Low Dose Allergy (LDA) Therapy

LDA is a treatment for “turning off” an overactive immune system.  This applies to allergies, autoimmune diseases or any process in which the immune system is activated.

Traditional “immunotherapy” involves administering a dilute solution of the allergen by injection, under the tongue drops or topical cream.  The concentration of allergen is relatively high and stimulates the body to make “blocking antibodies” which block the portion of the immune system that is overactive.  The injections take years to work and are dangerous due to the high concentration of allergen.  Under the tongue allergy drops are much quicker and safer, yet both injections and drops are limited for use only with inhalants such as to pollens or animal dander.

LDA is different because is uses much lower concentrations of allergens and may be used to treat not only inhalant allergies, but also allergies to foods, chemicals and certain autoimmune or overactive immune conditions.

The key, the “magic” if you will, to LDA is an enzyme called beta-glucuronidase which attracts certain specialized white blood cells called T cells that are involved in the immune response and makes them pay attention to whatever antigens are included with the enzyme.  The enzyme then causes a down-regulation of only that part of the immune system that was reacting to the included antigens.  Because of the enzyme, much lower concentrations of allergens can be used, yet the immune system is markedly desensitized to the allergens.  LDA therapy is really best described by the original name, “enzyme potentiated desensitization” or EPD.

EPD started in Europe around 40 years ago and is widely used there today.  There is a production facility in Milano, Italy, that provides the antigens for use in Europe.  EPD was used in the US until about 20 years ago when the FDA stopped importation of EPD.  Since that time, a doctor in the US has reformulated the original EPD mixes and has called them LDA.  The current supply of LDA antigens in the US are obtained from a compounding pharmacy in compliance with FDA regulations.

LDA is traditionally given as an intradermal injection because that is the layer in the skin in which the immune system cells are found.  A subcutaneous injection into the underlying fat is not likely to attract enough T cells to do much good.  The cutaneous nerve plexus spreads out in this layer as well, which is why an intradermal injection stings more than a subcutaneous injection.

Of note, LDA is also given sublingual as an under the tongue drop since it gains access to the immune system quite well in this manner.  We are also finding it works well in most people without the enzyme.

LDA for Autoimmune Disease

To further confuse things, another term used for this type of therapy is “low dose immunotherapy” or LDI.  This term emphasizes using LDA for more than what is thought of as typical allergies, such as desensitizing the immune response to certain bacteria.

Using LDI for autoimmune diseases and conditions that involve an overactive immune system is a truly unique therapy.  It is well established that certain autoimmune diseases, and perhaps most of them, are “triggered” by an initial infection.  As the immune system recognizes the infection and mounts an attack there is a cross reactivity with their own tissue.  This process is called “mimicry”.

Sometimes this happens only in people with specific genetic mutations in their self-recognition genes called human leukocytic antigens (HLA), which are part of the major histocompatibility complex markers.  The HLA gene family provides instructions for making a group of related proteins known as the human leukocyte antigen (HLA) complex.  The HLA complex helps the immune system distinguish the body’s own proteins from proteins made by foreign invaders such as viruses and bacteria.

Even after the bacteria are eliminated the immune system remains activated and the autoimmune process continues.  Since the immune response is coded to recognize the original bacterial trigger, including the specific bacteria in the LDI will lead to a desensitization of the immune system, calling off the attack on both the bacteria and the body tissue.

Two examples of mimicry can elucidate this process better, and also point out why treating an acute infection may resolve a symptom, yet treating a chronic infection may be fruitless as the immune response is actually causing the symptoms.

First, consider acute strep throat, in which antibiotics kill the bacteria quickly before the immune system gets very upset.  If strep goes untreated however, about 1 in 1-3000 people will get rheumatic fever which is an autoimmune type reaction that requires anti-inflammatories to treat, not just antibiotics.  The autoimmune reaction was triggered by strep.

Second, consider Lyme’s disease, in which once again early antibiotic therapy will usually kill the bacteria before the immune system really gets involved.  But, with chronic Lyme’s, the immune system activation is what causes the symptoms.  Not only do the bacteria mutate and hide via different intracellular and cystic forms making eradication increasingly impossible, eradication still does not necessarily turn off the immune response that is causing most of the symptoms.  Chronic Lyme should be thought of as an autoimmune disease…

The Allergens

For simplicity, both LDA and LDI will be referred to as LDA from here forward.

The LDA injections come in different concentrations.  A 100-fold dilution is referred to as 1C.  Each “C” represents another 100-fold dilution, such as a 2C dilution would be a 10,000-fold dilution, a 3C is 1,000,000, and so on.  Most LDA dilutions are in the 6-8C range, making them 1,000,000,000,000 to 10,000,000,000,000,000-fold dilutions.

For comparison, homeopathic dilutions start at 12C, which is maximum dilution from which one molecule of the original substance potentially still exists.  Homeopathic preparations are usually in the 30-200C dilutions.  As another comparison, traditional immunotherapy typically uses 1-2C dilutions.

Common antigen choices and strengths:

  • Campylobacter
  • Collagen mix
  • Dental mix
  • DTap
  • Influenza 5-12C
  • Histamine/Histadine
  • HSV 5-12C
  • MMR
  • Mycobacterium (aka Crohn’s mix)
  • Mycoplasma/Chlamydia
  • Parasites
  • Rickettsia mix
  • SF-B = Skin Flora Bacteria
  • SG-F = Skin Flora Fungal
  • LX – foods,  low dose
  • MX – foods, medium dose
  • IC – inhalants, pollens, animal dander
  • CX – chemicals
  • Crohns/IBD – various species of common gut bacteria
  • Yeast
  • Lyme 5-25C – six strains of borrelia bergdorferi, six strains of bartonella, babesia
  • UTI mix (aka P/K) – proteus / klebsiella
  • Streptococcus
  • Clostridia
  • Yersinia

Guideline on choosing allergens:

  • Ankylosing Spondylitis                    LX/MX & Klebsiella
  • Arthritis, non-specific                      LX/MX, CF, Yeast, Strep
  • Asthma                                               LX/MX, IC, CF, Yeast
  • Crohns                                                LX/MX & Crohns/IBD, Klebsiella
  • Endometriosis                                  Yeast
  • GBS                                                     Campylobacter
  • Grave’s                                               LX/MX, Yersinia
  • Hashimoto’s                                      LX/MX, Yersinia
  • Hayfever                                             IC
  • Lyme                                                   Lyme
  • PBC / Intestinal                                LX/MX & Crohns/IBD, Yersinia
  • Rash                                                    LX/MX, CF, Yeast
  • (atopic dermatitis, eczema,
  • psoriasis, seborrhea, urticaria)
  • Rheumatoid Arthritis                        LX/MX & P/K
  • Ulcerative Colitis                               LX/MX & Crohns/IBD, Klebsiella
  • Fibromyalgia / CFS / MCS               LX/MX, CF, Yeast

Treatment Guidelines – LDA Allergen Selection

Some LDA therapies are such that one dilution seems to work well for all patients, while others have a wide range of dilutions.  If the dilution is too strong, the patient will have a flare of their symptoms.  If the dilution is too weak, the patient will not improve.  Since most patients respond by the 2nd or 3rd shot, if there is no improvement by then, a stronger dilution should be considered.  Or, consider that symptoms are related to a different antigen, or that the LDA is not the correct therapy in general.

If you have a delicate, fragile, or worried patient, consider using a weaker dilution.  If you have a patient that is anxious to see results and fairly stout of constitution, use a stronger dilution.  If a patient has a flare of symptoms from the LDA, a standard short burst of steroid is usually sufficient to regain control of symptoms.  The next injection should be more dilute.

Choose which antigen or antigens are used depending upon the patient’s condition and/or symptoms.  A thorough symptom review aimed at determining triggers is important.  If a patient clearly has hayfever symptoms when exposed to grass, or animal dander, then one would use the IC mix.  If perfumes or chemical smells trigger symptoms, then one would use the CF mix.  As many conditions are related to food allergies the LX/MX mixes are often used for conditions beyond simple food allergies, usually in combination with other antigens.

LDA injections are given at 7-week intervals – no sooner.  The immune system has a memory and does not like to be told twice to do something.  Repeating the same LDA injection sooner than 7 weeks will cause a flare of the patient’s symptoms.

However, you may administer different antigen mixes at any time in relation to one another.  For example, one might start the Lyme mix, wait to see how the patient responds, then a week later give another antigen mix, such as p/k for rheumatoid arthritis.  In this manner one can determine which mix produced a flare in symptoms.  Once the doses are determined one can then schedule all the injections on the same day for convenience.

Combinations of antigens can even be mixed into one syringe together but it tends to increase the volume of the injection and make the already painful intradermal injection hurt more, especially if three antigen mixes were mixed.  For this reason, we will generally give each injection separately.

For complicated or fragile patients, or when using antigen mixes more prone to need variations in dosing (e.g. Lyme, Yeast), it is simplest to start only one antigen at a time in order to know how to adjust in case of symptom flares or non-response.

Combinations can be started together for some conditions, such as Crohns, and are notated by the “and” notation, e.g. LX/MX “&” Crohns/IBD means both antigen mixes are usually started together.

For some conditions we might start with a single antigen, and if no response is achieved after a few doses, try a different antigen.  For example, with non-specific arthritis we might start with LX/MX, and if no response, try CF, and if no response try Yeast, and if no response try Strep, and so on…

Finally, one may use autologous samples from the patient to be used in the mix.  Stool samples represent a likely reservoir for chronic infection that may be triggering an immune response, so this is a logical antigen.  I’ve talked with a doctor who has used a skin/rash sample from a patient with discoid lupus as the antigen, and in another case used a standardized preparation of myelin basic protein as the antigen in a patient with MS.  In both cases marked clinical improvement was noted.

Initially most patients will get some relief of their symptoms for a few days to weeks.  They may call and beg to get another injection prior to the 7-week interval – don’t do it.  Eventually, by the 4th to 5th injection, they will start getting symptom relief all the way through the 7 weeks until the next injection.  At this point one can stretching out the injection interval, basically until symptoms start returning.  Typically, after a few years, patients only need the injection once or twice per year to maintain remission.


Author

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).   Call (970) 245-6911 for an appointment or more information.

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