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Low Dose Immunotherapy

Low dose immunotherapy is a method of treating food and environmental allergies. The original form of low dose immunotherapy, enzyme potentiated desensitization (EPD), was developed in England in the 1960’s. While trying to eliminate nasal polyps by injecting them with the enzyme hyaluronidase, Dr. S. Popper serendipitously discovered that patients’ pollen allergies were eliminated, although their nasal polyps remained. Further research showed that an enzyme which was a contaminant the hyaluronidase, beta-glucuronidase, plus extremely low doses of allergens, was responsible for the desensitization. After Dr. Popper’s untimely death, Dr. Leonard McEwen developed injections of very low doses of allergens combined with the enzyme beta-glucuronidase (an enzyme normally present in the human body) and called the shots EPD.

EPD was administered in the United States for several years under an Investigational Review Board (IRB) study. The IRB study showed that EPD was extremely safe (safer than “conventional” allergy shots) and effective for nearly 80% of the people treated for most allergic conditions. When the IRB expired, application needed to be made with the FDA for Investigational New Drug (IND) status for EPD. The IND application was not submitted soon enough, so in 2001 the FDA “shut down” EPD. Difficulties plagued the initiation of an IND trial, so an American-made injection was developed and was called Low Dose Allergens (LDA). In addition to the common allergens in EPD, LDA contains uniquely American antigens which are not present in EPD such as cottonwood, sage, mountain juniper, some New World evergreens, American perfumes, “new” foods such as avocado, etc. In my own personal experience, LDA has been more effective than EPD, especially for chemical sensitivities such as to perfume, possibly because it is designed to "fit" the allergic exposures Americans experience rather than the exposures that the British experience.

Low dose immunotherapy (both EPD and LDA) is effective for inhalant allergies, food allergies and intolerances, and chemical sensitivities. Because all of the patient’s problems are being treated at once, a great improvement in general health should occur. Some of the conditions that have been successfully treated with low dose immunotherapy include hay fever, asthma, urticaria (hives), eczema, angioedema, anaphylaxis, food allergies, preservative allergies, chemical sensitivities, ADHD (attention deficit hyperactivity disorder), autism, Tourette’s syndrome, irritable bowel disorders, Crohn’s disease, ulcerative colitis, migraine and other headaches, rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythmatosis.{1}

Because low dose immunotherapy “exploits” a natural phenomenon, it can be diverted by high-dose exposures to allergens at the time of the injection, medications, etc. Therefore, patients must exercise strict control of their environmental and dietary exposures to allergens as well as avoiding many medications at the time of their treatments. For this reason, low dose immunotherapy has the reputation of being somewhat of an ordeal to go through. Indeed, it does involve much participation on the part of the patient. If simple dietary manipulation is sufficient to restore your health, you may not want to take low dose immunotherapy. However, since my food allergies progressed to the point that diet was no longer sufficient help, I opted for low dose immunotherapy, which I find much less inconvenient than continual poor health.

Low dose immunotherapy injections are usually taken at two month intervals initially. As the patient progresses, the interval between injections is gradually extended until they are taken at yearly intervals after several years. Some patients may even be able to stop treatment for extended periods of time without their allergy symptoms returning. Other patients have taken injections 1 to 4 times a year for up to 20 years. Most patients can either go a long time between injections or stop entirely after about 16 to 18 injections.{2} For severe food allergies, 6 to 12 doses or 1 to 2 years of treatment may be necessary before good results are achieved. However, the patient should notice some improvement within the first three doses.{3} If no improvement is noted, factors which may be interfering should be considered. The most common problem when low dose immunotherapy does not work is intestinal dysbiosis.{4} (For more about this problem, click here). Low dose immunotherapy helps 70-80% of the people treated, although some patients may go through a period of feeling worse before they feel better in the course of their treatment. About 60% of patients have a good response to the first injection.{5}

If you elect to receive LDA treatment, your doctor should give you a copy of the Patient Instruction Booklet, commonly called the “pink book,” which explains all the “rules” about what must be avoided and done at the time of your injections. Because the low dose immunotherapy diet is quite limited and the organizational effort of preparing for your first shot may seem overwhelming, you may also wish to get a copy of The Low Dose Immunotherapy Handbook to help you.

In my opinion, low dose immunotherapy comes closer to a “cure” for food allergies than any other treatment, and for some people really is the cure. However, for those of us with severe food allergies and especially with dysbiosis, the road to health may not always be smooth and dysbiosis and other interfering factors may be challenging to correct. For more about my and my son’s experiences with low dose immunotherapy, click here.


1. Shrader, W. A. Jr., M.D. Enzyme Potentiated Desensitzation: American EPD Society Patient Instruction Booklet, American EPD Society, 141 Paseo de Peralta, Suite A, Santa Fe, MN 87501, 1997, p. 3.
2. Ibid, p. 2.
3. Ibid, p. 5.
4. Ibid, p. 7.
5. Ibid, p. 5-6.

The information on this page is abridged from
The Low Dose Immunotherapy Handbook
($9.95, eBook $6) © 2003 and
The Ultimate Food Allergy Cookbook and Survival Guide
($24.95, eBook $13) © 2007

For more information about these books, click on the book's title above.

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