The History of Low Dose Immunotherapy
In the 1960s, Dr. S. Popper in England serendipitously discovered that when he injected his patients with what he thought was the enzyme hyaluronidase in an attempt to treat their nasal polyps, their inhalant allergies disappeared. When he was unable to reproduce the same results later, he determined that it was actually a contaminant in the first batch of hyaluronidase, the enzyme beta-glucuronidase, that was responsible for the phenomenon. After his untimely death, his colleague Dr. Len McEwen developed injections of very low doses of allergens combined with beta-glucuronidase which he dubbed Enzyme Potentiated Desensitization, or EPD.
EPD was used in the United States under an Investigational Review Board in the 1990s. When the IRB expired, delays were encountered in the submission of an Investigational New Drug (IND) proposal with the FDA. As a result, the FDA banned EPD treatment in the United States in April 2001. An IND application was submitted in the fall of 2001, but bureaucratic difficulties plagued the IND trial. Therefore, an American-made injection based on the same principle as EPD was developed.
The American-made injection is compounded in a licensed American pharmacy from American-made antigens manufactured in FDA approved laboratories. The antigens used are the same as in conventional allergy desensitization shots, but in very low concentrations. These injections are called LDA for Low Dose Allergens. In addition to common allergens, 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, etc. American patients have had very good results with LDA, possibly because it is custom-made for the needs of American allergy patients rather than having been developed for the allergenic exposures of the British. The author of this book has had better results with LDA than EPD, possibly due to the more complete “coverage” of American antigens.
How to Live With Low Dose Immunotherapy
Being a low dose immunotherapy patient can take some getting used to. Every few months it may seem like your whole life is disrupted by your treatment. However, the good health you will enjoy after a few shots makes up for the inconvenience.
Low dose immunotherapy patients participate actively in their treatment by making necessary lifestyle and dietary modifications around the time of their injections. Your doctor and his staff will instruct you about “the rules” and their individual application to you. Your doctor will also give you a copy of the Patient Instruction Book (“the pink book”) to clarify the rules. Read this book very carefully several times, and ask your doctor or his staff any questions you have about the instructions in the book and how they apply to you. The two most helpful comments I heard from my doctor about the rules were, “The more you can do, the better off you will be,” and “Be careful, but not paranoid.”
Some low dose immunotherapy patients experience anxiety because they are afraid that they will, through forgetfulness or ignorance, neglect to keep one or more of the rules. Being organized, which is covered in the third chapter of this book, can help you to not forget anything and allay this anxiety. If you do accidentally break one of the rules, ask your doctor or his staff about it.
The application of the rules in the patient instruction book is an individual matter. For example, the book says that eczema patients may have difficulty avoiding creams and lotions, and encourages them to discuss a way around this rule with their doctors. Before I started treatment, I was concerned about having to avoid laundry detergent for several days because I have two sons, one of whom at that time was a five-year-old who liked to change his shirt every time he got a speck of food on it. I asked my doctor if I could use Granny's laundry products, and he said “Yes.” (Please ask your doctor which laundry detergents are acceptable for you, as this can vary with your level of chemical sensitivity).Discuss any questions or concerns you have about the rules with your doctor. Like the patient instruction booklet, this book is written with the most sensitive patients in mind.
Low dose immunotherapy is not a quick, easy cure for your allergies and you may have ups and downs in how you feel as your treatment progresses. The patient instruction book says “Do not be discouraged if...” in more than one place, but each time I was in one of those situations, I found that I was discouraged. Reassurances from my doctor and his staff that how I was feeling was normal for the stage of treatment I was in were very helpful. Call your doctor's office if you have concerns. They may be able to help, and if what you are feeling is not normal, they should know.
Another help for discouragement is having a friend, hopefully one who is a positive person and is a few shots ahead of you in treatment, with whom to correspond or talk to on the phone. Hearing that your friend actually did survive the “downs” and went on to reach new “ups” will make you feel better mentally immediately while you patiently wait to feel better physically.
Perhaps the best way to cope with discouragement is to prepare for it in advance. When we put so much effort into our treatments, we want to be “cured” immediately, but for many patients, it takes time to achieve good results, especially with food allergies and chemical sensitivities. Knowing this in advance will help. Also, even the best shots wear off, especially in the early stages of your treatment. When my son took his first shot at age 11 and was able to eat everything without having eczema problems two weeks after his shot, I warned him that it might not last until his next shot. Then our doctor told him the same thing. He asked me, “Why to do you guys keep telling me that?” and I said, “So if and when it happens you won't be upset ”And when it happened, he was able to cope much better than some adults do.
Finally, keep your eyes on the goal of good health and the times when you will feel better. About the time my son started treatment, there was a song they played on the radio which spoke to us as low dose immunotherapy patients:
“I can see clearly now; the rain is gone,
Gone are the obstacles that were in my way.
Here is the rainbow I've been waiting for,
It's gonna be a bright, bright, sunshiny day.”
Look forward to and enjoy the sunshine of relief from your allergies!
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