Low Dose Allergy Desensitization

Low Dose Allergen (LDA) Desensitization

At White Rock Naturopathic, we use a desensitization therapy for allergies known as LDA Immunotherapy, also known as Low Dose Allergen/Antigen Therapy or Low Dose Enzyme Activated Immunotherapy. Allergies of various kinds and issues with the immune/autoimmune system are treated using LDA immunotherapy. This covers a variety of issues, such as food sensitivity and intolerance, allergies to airborne and environmental allergens (pollens, dust, mites, dander, and molds), and even different chemicals that might be troublesome for individuals who have “multiple chemical sensitivities.” It has also shown helpful for a variety of chronic illnesses and immunological issues.

LDA is given via intradermal injection into the forearm. For the first six to eight treatments, LDA is administered once every two to three months. Over a three-year period, the majority of patients have 11 to 15 treatments overall. Although the effect of LDA may be virtually instantaneous, its full benefits can take some time to manifest. Patients typically have some kind of noticeable impact after the first or second injection. The response rate often becomes better with additional injections.

Traditional conventional allergy shots and treatments have shown to be very effective for some types of pollen and other specific allergies; however, they have less value for patients with allergies to multiple inhalants and have generally been ineffective for patients with autoimmune diseases, food and chemical allergies, and intolerances. The treatment of many different types of allergy, intolerance to inhalants, some autoimmune diseases, and sensitivity brought on by foods, pollens, molds, dust, and chemicals can all be successfully managed with the help of a more recent form of advanced immunotherapy known as “Ultra Low Dose Enzyme Activated Immunotherapy” or “Low Dose Allergens” (LDA).

People who have had LDA therapy have found it to be economical, quite equivalent financially to “standard” immunotherapy, and frequently no further testing is necessary to start LDA therapy. Many people prefer it since it requires fewer and less frequent injections, especially individuals who are uncomfortable with needles. LDA has proved effective in treating individuals with multiple chemical sensitivities and in reducing the overall burden of environmental and allergic stresses on the body. It is a highly safe kind of therapy and treatment that benefits a much larger range of people with diseases associated to allergies. Patients are informed and prepared before beginning this therapy, including being requested to read and study a patient education handbook created by Dr. Shrader, a recognised specialist and authority on the use of LDA in disorders associated to the environment.

A modest amount of the enzyme beta-glucuronidase is added to the immunotherapy technique known as LDA. When compared to normal allergy injectable materials, the beta-glucuronidase activates numerous allergens in incredibly little levels while also encouraging the development of “T-suppressor cells.”These cells disable the “helper cells” that mistakenly designate healthy substances in the body as allergens or foreign invaders, which triggers an inappropriate immune response that results in symptoms and issues related to sickness. LDA only needs to be injected every two to three months for the first six to eight months; then less frequently as therapy proceeds – fewer treatments are necessary for straightforward dust and pollen allergies. A little quantity of the injection (1/20 cc) is administered intradermally in the uppermost layer of skin during an LDA therapy, which involves injections on the inside of the forearm.

Patients who are allergic to or intolerant to the majority of substances as well as those with a variety of medical disorders can react to therapy thanks to LDA’s combinations of more than 300 allergens. Inhaled pollens, danders, dust mites, molds, fungus, yeast, including Candida species, foods, numerous food additives, the majority of common chemicals and fragrances (apart from pesticides and herbicides), and formaldehyde are among the LDA combinations that are readily available. Pregnancy should not be the time to utilize LDA.

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.

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

With the use of a little amount of the enzyme beta glucuronidase, Low amount Antigen Therapy (LDA) employs homeopathic doses of common allergens to cure allergies, chemical intolerances, and food intolerances. This enzyme acts as a potentiator for the injection’s contents. Extremely minute amounts of different allergens are activated by the beta glucuronidase, and when injected into the skin, they cause the formation of T-regulatory cells. T-regulatory cells are the part of the immune system that have the ability to “switch off” other immune cells’ mistaken reactions that make patients unwell by mistaking benign chemicals in the body for allergens. Both autoimmune and allergies are affected by this.

The medication stimulates T lymphocytes, which are white blood cells that are part of the immune system and govern allergic reactions. The T-lymphocytes establish lifelong memory cells and have a half-life of 12 to 16 weeks, which will eventually provide you with the long-term relief you require. Following therapy, patients say they use fewer drugs, experience fewer illnesses, and are more tolerant of foods, pollens, and toxins. About 12 months after beginning therapy, the majority of patients may consume any food—allergenic or not—without experiencing any adverse effects.

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 (T_reg) 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

Many allergists in Canada use the traditional “escalating dose” immunotherapy method, which involves starting the dose “low”—typically 1 to 10,000—and gradually increasing it to as high as 1 to 10, 1 to 20, or 1 to 100. This method is primarily used to treat IgE-mediated allergies like hay fever, cat, and dust mite allergies. In order to stop the mast cell’s capacity to release histamine, which causes allergy symptoms, “blocking antibody” (specific IgG antibody) is produced by the patient during this sort of immunotherapy.

The more blocking antibodies that can be made, the more effective the therapy. Studies have revealed that administering extremely large doses of the allergen is necessary to create appropriate amounts of blocking antibodies. Therefore, before clinical effectiveness can be achieved, therapy with this approach frequently results in intolerable swelling and other adverse effects. This method is also potentially dangerous owing to the possibility of severe responses such large edoema, anaphylaxis, collapse, and even death. Furthermore, no meals, chemicals, or other substances are utilised; only inhalants.

The majority of deaths following traditional increasing dosage immunotherapy are caused by anaphylaxis. This is because a strong clinical impact and high level of antibody require a very large dosage of antigen. However, LDA immunotherapy is cell-mediated (likely TReg) and administered at very low doses. The maximum dose of LDA is at least a million times lower than the typical dose used in traditional immunotherapy (although certain LDA antigens are lower).

The risk of fatal or seriously dangerous systemic responses to LDA therapy is quite low. In contrast to many other forms of immunotherapy, no reports of life-threatening responses to EPD or LDA have ever been made despite the fact that well over 400,000 doses of EPD and an estimated 300,000 doses of LDA have been administered globally.

For the first four to six months of treatment, conventional increasing dosage immunotherapy is typically given twice weekly. The treatment interval may be increased to once every two weeks or even monthly if the extremely high maintenance dose has been reached, although this is seldom done without a recurrence of symptoms. Typically, 3 to 12 months after ceasing treatment, conventional increasing dosage immunotherapy cannot be terminated without some or considerable recurrence of symptoms.

In contrast, LDA immunotherapy is only given occasionally—once every two months at first, then less frequently—and at a very low dosage. Initially, for a period of around 12 months, treatment is only necessary every two months. The treatment interval can thereafter often be increased to three months or more. The majority of persons with serious issues need 16 out of 18 treatments at these intervals of two months or less often, at which point treatment is frequently stopped. The majority of patients will continue therapy longer at intervals of six months to a year out of the about 50% of people who are unable to stop LDA after 16–18 sessions without experiencing some symptoms again. Children (under 12) may frequently prolong their therapies longer and discontinue them early without experiencing a symptom recurrence. small children as small as one month old have received safe treatment.

LDA Treatment

From Dr. Shrader: www.drshrader.com

LDA is delivered by injecting 0.05 (1/20) cc intradermally into the skin of the forearm or, on occasion, the leg. The LDA antigens are provided much like an intradermal skin test, using a straightforward intradermal injection technique. The typical patient receives 1-2 injections per session, often one on each forearm.

The reaction to LDA manifests quickly, and more than 60% of patients report a notable favourable response after just one treatment. By the third treatment, the majority of patients have responded favourably, and if not, we often reassess the situation. After six treatments, around one in 25 individuals respond with results that are highly favourable.Depending on the illness being treated, the total response rate for all conditions treated with LDA ranges from 65 to 95 percent. About 9% of attempts fail altogether (with no progress).

There are several LDA mixtures that can be used to treat contact skin sensitivity in woodworkers, including inhalants (inhaled pollens, animal danders, dust and mites, insects, fungi, yeast, including candida species, and molds), foods and food additives, chemicals (containing the majority of common chemicals and scents, formaldehyde, and detergents), and woods (a mixture of over 90 common and exotic woods).

Other particular LDA mixes are available to treat a variety of autoimmune disorders, including rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, scleroderma, and others. These mixtures function through a process known as molecular mimicry.

When compared to other forms of immunotherapy, LDA has a few drawbacks. For instance, the majority of patients are required to follow very tight dietary guidelines the day before, the day of, and the day following LDA therapy. In the three weeks following treatment, using certain drugs (such as aspirin and antihistamines) may greatly lessen or completely eliminate the impact of LDA.

On the other hand, LDA has many benefits and stands out for its apparent ability to effectively treat a wide range of disorders that aren’t typically thought to be immune-related or brought on by allergies, such as illnesses that respond poorly or not at all to other forms of treatment. This would cover a variety of conditions including Raynaud’s, Tourette’s, ADD, and ADHD.

It is crucial to highlight that LDA is very successful in treating all types of eczema. There is no comparison between this and the typical dermatological therapy with topical steroids, which is not actually curative and lasts virtually indefinitely. Angioedema, which includes facial swelling, swelling of the lips or eyes, or swelling of other regions of the body, has responded effectively to LDA immunotherapy. Angioedema is generally brought on by acute and chronic food allergies but can also be brought on by a variety of other substances. There is no standard immunotherapy that is both secure and efficient for this situation. The most traditional treatment for these problems involves prescribing avoidance (where the substance is identified) and treating the issue with medication therapy and epinephrine.

Similar to rapid pharmacological therapy, the only effective treatment for acute food allergy, which can result in anaphylaxis (a condition that is typically life-threatening), is avoiding the offending food agent. This covers potentially catastrophic issues such allergies to peanuts, shellfish, and prawns. After ten years of usage, LDA seems to be effective for this disease and can stop accidental anaphylaxis-related food exposure deaths.

Thousands of individuals in the US and Canada who use LDA immunotherapy to treat a wide range of issues view it as a remarkable treatment overall.

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.

LDA is administered about every two months during the first year, every three months during the next year, once every six months during the following year, and as needed after that. The patient may or may not require a yearly booster, depending on how well they adhere to the instructions. Following the treatment schedule is simple with this kind of timetable.

Both the Th1 (delayed hypersensitivity) and Th2 (immediate hypersensitivity) immune system responses to allergens appear to be down-regulated by enzyme-potentiated desensitisation. It seems to have an impact on T regulatory cells, which control the body’s immunological responses.For the first 6–8 treatments, injections are only given every 2 months due to the T cells’ lengthy half-life (60–90 days). Since the production of T regulatory cells takes roughly 3 weeks, symptom alleviation may start to appear as soon as 3 weeks following the initial injection. The frequency of injections may decrease as the number of regulatory T cells rises.If symptoms start to recur, injections may eventually only need to be administered once a year or possibly every 2-3 years. Approximately 60% of patients react to the initial therapy, and their alleviation might continue up to 5 weeks. With the exception of chemically sensitive individuals, who may require up to six treatments before seeing a meaningful improvement, the majority of patients will respond within the first three sessions.

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 6^th 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).