Low Dose Allergen immunotherapy (LDA)
Known as LDA, this type of immunotherapy treatment consists in the administration of ultralow doses of environmental and food allergens.
This treatment is based on clinical observations by a British scientist (Dr. Leonard Mc Ewen) who realized that the combination of a naturally occurring enzyme in the body (Beta-Glucuronidase) with ultralow doses of allergens led to the control of multiple allergy symptoms. Dr. Shrader introduced this treatment to the US in the early 1970’s and it was incorporated into our practice in 2009.
This treatment has the possibility to control usual environmental allergies as well as reactivities to foods. This treatment also can be used for patients that have reactivity to chemicals.
LDA is highly effective but more importantly, it is extremely safe. It is the ideal treatment for patients with allergies that are so severe that they can develop asthma attacks, throat tightness or other severe reactivities during allergy testing or treatment. LDA has the unique advantage that it does not require testing.
It is also highly effective for patients with eczema and other skin conditions with an allergic component. It is very effective for patients that have food intolerances or oral allergy syndrome developing itching, or mild swelling in the mouth, lips or tongue upon ingestion of foods, usually but not only, fruits.
LDA is administered by injections. Injections are given in the forearm. There is one separate injection for the environment, one for the foods and one for the chemicals. The treatment is administered once every 2 months. The effect of the LDA injections is usually evident shortly after the administration. Over time, usually after 1.5-2 years of once-every-two-months injections, the effect lasts longer and therefore the interval between injections is elongated. Eventually the patient will receive LDA shots 1-2 times per year. When the interval increases to once-a-year shots, the patient will be instructed to return when symptoms reappear. This can happen at intervals of 2-3 years or longer. Some patients never return after such time.
For very young children with fear of injections, the LDA mixes can be combined into one single shot. The mixes can even be applied as sublingual drops. While these 2 modifications are also effective, the treatment results are most effective when separate injections are given. In our experience we use these two alternatives only rarely, and usually, after a few administrations the patient becomes more cooperative. Often, we are able to continue the treatment with separate shots.
This treatment is based on clinical observations. It does not conform to present day criteria for scientific evidence. The treatment is therefore not approved by the FDA and as a consequence, it is not covered by any insurance carriers in the US.
Despite it being a not-covered service, it is extremely affordable and effective so patients with no insurance commonly choose this type of allergy immunotherapy.
Originally, a complex preparation was required before receiving this treatment. At the present time, the preparation for LDA treatment is simpler than years ago. The patient is advised to take large doses of vitamin D and to follow a mildly restrictive diet. Detailed instructions are provided to the patient opting this treatment. For patients that are actively using inhalers or with severe skin issues, prednisone and sometimes Diflucan® will be used for a few days.
How is LDA administered
LDA is given by injections. The injections are given in the surface of the fore arm (a similar injection as used to be done for the PPD test)
One injection contains the allergens involved int eh development of environmental allergies (dust, dander’s, molds and pollens) The other injection contains foods commonly used in a western diet.
There are other injections used less commonly for the management of chemical reactivities or even some autoimmune conditions.
Preparation for LDA
In order for it to work best there are a series of steps to be taken before, during and after the injections.
- Diet: results are best when a diet is followed for 3 days including the day before, the da of and the day after the injections. This is a restrictive diet that includes elimination of commonly allergenic fids including grains, dairy and “junk” food.
- Medications: Non-essential medication should be avoided during same time as the diet. The office personnel will advise you as to what medications will be discontinued.
- Vitamin D should be loaded before injection, a dose of 10.000 IU of vitamin D3 will be consumed for 10 days, ending day before injections.
- From day of injection onwards, allergy and pain medication as well as alcohol consumption should be avoided for 10 days.
- Patients that are actively using inhalers will be prepared with a short course of prednisone ((prednisolone for children) for 5 days, from 2 days before the shots to 2 days after that. The total dose is small. The objective is to minimize the need for inhalers during these days. As soon as the patient improves and does not use inhalers any more the use of prednisone will stop.
- Some other cases may require prednisone or another preparation. These cases will be discussed with the doctor before treatment is instituted.
Is LDA effective
Without a doubt the question is a resounding YES.
What is not clear is if this treatment is as effective as other more established modalities. Dr. Saporta has published the only known comparative study where treatments results between usual allergy immunotherapy (weekly “allergy shots”) and LDA was done. He found that both treatments gave similar results.
How often is LDA administered
Initially treatment is disinterred once every 2 months, but when effect gets established administration interval increases therefore shots will be then administered once every 3 months, 6 months etc. According to patient’s response it is not unusual by the 3rd year of treatment to require LDA shots once or twice per year.
When patient comes once a year the patient does not receive formal appointment any more rather is instructed to return when stops recur. In this case we observe patient that come at longer interval including 3 years. It is advisable to return as soon as symptoms reoccur so the next LDA administration acts more like a booster and effect is more prolonged.
Low Dose Allergen immunotherapy or LDA
- Address 470 North Ave. Elizabeth, NJ 07208
- Email EntAllergyNJ@gmail.com
- Phone (908) 352-6700