the first or second injection. The response rate usually improves with subsequent injections.

Traditional conventional allergy shots and treatments have proven to be very effective for certain pollen and other specific types of allergy; however, they have more limited value for patients with allergy to multiple inhalants and have generally been ineffective for patients with autoimmune diseases, food and chemical allergy, and intolerances. A newer method of advanced immunotherapy called, “Ultra Low Dose Enzyme Activated Immunotherapy” or “Low Dose Allergens” (LDA) is an effective alternative in the treatment of many types of allergy; intolerance to inhalants; some autoimmune diseases; and sensitivity caused by foods, pollens, molds, dust and chemicals.

People who have used LDA treatment have found this to be cost-effective, very comparable cost-wise to “standard” immunotherapy and often no further testing is required to begin LDA therapy. Since fewer and less frequent injections are required, it is preferred by many — especially needle-weary patients. LDA has been very successful in easing the total body load of environmental and allergy stressors, and has been helpful in treating multiple chemical sensitivity patients. It is a very safe type of therapy and treatment that reaches a far wider spectrum of the population with allergy related conditions. Before starting this therapy, patients are prepared and instructed about LDA treatment requirements, including being asked to review and study a patient education manual prepared by Dr. Shrader, a leading expert and authority on the use of LDA in environmental related illnesses.

LDA is a method of immunotherapy enhanced by a small dose of the enzyme, beta-glucuronidase. The beta-glucuronidase activates extremely low amounts of various allergens (extremely small amounts when compared to standard allergy injection materials) and stimulates the production of “T-suppressor cells.” These cells turn off the “helper cells” that causes the misidentification of normal substances in the body that get mislabeled as allergens or as foreign invaders, which in turn leads to an abnormal immune reaction, causing illness symptoms and problems. Since T-suppressor cells take a while to mature in the bloodstream, LDA only needs to be administered every two to three months for the first six to eight months; then less often as treatment progresses — fewer treatments are required for simple dust and pollen allergies. An LDA treatment consists of injections on the inner aspect of the forearm with a small amount of the injection (1/20 cc.) given intra-dermal in the first layer of skin.

LDA includes mixtures of over 300 allergens that allow patients — who are allergic or intolerant to most substances and those with diverse medical conditions — to respond to treatment. Available LDA mixtures include inhaled pollens, danders, dust and mites, fungi, yeast including Candida species, molds, foods, many food additives, most common chemicals and perfumes (except pesticides and herbicides), and formaldehyde. LDA should not be used during pregnancy.

Dr. Grodski is a member of the American Academy of Environmental Medicine (AAEM) and has received training in environmental medicine, allergy treatment and LDA therapies through AAEM.

Low Dose Antigen Therapy (LDA) is a way of treating allergies and chemical and food intolerances that uses homeopathic doses of common allergens (substances that make you react), enhanced by a minute dose of the enzyme beta glucuronidase.  This enzyme is a potentiator for contents of the injection. The beta glucuronidase activates extremely minuscule doses of various allergens that, when injected into the skin, stimulate the production of T-regulatory cells. T-regulatory cells are the component of the immune system that can “switch off” the erroneous responses of other immune cells that cause patients to be ill by misidentifying normal substances in the body to be allergens. This has implications in allergy as well as autoimmunity.

The treatment activates the T-lymphocytes (immune system controlling white blood cells) which shut off the undesirable allergic response. The T-lymphocytes have a half-life of 12 to 16 weeks and form life-long memory cells that eventually give you the long term relief you need. Patients who have gone through the treatment report that they need fewer medications, get fewer infections and have more tolerance to foods, pollens and chemicals. Most patients can eat all foods (allergenic or not) about 12 months after they start the treatment without reactions.

LDA & EPD

LDA Immunotherapy was developed from EPD Immunotherapy (enzyme potentiated desensitization) by Dr. W.A. Shrader, MD.  EPD immunotherapy was discovered and developed by a brilliant British allergist, Dr. Leonard McEwen.  It is a type of immunotherapy enhanced by the enzyme beta glucuronidase, given only every two months at first and less often as time progresses, that effectively treats a myriad of problems having to do with any degree of failure of the immune response.

LDA (short for “low dose allergens”, or ultra low dose enzyme activated immunotherapy) is a method of immunotherapy enhanced by a minute dose of the enzyme, beta glucuronidase (dose is 10-13).  The beta glucuronidase activates extremely miniscule doses of various allergens (10-6 to 10-17) and stimulates the production of T-suppressor cells, now called T Regulator (T Reg) cells.  These cells actively “switch off” helper cells that are erroneously causing patients to be ill by misidentifying normal substances in the body to be allergens.  T-cells may live for long periods of time in the bloodstream, so LDA needs to be administered only every 2 months at first, and then less often as time passes, generally with one to three tiny (1/20 c.c.) intradermal (in the first layer of skin) injections on the inner aspect of the forearm.

LDA is used to treat all types of allergy, sensitivity and intolerance to inhalants (pollens, dust, mites, danders, etc.), foods and chemicals.  LDA and EPD may be used to treat such conditions as seasonal and perennial hay fever, asthma, all types of food allergy, multiple chemical sensitivities, autoimmune conditions, and a considerable number of other conditions.

LDA is patterned after Enzyme Potentiated Desensitization (EPD), developed by the brilliant clinical and academic allergist, Leonard M. McEwen, M.D., in England in the mid 60’s [1-9].  The method involves desensitization with combinations of a wide variety of extremely low dose allergens (10-14 to approximately 10-6, or 1 part in 10 million to as low as 1 part in 1 quadrillion).  These allergens are given with the enzyme, beta-glucuronidase.  The beta-glucuronidase acts as a lymphokine, a substance that potentiates the immunizing ability of the allergens.  EPD appears to specifically induce the production of activated T-regulator (Treg) cells, once known as T-suppressor cells, which can live in the circulation for many years.

Difference with Conventional Allergy Immunotherapy (SCIT, or subcutaneous immunotherapy):
SCIT changes the type of immune molecule that your body produces to the allergen (from IgE to IgG4, which is non-inflammatory). LDA works by altering the T helper cells’ response that causes allergy in the first place.

Other than that, the major difference is how the therapy is administered. LDA has several advantages over conventional allergy shots.

LDA:

  • No testing is required ahead of time (the allergy serum is compounded to include the spectrum of inhalant allergens, for example)
  • There are far fewer shots (they’re administered once every two months up front, and less often after that)
  • It is much safer (in hundreds of thousands of injections, there have been no reported cases of anaphylaxis from treatment)
  • Responses are usually seen much sooner (often within days)
  • We can treat other immunological problems as well (food allergy/sensitivity, multiple chemical sensitivity, and autoimmunity)

SCIT (conventional allergy shots):

  • SCIT is administered twice a week for months, then twice a month for months, then monthly for years
  • There is a rare but real risk of death from the therapy (anaphylaxis) which has resulted in its removal from the market in the UK unless done in a hospital setting
  • Injections are given one allergy at a time
  • It is not applicable for food allergy

From Dr. Shrader: www.drshrader.com

Conventional “escalating dose” immunotherapy (where the dose is started “low” – generally 1 to 10,000, and increased over time to as high as 1 to 10, 1 to 20 or 1 to 100) is employed in this Canada by many allergists, primarily to treat hay fever and cat and dust mite allergy, which are primarily IgE mediated.  This type of immunotherapy works by causing the patient to produce “blocking antibody” (specific IgG antibody), which inhibits the histamine-releasing ability (which produces the allergy symptoms) of the mast cell.

The higher the level of blocking antibody that can be produced, the more successful is the treatment.  In order to produce adequate levels of blocking antibody, studies have shown that it requires administration of very high doses of allergen.  Therefore, treatment using this method often causes intolerable swelling and other side effects before clinical efficacy can be attained, and can be dangerous due to the risk of severe reactions such as massive swelling, anaphylaxis, collapse and even death.  Furthermore, only inhalants – not foods or chemicals – are used.

Deaths from conventional escalating dose immunotherapy are generally a result of anaphylaxis.  This is due to the extremely high dose of antigen required to produce a significant clinical effect and high level of antibody.  LDA immunotherapy, however, is cell-mediated (probably TReg) and extremely low dose.  The very highest possible dose of LDA (some LDA antigens are lower) is at least a million times less than the standard dose for conventional immunotherapy.

The danger of fatal or life-threatening systemic reactions to LDA treatment is negligible.  Well over 400,000 doses of EPD and an estimated 300,000 of LDA have been given worldwide, and – unlike many other types of immunotherapy – life-threatening reactions to EPD or LDA have never been reported.

Conventional escalating dose immunotherapy is generally administered twice weekly for the first four to six months of treatment.  Once the very high maintenance dose is reached, the treatment interval may be extended to once every two weeks or even monthly, but rarely less often without return of symptoms.  Conventional escalating dose immunotherapy cannot usually be stopped without the return of some or significant symptoms within 3 to 12 months of cessation.

In contrast, LDA immunotherapy is extremely low dose and administered infrequently, only every two months at first, and later less often. Treatment is required only every two months initially for a period of approximately 12 months.  After that time, the treatment interval may generally be extended to three months or longer.  Most adults with significant problems require 16 of 18 treatments at these intervals of two months or less often, at which time treatment often may be discontinued.  Of the approximately 50% of patients who are unable to discontinue LDA after 16-18 treatments without return of some symptoms, the majority will continue treatment longer at intervals of 6 months to a year.  Children (under 12) may often stretch their treatments out earlier, and stop sooner without return of symptoms.  Children as young as one month of age have been treated safely.

LDA Treatment

From Dr. Shrader: www.drshrader.com

LDA is administered using intradermal injections of 0.05 (1/20) cc in the skin of the forearm or sometimes in the leg. The method of intradermal injection is quite simple, and the LDA antigens are administered exactly as you would an intradermal skin test.  The average patient receives 1-2 injections (usually one on each forearm) per treatment.

The response to LDA does not take long to appear, and certainly over 60% of patients note a significant positive response with their first treatment.  Most all patients respond positively by the third treatment, and if no response is noted by then, we generally re-evaluate the situation.  About one in 25 patients do not respond with strongly positive results until they have had 6 treatments.  The overall response rate for all conditions treated with LDA is approximately 65-95%, depending on the condition being treated.  The overall failure rate (no improvement) is about 9%.

Available LDA mixtures include 1) inhalants (inhaled pollens, animal danders, dust and mites, insects, fungi, yeast including candida species and molds), 2) foods and food additives, 3) chemicals, (containing most common chemicals and scents, formaldehyde and detergents, except for pesticides and herbicides,), 4) and woods, (a mixture of over 90 common and exotic woods), used for the treatment of contact skin sensitivity in woodworkers..

Other specific LDA mixtures work by way of a mechanism called molecular mimicry, and are available to treat several specific autoimmune diseases, such as rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, scleroderma and others.

LDA has a few disadvantages compared to other types of immunotherapy.  For example, most patients must adhere to a very restricted diet the day before, the day of, and the day after LDA treatment.  There are also a number of medications (such as antihistamines and aspirin), that may significantly reduce or destroy the effect LDA if taken in the three weeks after treatment.

On the other hand, LDA has tremendous advantages, and has a distinct advantage in that it appears to effectively treat a very wide variety of disorders not generally perceived to be immune-related or caused by allergy, including illnesses that respond poorly – or not at all – to other methods of treatment of any kind.  This would include migraine headaches, ADD and ADHD, Tourette’s, Raynaud’s and many others.

It is very important to note that LDA is dramatically effective for the treatment of eczema of all kinds.  When you compare this to the usual dermatological treatment with topical steroids that is not really curative and goes on essentially forever, well, there is no comparison. LDA immunotherapy has worked well for angioedema, which consists of facial swelling, swelling of the lips or eyes or swelling of other parts of the body, primarily as a result of acute and chronic food allergy, but can be caused by many substances.  There is no safe and effective traditional immunotherapy for this condition.  The best conventional treatment can do with these conditions is by advising avoidance (when the substance is known) and using drug therapy and epinephrine to treat the problem.

Likewise, immediate food allergy, which can cause anaphylaxis (a condition that is generally life-threatening), has no effective treatment except for emergency drug treatment and avoidance of the offending food agent.  This includes such potentially fatal problems as peanut and shrimp or shellfish allergy.  After ten years of use, LDA appears to work well for this condition and can prevent death from accidental exposure to anaphylaxis-inducing foods, such as these.

Overall, LDA immunotherapy is considered a miraculous treatment by thousands of patients across the US and Canada who rely on it for treatment of a myriad of problems.

Conditions

Conditions that have benefited from an environmental medicine approach with LDA treatment include allergies — sensitivity and intolerance to inhalants (pollens, dust, mites, danders, etc.), foods and chemicals; rhinitis, asthma, seasonal and perennial hay fever; all types of food allergy; hyperactivity/ADD; eczema; irritable bowel syndrome; migraine headaches; rheumatoid arthritis; post viral syndrome (ME, CFIDS or CFS); multiple chemical sensitivities; Tourette’s syndrome; and many other environmentally associated health problems.

The list below is a fairly complete compilation of conditions that have been shown to respond to both EPD and LDA immunotherapy, though the list is growing. If you don’t see your problem listed here, please call us.

1.      Rhinitis, perennial (runny nose, nasal congestion, etc., year `round) 35.  Chronic fatigue, not of sudden post-viral onset but of gradual onset
2.      Rhinitis, seasonal, allergic (above but seasonal, hay fever, etc.) 36.  “Candida” or fungal-related illness whose symptoms respond clinically to antifungals
3.      Nasal polyps 37.  Hyperventilation complex (medical diagnosis, U.K.)
4.      Allergic conjunctivitis (itchy/watery eyes) 38.  Multiple complaints (patient has more than 6 conditions to evaluate, such as “E.I.”
5.      Asthma, year `round 39.  Plugged ears, moderately severe
6.      Repeated chest infections 40.  Pruritis (Itching)
7.      Chronic sinusitis, documented by X-ray 41.  Depression
8.      Chronic face ache/sinus pain, not proven by X-ray or negative X-rays 42.  Insomnia, moderately severe
9.      Secretory otitis media (“glue ear”) 43.  Vulvadynia
10.  Repeated ear infections 44.  Anosmia
11.  Immediate food allergy (foods cause  itching, swelling, collapse, shock) 45.  Emotional/Behavior problems (not #21)
12.  Food (or food chemical) allergy or intolerance/adverse response (not  #11 above) 46.  Interstitial cystitis (IC), documented
13.  Chemical or fume intolerance (severe symptoms, when exposed by breathing) 47.  Post nasal drip, chronic, severe
14.  Migraine/severe headaches 48.  Chronic cough
15.  Headaches, other 49.  Asthma, seasonal only
16.  Eczema, “dermatitis” 50.  Ankylosing spondylitis, documented
17.  Contact dermatitis (from skin contact with a substance) 51.  Dermatographia
18.  Urticaria (hives) 52.  Autism
19.  Swelling of the lips, face or tongue  (angioedema) 53.  Hypertension
20.  Mental confusion (brain “fag,” “fog,” confusion, etc.) 54.  Diabetes
21.  Hyperactivity, ADD, ADHD, PDD 55.  Sjogren’s Syndrome
22.  Epilepsy (any type) 56.  Meniere’s Disease
23.  Rheumatoid arthritis (RA) 57.  Psoriasis
24.  Osteo-arthritis or joint pains: non-specific 58.  Anaphylaxis due to ingested food or food substance
25.  Muscle pains, severe 59.  Anaphylaxis, cause unknown (idiopathic)
26.  Ulcerative colitis 60.  Tourette’s
27.  Crohn’s disease 61.  Multiple sclerosis
28.  “Irritable bowel”, “spastic colon” or chronic diarrhea 62.  Rhinitis due to cats only
29.  Constipation (less than 1 bowel movement on most days) 63. Pre-menstrual syndrome (PMS)
30.  Gut “fermentation” (bloating after most meals, especially sugar) 64.  Conjunctivitis, chronic, diagnosed as “non-allergic”
31.  Chronic anal irritation/itch (not caused by hemorrhoids) 65.  Raynaud’s
32.  Chronic vaginal symptoms 66.  Reactive arthritis (autoimmune, non-RA)
33.  Urinary tract symptoms (not due to infection) 67.  Pharyngitis
34.  CFIDS, CFS or ME (U.K.) (history of  definite sudden viral onset, healthy prior) 68.  Laryngitis
69. All autoimmune diseases, especially those associated with one or more HLA receptors (active autologous LDA immunization is used)

LDA is given about once every two months in the first year, once every three months the second year, and once every six months in the third year, and thereafter if needed. Depending on how closely the patient follows the recommendations, she/he may or may not need an annual booster. This type of schedule makes following the treatment plan easy.

Enzyme potentiated desensitization appears to down-regulate both the Th1 (delayed hypersensitivity) and Th2 (immediate hypersensitivity) immune system responses to allergen. Its effect appears to be on the T regulatory cells which modulate all the immune responses of the body. Because the T cells have such a long half life (60-90 days), injections are given only every 2 months for the first 6-8 treatments. It takes about 3 weeks for T regulatory cells to be produced in any significant numbers, thus symptom relief may be seen as early as 3 weeks after the first injection. As the number of regulatory T cells increases, the frequency of injection can decrease. Eventually injections may be given only once a year, or even every 2-3 years, if symptoms begin to return. About 60% of people respond to the first treatment, and their relief may last for up to 5 weeks. Most patients will respond within the first three treatments (with the exception of chemically sensitive patients, who may take up to six treatments before they see significant benefit).

What are the benefits of LDA?

  1. There is no need for extensive skin testing.
  2. There is no need for frequent or long office visits.
  3. LDA can treat a wider spectrum of allergic conditions than conventional immunotherapy.
  4. In addition, LDA appears to help auto-immune conditions as well as a number of other chronic conditions not typically associated with allergies.
  5. It is safe and effective for all ages.
  6. It is safe and effective for all degrees of severity for allergies or sensitivities.
  7. It has been shown to be helpful for associated chemical sensitivities, chronic illnesses and auto-immune conditions.
  8. Approximately 75% report some type of an overall improvement or elimination of severe allergic symptoms without the need for additional allergy medications or the use of medications as often as previously used or at doses as high as previously needed.
  9. Over half of the patients with multiple allergies can stop LDA completely after 16-18 treatments.
  10. The remainder will be able to be maintained by continued treatment from “booster shots”. The frequency of such booster will vary significantly based on the person’s case. Intervals range from 6 months to several years before a booster is needed.

Any drawbacks?

  1. It may take 6-8 injections (12 months) to achieve sustained relief except for simple seasonal allergies. Failure is not considered until 6-8 injections are given without any benefit.
  2. Those who don’t respond initially to treatment will need to avoid various medications and follow a specific diet around the time of injections to enhance its efficacy.

THE BASIC LDA DIET – For Patients who have Food or Chemical Allergies

(not necessary to follow for those who strictly have hay fever or seasonal allergies)

To be followed for the “3 critical days”: the day before LDA, the day of LDA, and the day after LDA.

You should eat ONLY:

  • Lamb, rabbit, venison (only if you rarely eat it) or fish (if you are not specifically allergic to it). Some other unusual meats may be acceptable. Discuss these with your physician.
  • Sweet potatoes (any type) or yams;
  • Parsnips, rutabagas, tapioca root products or cassava root, manioc, yucca, sago (turnips OK for some);
  • Tapioca granules, flour or starch, plain (see tapioca wafer recipe in recipe section);
  • Rhubarb;
  • Pure baking soda (without additives);
  • Sea salt: plain see salt (non-iodized – do not use “regular” salt);
  • Bottled, Reverse-Osmosis, filtered or purified water, flat or fizzy for drinking and cooking;

Note: no margarine is safe to use during the 3 critical days; Avoid all margarine and all other seasonings totally. The only seasoning permitted is non-iodized sea salt.

Note: Any food not listed above is unsafe to eat in any quantity during the critical three days. This includes medications (unless advised by the doctor), herbs, beverages, chewing gum, and any other things you might put in your mouth, and no, sorry, coffee and tea are NOT allowed!

VITAMIN D Note: For LDA to work well, you need to have pretty normal levels of Vitamin D in your body (blood). This can be determined by a simple blood test.

LDA Recipes

Let’s face it, folks – there’s not a whole lot you can do with the limited foods available during the 3 most critical days of each LDA treatment! But on the following pages we’ve got a few “LDA Nouvelle Cuisine” recipes for you to try.

Lamb Stew

Cut lamb into chunks. Brown lamb in skillet. Do not add oil! There is plenty of fat on the lamb to prevent it from sticking, especially if you rub a piece of lamb fat on the skillet first.

Toss browned lamb into pot with cut up vegetables – carrots, potatoes, sweet potatoes or yams, celery, cabbage and /or lettuce. Cover with bottled water and bring to a boil.

Mix approximately 2 tbsp of tapioca starch into ½ cup bottled water (the tapioca isn’t really needed if you use sweet potatoes or yams – they thicken the stew themselves. Add to stew mix. Simmer with lid on until lamb is tender. Salt to taste with pure sea salt. Add extra water, if necessary, for desired consistency.

Vegetable Stew

Same as lamb stew, minus the lamb.

Vegetable Soup

Same as vegetable stew except cut the vegetables smaller and do not thicken with tapioca starch.

Fish Stew

Put raw fish chunks in with raw vegetables and cook like lamb stew.

Non-Fat Potato Chips

Slice white potatoes thinly. Sprinkle with salt. Place on wire racks. Broil/bake until golden brown and crispy. May need to be turned while abking.

Potato Noodles

Broil until al dente. Add to soups, or serve with vegetable / fish / lamb.

Sweet Potato Yam Parfait

Buy sweet potatoes and yams. Bake in covered glass dish at 300 degrees until soft when stuck with fork. Peel and whip each individually, add bottle water as necessary to produce a smooth, pudding like consistency. Salt to taste. Layers in a tall, clear glass and garnish with a bit of lettuce leaf. Enjoy!

Lamb Meat Loaf

1 lb. ground lamb, as lean as possible

2 cups grated potatoes

½ cup celery, chopped fine

½ tsp sea salt

4 tbsp tapioca starch or potato starch

Preheat over to 300 degrees. Combine all ingredients. Add a little water if the mixture seems dry. Turn into a loaf pan and bake at 300 degrees for about 1 hour or until done.

Cabbage Rolls

Use meat loaf recipe. Brown mixture in pan on stovetop. Roll approximately 1/3 cup of meat loaf mixture in a blanched cabbage leaf (blanch cabbage leaves by boiling for 1-2 minutes). Bake in covered glass dish at 300 degrees for approximately 30 minutes or until done.

Carrot Soup

Boil carrots in salted water until tender. Pour ¾ of the carrots into a blender and puree – variations: boil celery, cabbage, and potatoes to add with remaining carrots. Add carrot puree.

Rhubarb Relish

Chop rhubarb finely. Boil until tender. Dissolve 1 tsp tapioca starch in ¼ cup water and add to pot with rhubarb. Simmer until thick. Serve with lamb, fish or over sweet potatoes.

Variation: mix rhubarb relish with finely chopped, cooked sweet potatoes.

Shepherd’s Pie

Boil 4-5 cups of LDA vegetables in small amount of water until slightly tender but not done. Salt to taste. Thicken with tapioca starch (approx 1 tbsp – dissolved in water). Simmer 5 minutes. Turn into casserole dish. You may add cooked lamb, if desired.

Peel, cube and boil 2 large red potatoes until done, then mash potatoes, adding salt to taste. Add a little water if too dry.

Top casserole with a layer or ring of mashed potatoes. Bake 15 minutes. Broil for an extra 3-5 minutes to brown the potatoes.

Carrot Juice / Celery Juice / Cabbage Juice

Use any vegetable juicer to extract juice from raw vegetables. Bring to a boil. Serve hot or cold. Do not use raw juices!

Fish Patties

1 medium potato, boiled and mashed

2 tbsp tapioca starch or potato starch, dissolved in a little water

2/3 cup flaked cooked (baked) fish

½ stalk celery, chopped fine

Salt as desired, fry with water.

Lamb Stir Fry

Cut lamb in thin strips. Rub lamb fat on hot skillet to grease. Brown lamb, adding salt as desired. Remove lamb from pan, add a little water and chopped vegetables (carrots, celery, cabbage). Stir-fry until done tender crisp, adding salt as desired. Stir lamb into vegetable-mixture.

Serve as is or over potato starch noodles. Be sure noodles are 100% potato starch.

Pigs In Blankets

Cut whole carrot crosswise into 2-3 pieces. Steam/boil/broil until tender. Steam/boil cabbage leaves until tender. Salt as desired. Roll carrot pieces in cabbage leaves. Secure with toothpicks.

For more recipes, please see Nicholette Dumke’s “More Allergy Cooking with Ease” and “The LDA Patient’s Cooking and Life-style Guide” which are available online and from: Allergy Adapt, 1877 Polk Ave., Louisville, CO, 80027, (303) 666-8253.

There are 3 levels of guidelines to follow for patients with different types allergies:

Level 1: Seasonal or Environmental (Inhalant) Allergies ONLY

Level 2: Environmental & Food Allergies

Level 3: Chemical Sensitivities

 

Level 1: Guidelines for Patients with ONLY Seasonal Hay Fever

At the time of LDA:

  • Avoid alcohol for 10 days after treatment.
  • Don’t snuggle with your pets (especially cats) and avoid indoor molds at the time of treatment. Try to limit your exposure to pollens and dust 12 hours before and 36 hours after LDA (for example, don’t sleep with your cat or dog during that time). If you receive LDA inhalants near a pollen season, and you are experiencing symptoms outdoors, you may need to extend that time.
  • If you have ever had a water leak in your home and mold was discovered, you might do best to stay elsewhere during that time.
  • You may exercise normally during LDA, but avoid fatiguing exercise, extreme heat, and sunburn for 3 days after LDA.
  • Follow the rules for drugs known to interfere with LDA (page 29) and immunization (page 44).
  • Do not put ointments, creams and lotions on the site of the injection(s) on the day of treatment.
  • Use an unscented soap and shampoo (e.g. Magick Botanicals shampoo or similar) on the day you receive LDA (or the night before if you bathe at night).
  • Do not wear perfumes or other scented agents to the office on the day of LDA (this is partly to protect your doctor’s patients who have chemical sensitivity).
  • Avoid yard work for the three critical days.
  • If you know you are allergic to your pets (especially cats), and your pets spend time inside the house, you should not stay in your home during the three critical days. Wash your hands after handling your pet. The danger is sensitization to a pet, and this has been shown to occur in rare patients, usually after 3-6 injections. If this does happen, the sensitization can be reversed with the next LDA, but stricter guidelines must be followed. If you are not allergic to your pets, try to keep them out of the bedroom and don’t snuggle your face into your pet’s fur.
  • If you are allergic to feathers, do not sleep with a feather pillow or down comforter for at least a week after LDA. Use a cotton or foam pillow.
  • Do not have LDA if you are trying to get pregnant within 2 weeks of the injection.

Exertion & Temperature Do’s and Don’ts

For one week after LDA:

  • Do not take a sauna
  • Do not do excessive sunbathing. Sunbathing more than 5 days before LDA is likely to be an advantage (enhances Vitamin D production in the skin).
  • You may use ChapStick during the three critical days, but probably best to avoid it on the day of LDA.
  • You may wear make-up during this time.

Do your best to avoid high concentrations of mold spores indoors: mold floats indefinitely in the air inside houses that are damp, suffer from condensation, smell musty or even have had a leak or water damage in the past. Keeping the door of a damp room or cellar shut is not likely to give effective protection, since the spores float so well in the air. If you have a mold problem, keep windows open night and day while you are in the house, if possible, to reduce your exposure. It is sometimes best to stay at a friend’s dry, modern, mold-free house with no pets for the day before, the day of and the day after LDA. If your house is extremely damp and there has been any evidence of mold, you should try very hard to get away from it during this time. Don’t worry about outside mold.

Many patients simply cannot avoid molds in the home, especially those of you who live in terribly moldy areas of the country. For rare patients, this could jeopardize the effect of LDA, since mold spores are the most prominent airborne allergen during all times of the year. For the rare patient who is severely mold –sensitive, it might be wise to receive the first several LDA injections in an area with a very dry climate, and stay there for a few days before and after LDA.

Food, Pollen and Mold Cross Reactions

Patients who suffer from allergy to tree pollens, especially birch or ironwood, must not eat nuts, fresh apples and oranges, raw carrots or celery for about a week after LDA, if those pollens are in season (spring). Mold spore allergens from different species may cross-react with LDA. If you are allergic to inhaled mold spores, avoid tea, cheese, and other fermented or aged foods for 10 days after LDA. If the desensitization is unsuccessful, discuss the use of an antifungal regime for your next LDA treatment with the doctor.

Level 2: Guidelines for Patients with Food and Other More Complex Problems (in addition to, or instead of seasonal allergy) Note: Most patients are in the Level 2 category.

If you are a patient who has intestinal, food issues or autoimmune disease, may or may not have pollen allergy, and do not have significant chemical sensitivity, the guidelines you will follow appear in this section.

Also, if you think you only have pollen allergy and you have a sub-optimal response to LDA on the Level 1 regimen, you must strongly consider following more of the Level 2 or 3 guidelines in this booklet. If you’re not sure which category you belong, discuss it with the doctor.

So, if you have problems other than simple hay fever, you must follow all Level 1 guidelines, AND in addition:

Before LDA:

  • Again, you must also follow all Level 1 guidelines;
  • Take a good multivitamin/mineral supplement, approved for LDA (less than 500mg. of Vitamin C);
  • Use an appropriate bowel preparation for candida, if determined necessary by the doctor;
  • Take zinc 20-30mg daily, in addition to the amount you may be receiving in your multiple vitamins for a week before and three weeks after LDA;
  • Take magnesium (citrate or glycerinate), 200mg/day in addition to the magnesium you may be receiving in your multiple vitamins, for a week before and three weeks after LDA.

On the day of LDA:

  • Do not wear lipstick or eye-liner (or any make-up that might get in your eyes) on the day of LDA.
  • Do not put anything in your mouth except the foods permitted on the LDA diet;

Critical three days:

  • Follow the LDA Diet;
  • Do not use ChapStick or other lip balm on the day of LDA;
  • Use unscented soap only;
  • Use unscented shampoo and conditioner;
  • Do not use toothpaste. Use pure baking soda instead;
  • Sexual activity may be a problem, especially in women, since they risk sensitization to their husband’s semen. This seems a particular risk for eczema sufferers. Intercourse probably should be avoided for the critical 3 days around LDA therapy.
  • Minimize your exposure to animals, perfumes, aerosols, sprays, painting, etc.
  • Never take any vitamins, minerals, or other supplements during the three critical days, and only take meds you discuss with your physician;

After LDA:

  • Avoid foods that have caused you to have significant symptoms in the past for three weeks after LDA. This does not include foods for which you had a positive blood test unless you know you react badly to them.
  • Optional: Folic Acid, 10mg/day, may be taken to attempt to enhance the effect of LDA for 30 days after LDA (side effect: possible nausea, so take with meals);

Food Guidance for Patients with Moderate to Severe Food Allergy or Intolerance

At the time LDA is give to some patients, and up to three weeks afterwards, doses of allergen from a food that has been eaten may cause increased sensitivity to that food. And since many food allergens cross-react, exposure to the wrong foods, certainly during the 3 critical days, but especially in the three weeks after LDA (as the lymphocytes are maturing), may be harmful. Patients have sensitized to a wide variety of other foods, pollens and molds when they have done this. The foods for the LDA diet have been very carefully selected to avoid cross-sensitization to multiple allergens.

Therefore, you should definitely avoid the foods to which you know you are intolerant or allergic (foods that have caused symptoms any time you’ve eaten them in the past) for the three week period after LDA. If you have severe foods problems, the doctor or one of the staff may discuss a different elimination diet you should follow before and after the 3 critical days of LDA. The doctor may combine one or two diets for you to follow at this time.

It has remained the policy in our office that all patients with other than simple hay fever must follow the Basic LDA Diet. The exception is the select group of children with autism, who simply cannot do the LDA diet with any success. Your doctor may have another policy.

Significantly autistic children, generally speaking, will only eat specific foods and nothing else. They’d literally rather starve. In these instances, the benefits of LDA likely considerably outweigh the potential harm of not following the diet. In those instances, I’ve always given LDA anyway, no matter what these kids may be eating. The treatment has appeared to work. If the treatment fails, at least we’ve tried.

In recent years, I’ve heard of adults not following the LDA diet and doing well. There will be more discussion about this, since certainly LDA would be much easier without having to “do the diet”. My advice to most patients is that they should follow the diet strictly for the first several LDA treatments, if they have food problems. Later on, it might be OK to try to add a few foods to the diet. If you try this, be aware that your LDA may not work as well, and you must switch back to following the diet.

Fasting

The LDA diet contains every food that has been shown to be safe with LDA. However, some extremely food intolerant patients are sensitive to some or all of the foods on the diet. These patients have no choice but to fast for 24 hours before and 24 hours after LDA for the first few injections. Once LDA enhances food tolerance, patients who have had to fast are usually able to eat at least some of the LDA Diet foods. I have not seen problems with fasting, and I recommend it for all adult patients who don’t tolerate the foods on the LDA diet, on the day of LDA.

After the LDA Diet

Most patients with food sensitivities must simply avoid the foods to which they know they are allergic or intolerant as much as possible for the three weeks after LDA. This does not mean foods that may just have been positive for the three weeks after LDA. This does not mean foods that may just have been positive as a result of a blood test, and the patient has never physically tested (challenged after a 6-7 day elimination) – only foods that are known to cause symptoms when eaten.

If you don’t have major food problems, you may begin adding regular foods after the critical three days. However, if you do have severe food problems, for the next 5 days after the 3-day LDA Diet, it is best to count the LDA Diet foods as safe and then add small amounts of a wide variety of “rare” foods, preferably ones which have not generally caused you to have symptoms in the past, or foods you have rarely or never eaten.

The amount of added foods can be increased over the next week. After that time, regular foods may be added back and should be tolerated much more easily. Very few patients must resort to this. As time goes on, the necessity for avoidance of foods lessens. The doctor or staff will advise you hot to do this, if it is necessary.

Vitamin and Mineral Supplements

Certain vitamin and mineral supplements theoretically improve the effect of LDA. These supplements act primarily by affecting the T-cell receptor sites we are stimulating. The following recommendations for supplements may be important for patients who have moderate to severe problems. These should be taken along with an approved multivitamin and mineral. Patients with milder problems, and kids under the age of 12 generally do not require these supplements. Patients with milder problems should probably only take the supplements directed. Discuss this with the doctor if you aren’t sure whether you should take any or all of these supplements. Vitamin D seems particularly important, and all adults should probably take 2000 to 3000 IU per day.

Level 3: Guidelines for Patients Who Have Significant Chemical Sensitivity (in addition to, or instead of the preceeding problems). This is the least common Level. Level 1 and Level 2 patients do NOT need to follow these following guidelines, so if you do not have significant chemical sensitivity, skip to LDA:

Reactions and Side Effects

Those of you with chemical problems should follow all of the preceding instructions in this booklet for Level 1 and Level 2 patients. In addition, our advice is that you follow the remainder of these guidelines in this booklet as closely as possible, at least for the first several injections. Later on, especially after you’ve had 6-8 injections, you might be able to be less careful about the rules.

You should do as well as you are able to adhere to the instructions without totally disrupting your life. Whether you do or you do not have chemical sensitivity, mild chemical exposures or chemical exposures for a brief time will not affect your LDA.

In addition to Level 1 and 2 guidelines, you should also do the following:

For at least 12 hours before and 2 days after LDA (preferably 3 days after):

  • Do not read the newspapers, glossy magazines, or new books;
  • Use no insecticides that produce vapor or might be breathed in: sprays, aerosols, etc. Use traps or bait if you must have insect control;
  • For cockroaches, etc., use boric acid and put it in the cracks under the skirting or molding, etc., where the insects hide. The protection is long lasting and unlikely to cause problems.

For the Three Critical Days:

  • Avoid ointments, creams, and lotions on any part of the body, especially anywhere near the site(s) of the injection(s). This includes “homeopathic” creams and ointments, as many contain agents that are problematic.
  • Use no aerosols, spray polishes or perfumed sprays;
  • Use no scents (perfumes, etc.), or air fresheners of any kind;
  • No chemical deodorants. Use a mineral rock crystal (such as The Body Crystal) or baking soda during this time. At other times, use “natural”, non-aerosol deodorants made without aluminum compounds (look in health food stores).
  • Makeup should not be used during these three days. If you choose to use it, it should be kept to the absolute minimum, not perfumed, and not near the eyes. Use only non-scented, “hypoallergenic” types. You run the risk of becoming sensitized to makeup if you are sensitive.
  • No bath oil, liquid soap, dishwashing or laundry liquid/powder, especially on the hand of the treated arm. Use plastic or vinyl – not latex – gloves for unavoidable washing dishes, etc. (many physicians have these available for purchase in their offices).
  • No hair sprays, hair mousse, hair conditioners or hair oils;
  • Avoid tobacco smoke;
  • Do not do laundry on the day of your treatment. If you do, avoid inhaling scented washing powders, soaps, bathroom cleaners, etc. You can avoid scented laundry detergents and scented fabric softener if you use unscented agents, such as Downy Free and Cheer Free or other natural detergent.

For One Week After LDA:

  • If you have a hypoallergenic lotion you use that you know is safe, you could begin to use it after the critical three day period. Some patients, however, will have a problem if these are used in the week after the three critical days, so be cautious.

These restrictions may be difficult for patients with eczema. Discuss this with the doctor.

Two to Three Weeks After LDA

  • Avoid new carpets, new vinyl wallpaper, smelly plastic sheeting (new shower curtains, etc.) and new furniture;
  • Avoid smelly or new paint. The newer latex paints may be OK.
  • Avoid insecticides that produce vapor or might be breathed in: sprays, aerosols, etc. Use traps or bait if you must have insect control.
  • Avoid situations where you cannot control your environment, such as attending parties, going to church (perfume exposure), entering department stores, etc.
  • No medicated shampoos for 2 weeks after LDA!

For one week before and two weeks after LDA:

  • No permanent waving, hair coloring or other extensive hair treatment. Hairdressers’ salons are always full of scents and fumes. Avoid totally during this time.

Transportation

Since many patients travel to get their LDA injections, the question of transportation arises. We have found, even with patients with fairly sever chemical sensitivity, brief exposure to exhaust fumes from cars, busses, etc., don’t seem to interfere with LDA. However, it would seem wise to take the following precautions:

  • Don’t sit next to a smoker or ride in a car with someone smoking, or with someone wearing perfume or heavily scented agents;
  • Avoid traveling in new cars; it’s preferable to travel in an older car with an air re-circulation system;
  • If you travel by air and have severe chemical problems, it would be wise to wear a chemical-type respirator in the airport if necessary, in jet-ways while disembarking and in the planes themselves until at least 5 minutes after takeoff.

Hotels / Motels

One of the greatest problems for our patients from “out of town” with severe adverse reactions to chemicals / “MCS” is finding a “safe” place to stay. Usually one of the office staff can direct you to the most chemically free hotel(s) in the vicinity. If worse comes to worst, some of you may even need to “camp out” during the 3 critical days in those areas of the country where temperature allows.

The rules and regulations regarding LDA are summarized in a chart that will be available from our office and appear in this booklet.

About Your Workplace During LDA Treatment

Chemicals at Work – For Patients Sensitive to Chemicals

If you have a history of problems with adverse reactions to things in your work or home environment, you must use caution when returning. If, for example, smoking is allowed in your workplace and you have had significant problems when exposed to smoke, you need to stay away from work on the day of the injection, and preferably at least the day after. Two days after would be even better.

Work hazards that often cause problems for patients are some of the following: perfumes, cigarette smoke, sick buildings, industrial complexes which produce products with significant chemical odors, or those using chemicals, such as print shops, foundries, welding, soldering, etc.

If your office is a small, enclosed space (without a window to the outside) with a new computer, a fax machine, blueprint machine, laser printer or copier, it is best for you to avoid it for at least 24 hours after the first few injections. 2 days’ avoidance after LDA would be best for the first three injections.

A good rule of thumb would be to try to have your LDA injection near a weekend for the first 3 injections. If you are chemically sensitive and work with many of the materials mentioned above, it would be a good idea to do this for first year of therapy.

Some patients may experience an immediate “panic”-type response when exposed to some chemicals. If this occurs after an injection, it doesn’t usually mean enough of the chemical has been absorbed to upset LDA, providing you can remove yourself from the chemical after a brief exposure.

Basically, patients who know they are upset by allergens or chemicals at work should not return to it for at least 24 hours (and preferably 2 days – but that’s often not possible) after an LDA treatment.

Note: Remember, if you are not sensitive to chemicals, you do not need to follow Level 3 guidelines above. However, a prolonged or heavy exposure to any chemical could adversely affect the response to LDA in any patient.

This is the end of the section discussing “levels”.

LDA: Reactions and Side Effects

Immediate and Local Reactions

Most reactions to LDA consist of local redness and swelling. The doses of allergens contained in LDA are so small that the chance of a true acute generalized allergic reaction is so extremely remote that it has never occurred. Immediate reactions to the inhalant component of LDA (I or IC), with swelling of the entire forearm do occur occasionally. These may be treated with a cold cloth. Do not use ice!

Although unusual, swelling involving a whole forearm is the major significant local reaction after LDA, though rare. A local reaction is generally associated with a good immunological response. It should not be treated, but, if severe, Tofranil (or generic imiprimine) should be tried. Before you take any medication after an LDA injection, contact the doctor’s office if this should happen. Do not use any local treatment on the swelling besides a cold compress! Continue to use the arm normally.

Local reactions rarely persist for more than 3 days and should be subsiding noticeably by the fourth day. It is possible that the whole forearm may become swollen. Occasionally, the site(s) of the injection(s) may become inflamed off and on for 3-4 weeks after an LDA injection. This probably indicates exposure to allergens in the LDA mixture. If local reactions are recurrent and significant, preparation with a low dose of prednisone may be helpful.

Prudence dictates that all patients who are highly sensitive to their allergies, and receive treatment with LDA must remain under observation in the office for 30 minutes, at least after their first few treatments.

Circumstances When You Should NOT Receive an LDA Treatment

Do NOT Have a Dose of LDA:

  • If you are in the first three days of a cold, have any other infection or suspect that you might be developing one. Use whatever natural agents (chymotrypsin, echinecea, propolis, etc.) you can to treat the infection, and if they fail, you may need an antibiotic. If you are given an antibiotic, be sure to take nystatin with it. If you can get over the infection in time, you may still be able to receive LDA.
  • If you are pregnant or think you might be pregnant. If you are trying to have a baby, plan on receiving your LDA treatment only during the first two weeks after a period, if possible. If you become pregnant on LDA, advise your doctor. Again, there have been many pregnant women who have received LDA without any adverse effects. On the other hand, pregnancy generally carries more risk that a “normal” state, so we advise it may be unwise to do LDA during pregnancy.
  • If you have taken any pain killer like aspirin or Tylenol, NSAIDS or others in the past four days (don’t take any for the next three weeks, either);
  • If you have just been immunized (See “Rules for Immunization and Malaria Prevention”);
  • If you are taking any of the drugs which might upset LDA (see text, chart and specific drug interactions);
  • If you have had dental work (fillings, etc.) 5 days before LDA, or you plan it within 2 weeks after LDA. Cleaning or checkups at the dentist’s office are OK.
  • If you are allergic or intolerant and have not dieted as instructed before the dose;
  • If you have a candida or other dysbiotic intestinal problem and have forgotten your preliminary course of antifungal or other medication(s);

If you take large doses (5-20 grams or more daily) of Vitamin C as a routine before you start LDA, you should taper it down to 3 grams or less during the 2 weeks prior to LDA therapy. Do not stop it abruptly, or you’ll likely have withdrawal symptoms.

Unmasking, Rotation Diets and the Very Mixed Diet

The primary side effect of LDA for patients with food sensitivity may be “unmasking”. With LDA immunotherapy, things you think you know about your foods, both “safe” and “unsafe”, may change. Many patients with significant food sensitivity are allergic or intolerant to most of the foods they eat every day, but these foods are “masked”. They usually cause minor symptoms, up and down, but patients don’t attribute their symptoms to any particular food(s).

After one to three LDA injections (most often after 2-3), this food tolerance curve may shift. Then foods that you had previously eaten in large quantities (perhaps even in rotation) will sometimes make you ill if you attempt to eat the same quantity of those foods as you have in the past during the 3-4 weeks after LDA. This is called “unmasking”, and LDA can cause it to happen. Likewise, foods that made you ill before LDA in very small quantities should become more tolerable as time goes on. This confuses people who have been on rotation, but is natural progression of LDA.

Patients who unmask to foods may complain that they have “lost” foods or have “become sensitive” to foods after two to three LDA injections, because of this shift of the food tolerance curve. This almost always stops occurring to any major degree after about the 6th injection. When it does happen, it generally occurs for one to three injections, and symptoms can last for one to four weeks.

Although this type of problem is not extremely common, the best suggestion to deal with unmasking caused by LDA is the Very Mixed Diet (VMD). This consists of eating very small quantities of multiple foods, usually on a daily basis. Your physician’s office may have copies of the VMD booklet. If not, it is available from the author Nikki Dumke, at Allergy Adapt, 1877 Polk Ave., Louisville, CO, 80027 (www.food-allergy.org).

You should know that if you persist in eating large quantities of your previously “safe” foods that begin to cause you to have symptoms after a few injections of LDA, you will likely continue to have symptoms. This will often delay or destroy the desensitization to those foods that LDA would normally produce. You may have to change your diet and your thinking temporarily. If this should happen, I can assure you that this will go away, but the longer you do it, and the larger quantities of these foods you eat, the longer it will last.

So some patients who experience unmasking may need to vary the diet with large varieties and much smaller quantities of low-allergenicity foods, usually until the second or third LDA injections. You need to try to do this early in therapy if previously tolerated foods suddenly began making you ill – sometimes for 3-4 weeks after an injection. The need to do this diminishes with further injections. We advise our patients with severe foods intolerance or allergy that experience unmasking with LDA to eat very tiny quantities (tsp. to tbsp amounts at each meal) of a wide variety of low-allergenicity foods, or of foods they seem to tolerate. Since patients then are not able to rotate on a 4-5 day basis (because they “use up” their tolerable foods quickly), they then may not be able to rotate foods at all, or at best, on a 2 day rotation, making use of 20-30 foods either in rotation basis or in a ‘stew’ form.

Fortunately, this issue of unmasking is ultimately self-correcting, and the need to do either diet is rare and temporary.

However, you should get away from the idea of eating mono diets or large quantities of foods in rotation. Remember, after even one LDA injection, your food tolerance begins shifting, and some patients complain that they’ve lost many of the foods which were previously safe for them to eat. Again, stick with the program, do your best to make it work, and LDA should usually come through for you quite well indeed.

It’s critical to remember that if you should have an adverse reaction to one of the first few LDA injections, YOU SHOULD NOT STOP LDA. The doctor should be able to figure out the problem and treat it appropriately for your next appointment.

As LDA gains effect with additional treatments, you should be able to eat larger quantities of most all varieties of foods. If you had to rotate foods before you began LDA treatment, rotation should become less and less necessary. Remember, rotation – if you eat large quantities of single foods – if you do it in the three weeks after LDA, could interfere with LDA and make you ill. If this happens, it usually occurs after treatment 1-3 and may last for 1-3 weeks if you don’t do anything about it.

Drugs and LDA

Please note that with the number of new drugs appearing each year, it is impossible to keep up in this booklet. If a drug is not listed here, but if is in the same “class” as a drug that is, the new drug will interfere in the same manner. This booklet contains all of the drugs that are known to be a problem with LDA. If you have questions, ask your doctor. The drugs here have known effects; those not listed must be considered to be wild cards.

Basic Bottom Line Rule for Drugs: Whatever the drug in question, if it appears on this list, its effect on LDA are known and stated. The first rule is: follow the rules below. The second is that if you MUST take your medication, our advice is to take it only if you absolutely have to (e.g. severe high blood pressure). Try to avoid it at least on the day of LDA. If you can, avoid it for the three critical days if possible.

If none of these options are possible, you probably must continue to take your medication. The stern warning here is that many drugs interfere with LDA, so if you are taking any drug, be sure to discuss it with your physician. You must take full responsibility that if you take any drug not listed here, it may lessen or destroy the beneficial effect of LDA completely.

The great thing about LDA is that the necessity to take drugs for most conditions LDA treats diminishes pretty rapidly. Very often, patients are extremely worried about stopping pain meds, for example, for the three weeks after LDA. However, since even the first LDA can last for three weeks, many patients find their need for medications vanishes or diminishes during that period of time, and they had nothing to worry about. Many patients have not started LDA because of this fear, and they well could have gone ahead with it.

This does not pertain to narcotics, as these cannot be stopped abruptly without withdrawal symptoms, but it does pertain to other medications, such as acid blockers for GERD or reflux, etc. Try not to panic about this problem!

Drugs That Interfere with LDA

The following drugs or substances interfere with LDA, and ideally should not be taken (except as directed below) for three days before and three weeks after LDA:

  1. All medications for pain; acupuncture and homeopathics are OK.
  2. NSAIDS (aspirin, ibuprofen, motrin, advil, naproxen, relafin, prostaglandin inhibitors); the only NSAID that can be taken through LDA time is ketoprofen (Orudis); it must be taken all the way through LDA.
  3. Cox-2 Inhibitors (Vioxx, Celebrex, Bextra, all others); likely interferes with LDA.
  4. Tylenol (acetaminophen).
  5. White Willow Bark
  6. Decongestants (Sudafed (pseudoephedrine), ChlorTrimeton (chlorpheneramine), and others, many of which are found in combination with antihistamines. Guaifenesin (Mucinex) is fine after the three critical days).
  7. Antihistamines appear to interfere with LDA. These would include: chlorpheneramine, Actiphed, Benedryl, and all others. The only antihistamine which is safe is Tofranil (imipramine) 10-25mg, 1-4 x/day. It may be taken during the critical 3 day period. Quercitin is also fine, just not on the critical three days.
  8. H-1 antihistamines (Claritin, Allegra, Zyrtec, others) are unsafe if taken within 7 days before LDA, or sooner than 3 weeks after LDA.
  9. Zyrtec (centrizine – same type as above);
  10. Beta sympathetic drugs – generally the type used for asthma (inhaled or oral, such as Maxaire, Proventil, Ventolin, Abuterol, Alupent,etc) interfere with LDA when used the day before, the day of, and 2 days after LDA. For this reason, a burst of prednisone or prednisolone is used during that time (see schedule) to get patients off these drugs if at all possible. Never use the newer, longer acting inhaled drugs, such as Seravent and Tilade, Advaire, Symbicort, Serevent, Foradil, etc. for at least 5-7 days before or after an LDA treatment – use something else.
  11. Histamine H1-H2 receptor blockade – type drugs (Zantac, Tagamet, Pepsid, Axid, etc) in the 3 week period after LDA will interfere severely with desensitization. Protonix, Aciphex, Dexilant, Nexium, Prevacid and others interfere the same way. Instead take simple antacids or bicarbonate.
  12. Leucotriene receptor antagonists (Singulaire, Accolate, Zyflo for asthma and allergy, and any new ones that come on the market) definitely interfere with LDA and should not be taken 5 days before and until 3 weeks after LDA.
  13. Enbrel, Remiacaid, Arava and all of the similar drugs for rheumatoid arthritis and other autoimmune diseases interfere severely with LDA. These must be discontinued completely at least three weeks prior to starting LDA, and never resumed.
  14. Sulfa drugs: sulfonamides, trimethoprim, or combinations of the two (Septra, Bactrum, and others), if taken within 3 days before and three weeks after LDA.
  15. Stimulant Drugs such as Ritalin, Concerta, Stratera, Adderall, etc. seem to interfere with LDA immunotherapy, but this is not consistent. If a child or adult cannot stop these drugs, we suggest trying LDA anyway – it may work.
  16. Prilosec (omeprazole) seems to have less ill effect and is possibly safe before and after LDA for patients who absolutely cannot get off ant-acid drugs. If this is done, if should be taken all through LDA (including the three critical days) and not discontinued for three weeks after LDA.
  17. Anti-folate drugs, such as antimalerials, trimethoprim (in Septra, Bactrim, pyrimethamine, pemetrexed and others), will tend to interfere with LDA. Sulphonamide is possibly OK (not during the critical 3 days). Anti-epileptic drugs may interfere as well. Methotrexate may not interfere if taken as far from LDA as you are able (usually taken weekly).
  18. Opiates, such as codeine, oxycodone (such as Percoden), hydrocodone (Tussionex) and others interfere with LDA in the forms available in the US, and should not be allowed within 3 weeks after LDA.
  19. Anti-malarial drugs (quinicrine, Atabrine), taken within 3 weeks of an LDA injection, will usually destroy the effect.
  20. Immunosupressants (5-FU, etc.) penicillamine, hydroxychloroquine (Plaquenil), and cyclophosphamide usually block LDA. Methotrexate taken outside the three critical days may not.
  21. Synthetic Estrogen (Premarin) at any dose seems to interfere with LDA. Switch to the “natural” estrogen.
  22. Synthetic Progesterone (Provera, etc) – in any dose interferes with LDA if taken within a week before and 5 weeks after a treatment! Switch over to natural progesterone. Note: I haven’t seen “natural” hormones interfere, and have often seen them help with difficult patients. Our typical approach is to switch a patient over entirely to natural (bioidentical) agents and then once they’ve taken full effect to proceed with the LDA. It is important to not apply the hormone creams or gels at the sites of LDA injections.
  23. Birth Control Pills; any dose, will interfere with LDA. The exception was thought to be Desogen, but I have seen failures with patients taking this BCP. Estrace is likely similar; we don’t know for certain yet.
  24. Estrogen Implants: likely will block LDA for up to 6 months after removal.
  25. Estrogen Patches: should not be used for the critical 3 days around LDA therapy, as sensitization to the patch is possible. They probably interfere afterwards as well, but this is not clear yet.
  26. Danazol and Lupron – (for endometriosis): both block LDA, although Lupron may be less of a problem.
  27. Gastrocrom: (chromolyn sodium): not safe to use until after 3 weeks after LDA therapy for a single dose. Exchange it for digestive enzymes. Never use Gastrocrom/Nalcrom more often than once each week at any time, even after the 3-week exclusion period. It can destroy the effect of LDA when used more than directed above, and I think I’ve seen it interfere when used any time with LDA.
  28. Cytotec (misoprostol): if taken before LDA, will destroy the treatment (when taken after LDA, it may enhance the action of the injection; talk with the doctor).