Low Dose Allergen Treatment (LDA) patient information

There are a number of different desensitization or immunotherapy treatments for allergies available. The ‘classic’ immunotherapy typically available from allergist offices for hay pollen, dust mites, molds, etc. is largely antibody mediated. That is, injecting relatively high doses of particular antigens (Ag, i.e. the stuff you are allergic to) in order to stimulate specific white blood cells to produce IgE antibodies (Ab). These IgE Ab are relatively short lived and the antigens available more limited. Thus, the allergy symptoms typically return quickly without continued treatment, the range of allergies treated and other allergy medications are often used concurrently. Provocative Neutralization (PN or PNT) uses extremely dilute concentrations of a greater variety of allergic substances administered into the skin or under the tongue. It likely works by stimulating a low dose immune tolerance with limited duration of effect. In addition, the treatment is frequently limited by the number of substances that can be tested and treated at any one time. It is also more labor and time intensive testing to work through the proper antigens and their dilutions tested by skin injections or sublingual dosing. While effective and specific, PN may require frequent testing and adjustment of antigens and it is difficult to find adequately trained practitioners. Enzyme Potentiated Desensitization (EPD) was developed in the 1960’s but was banned by the FDA in 2001 for various reasons that were generally not safety concerns. Because of its efficacy, EPD was reformulated as Low Dose Antigen (LDA) therapy by W. A. Shrader, MD and has been safely used since 2002. LDA consists of 4 different cocktails of numerous antigens in fixed combinations enhanced by including a minute dose of chondroitin sulfate and an enzyme, beta glucuronidase. This mixture is injected into the first layer of the skin on the inner aspect of the forearm in very small amounts. The antigens used are in homeopathic or very dilute concentrations. LDA seems to work by ultimately stimulating the production of T-suppressor cells, shutting down overactive allergic responses. Thus, LDA activity appears to be primarily cell-mediated creating a much longer lasting desensitization than the conventional antibody mediated immunotherapy. Typical LDA therapy is repeated every two months for the first six to eight injections and then less often with time as patients experience fewer symptoms and avoidance becomes much less necessary. LDA immunotherapy is used to treat all types of allergy including: sensitivity and intolerance to foods, inhalants (pollens, dust, mites, dander, and molds), and even various chemicals problematic in Multiple Chemical Sensitivity. It has also been useful for many chronic diseases and auto-immune conditions related to or triggered by allergies including: ankylosing spondylitis, rheumatoid arthritis, interstitial cystitis, asthma, IBS, psoriasis or eczema and others listed below. All the components in LDA are compounded by a special FDA approved pharmacy for prescription to patients. However, the method is not regulated or sanctioned by the FDA and, therefore, not suitable for billing to insurance. Thus, LDA is not available as a retail product and cannot be advertised by the compounding pharmacy. Likely, the only way you will hear about LDA is word of mouth from other patients who have experienced it or from physicians utilizing it in their practice. Please see www.drshrader.com for further discussion on the history of LDA and associated research and comparison to other allergy treatments.

Advantages of LDA

• No need for extensive testing, frequent dosage adjustment or long office visits.
• Prevents ‘spreading’ of sensitivities or development of additional allergies.
• Good for multiple allergies.
• Helpful for auto-immune conditions and many other chronic conditions not typically associated with allergies.
• Safe for all ages and severities of sensitivities.
• Helpful for associated chemical sensitivities, chronic illnesses and auto-immune conditions.
• ~75% overall improvement or elimination of allergies without need for additional allergy medications. Over half of the patients with multiple allergies can stop LDA completely after 16-18 treatments with the other half needed continued treatment with long intervals of 1-4 years between treatments.

Disadvantages of LDA

• It may take 6-8 injections to achieve sustained relief of symptoms except for simple allergies. Failure is not considered until 6-8 injections are given without any notable benefit.

DO NOT START LDA UNLESS YOU ARE WILLING TO BE TREATED FOR 12 MONTHS TO SEE IF YOU MIGHT HAVE LASTING RESULTS.

Most patients, however, see relief long before then.

Need to avoid various medications other guidelines around time of injections.  Please check with our staff to ensure your medications are safe to take.  We will not assume responsibility if you take medications that may interfere if you don’t ask.

Safety – There has never been a fatal or life-threatening systemic reaction to LDA. It can be used to treat IgE mediated anaphylaxis responses. However, people with history or anaphylaxis, severe eczema, recurrent hives or angioedema, reactive asthma or significant auto-immune disease should be pretreated with prednisone for the first several doses of LDA. Worsening symptoms with subsequent doses are suggestive of something blocking the effect, eg. Dysbiosis, heavy metals, exposure to allergens around the LDA injection, other contra-indications.

Administration- Intradermal injections given usually on forearm, but legs or abdomen are options. Frequency- Injections are administered every 2 months for 6-8 injections, then less often as improvement dictates. Hay fever treatment only is 1-3 doses per year starting 3-4 months before the onset of the season. After the first season, only one booster dose may be required yearly, given 3 weeks before the season starts. This also applies to house dust mites, with boosters given as required. Food allergy and chemical sensitivity treatments tend to be done at 2 month intervals for the first 6-8 treatments. Injections cannot be given more frequently than every 7-8 weeks. Milk and wheat generally take the longest to desensitize. Once a response is well established, the frequency of treatment becomes less frequent.

How long before improvement is seen?

• Most often immediate response is seen but the full benefit of LDA will take longer. Sustained improvement may be noticed within the first 6-12 months and for severe reactions, up to two years. Response can also be blocked by various medications and not following the recommended diet.

What can you expect after an injection?

• Immediate Response: An immediate temporary “cure” of symptoms in 70% of patients after the first treatment and may last 2-5 weeks. A neutral response occurs in about 23% of patients and poor response in 7%. An increasing rate of positive responses occurs with subsequent injections.

• Delayed Response: This should begin after 3-4 weeks (after the lymphocytes mature) and may last to some degree for 2-4 month initially and then longer by the sixth and eighth treatments. Some patients see no results until their shot kicks in at about 3-4 weeks.

• After the first injection, most feel better for 2-5 weeks. When the shot begins to wears off, you must wait for the next injection period to get continued treatment or at least 7-8 weeks. Occasionally, a decreased response may be followed by an increased response again. Eventually you should feel quite well for a full 2 months between injections. At that point, increased intervals between injections should occur (approx. 1 year for adult and less for children).

WARNINGS:

• Be certain the doctor knows of any history of autoimmune disease, eczema, skin allergies of any kind, hives, swelling of lips, face or body, and especially any anaphylactic reactions before you ever receive LDA. SPECIAL PRECAUTIONS need to take place with your injections.

• Do not mix conventional nor provocative neutralization with LDA injections even as the LDA appears to be wearing off.

General Rules to Receive LDA

• Success depends partly on factors that interfere with it. This will vary somewhat with the severity or “Levels” of your sensitivities.

• LDA effect may be enhanced by taking recommended vitamin and mineral supplements. These have been specially formulated for LDA and should replace your other supplements for at least the week before and three weeks after the injections.

When Not to have LDA

• During the first 3 days of any infection, including colds
• Following recent immunization
• Within 5 days of dental work or 2 weeks of planned dental work except cleanings
• Within 4 days of taking any pain killers including Tylenol.

CONDITIONS TREATED EFFECTIVLY WITH LDA

• Food or food additive anaphylaxis, allergy, intolerance or other adverse response
• Chemical or fume intolerance (severe symptoms, when exposed by breathing)
• Anaphylaxis, cause unknown (idiopathic)
• Rhinitis, seasonal or perennial
• Post nasal drip, chronic
• Chronic or recurrent sinus infections
• Chronic face ache/sinus pain
• Nasal polyps
• Anosmia (lack of smell)
• Conjunctivitis (itchy/watery eyes)
• Repeated ear infections
• Serous otitis media (“glue ear”)
• Plugged ears (not wax)
• Meniere’s Disease, dizziness
• Pharyngitis
• Laryngitis
• Repeated chest infections
• Swelling of the lips, face or tongue (angioedema)
• Asthma, seasonal only
• Chronic cough
• Asthma, year `round
• Hypertension
• Reynaud’s
• Irritable bowel syndrome
• Gut “fermentation” (bloating after most meals, especially sugar)
• Constipation
• Chronic anal irritation/itch (not caused by hemorrhoids or parasites)
• Ulcerative colitis and Crohn’s disease
• Interstitial cystitis
• Mental confusion (brain “fag,” “fog,” confusion, etc.)
• Multiple sclerosis
• Rheumatoid arthritis (RA)
• Reactive arthritis (autoimmune, non-RA)
• Ankylosing spondylitis, documented
• Sjogren’s Syndrome
• Pruritis or itching
• Contact dermatitis
• Dermatographia
• Urticaria (hives)
• Eczema, “dermatitis”
• Psoriasis