LDA Treatment

Patient Instruction Booklet

Modified from the work of

W.A. Shrader., MD

 

 

Low Dose Allergen Treatment (LDA)

There are a number of different desensitization or immunotherapies for various 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).  The problem is that these IgE Ab are relatively short lived and the treatment more limited in the range of allergies treated.  Thus, the allergy symptoms typically return quickly without continued treatment and other allergy medications are often used concurrently.  Provocative Neutralization (PN or PNT) uses extremely dilute concentrations of perhaps a greater variety of substances administered into the skin or under the tongue.  It likely works by stimulating a low dose tolerance with limited duration of effect.  In addition, the treatment may be limited in the number of substances tested and treated at any one time and typically requires labor and time intensive testing of the proper antigens and dilutions by skin injections or sublingual testing.  PN, while effective and specific, 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.  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 immunotherapy. Typical LDA therapy is repeated initially every two months up to the first six to eight injections and then less often with time as patients experiences fewer symptoms and avoidance becomes much less necessary.  LDA immunotherapy is used to treat all types of allergy, sensitivity and intolerance to foods, inhalants (pollens, dust, mites, danders, and molds), and even various chemicals problematic in Multiple Chemical Sensitivity.  It has also been useful for many chronic diseases and auto-immune conditions including ankylosing spondylitis, rheumatoid arthritis, interstitial cystitis and others listed below. All the components in LDA are compounded by a special pharmacy accepted by the FDA by prescription for specific patients.  However, the method is not regulated by the FDA and therefore not suitable for billing to insurance.  Thus, LDA is not available as a retail product and cannot be advertized 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 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 a number of 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 except for simple allergies.  Failure is not considered until 6-8 injections are given without any 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 and follow specific diet around time of injections.
  • Need to do injections at the clinic up to 30 minutes at least for the first few injections.  The antigen mixture is relatively fragile and must be kept in a controlled environment.  Thus, the injections cannot be shipped to administer elsewhere.

Safety – There has never been a fatal or life-threatening systemic reaction to LDA.  It can be used to treat IgE mediated anaphylaxic 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,

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.

Hayfever treatment is 1-3 doses per year.  First injection preferable 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.

Foods 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 may 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?

  1. Immediate Reaction:  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%.  More positive responses occur with subsequent injections.
  2. Delayed Action:  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 later between the sixth and eighth treatment.  Some patients see no results until their shot kicks in at about 3-4 weeks.
  3. After #1 injection > feel better for 2-5 weeks.  When the shot wears off, you must wait for the next injection period to get continued treatment.  Occasionally, a decreased response may be followed by an increase 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:

History of eczema, skin allergy of any kind, hives, swelling of lips, face or body, autoimmune disease, or especially anaphylactoid reaction or anaphylaxis, be certain the doctor know your condition before you ever receive LDA.  SPECIAL PRECAUTIONS need to take place.

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

General Rules to Receive LDA

  • LDA works best if important guidelines for food and listed drugs to avoid are obeyed.
  • Success depends partly on factors that interfere with it.  Follow the guidelines!!!
  • The lower the dose, the more potential there is for interference from outside things.
  • There Are Three Levels Of Patients With Guidelines To Follow Shortly.

Pregnancy-LDA should not be used during pregnancy.  If a patient elects to be treated, precautions must be taken with drugs used in conjunction with LDA such as most antifungals, vitamin A and maybe even bismuth.

 

FAILURE CAUSES:

  • Not following IMPORTANT RULES for LDA especially related to medications or diet.
  • Improper dosage or timing of dosage
  • Rare:  Interference by gut organisms or improper preparation.
  • Rare:  Interference from high levels of heavy metals, silicone breast or other implants, active infection such as root canal or other immunological issues.
  • Unknown reasons which are occasional.
  • Not following guidelines around the time of treatment.  Medications, some herbs, homeopathics, other treatment modalities, unrestricted activities not listed should be considered “unknowns”.

BEST ADVICE:  If you have significant illness, avoid questionable things for 3 weeks after LDA.

The list that follows is a fairly complete compilation by others of conditions that have been shown to respond to both EPD and LDA immunotherapy for patients with classical and non-classical inhalant, food and chemical allergy.

CONDITIONS TREATED EFFECTIVLY WITH LDA

  • Food or food additive anaphylaxis, allergy, intolerance or 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
  • Raynaud’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
  • Vulvadynia
  • Chronic vaginal symptoms
  • Urinary tract symptoms (not due to infection)
  • Migraine/severe headaches
  • Mental confusion (brain “fag,” “fog,” confusion, etc.)
  • Epilepsy (any type)
  • Multiple sclerosis
  • Tourette’s
  • Hyperactivity, ADD, ADHD
  • Depression
  • Autism
  • Emotional/Behavior problems
  • Insomnia
  • Muscle pains, severe
  • Rheumatoid arthritis (RA)
  • Osteo-arthritis or joint pains, non-specific
  • Reactive arthritis (autoimmune, non-RA)
  • Ankylosing spondylitis, documented
  • Sjogren’s Syndrome
  • Pruritis or itching
  • Contact dermatitis
  • Dermatographia
  • Urticaria (hives)
  • Eczema, “dermatitis”
  • Psoriasis
  • CFIDS, CFS
  • Diabetes
  • Pre-menstrual syndrome (PMS)
  • “Candida” or fungal-related illness symptoms that respond clinically to antifungals

General Rules of Preparation  For  LDA  Treatment

LEVEL 1,   2,   3   PATIENTS

 

All Levels — GUIDELINES –Level 1 guidelines apply to Levels 1,2 & 3

 

Level 1 and section that follows.

  • Drugs Often Interact with LDA -  No drugs, vitamins or herbs, except as listed in this literature or specifically given to you as part of an LDA prep or bowel protocol, or those you specifically discuss with the doctor, should be taken the day before, the day of or the day after LDA.
  • If you take large doses (5-20 grams or more daily) of Vitamin C as a routine before you start LDA, you should taper it down to 3 grams or less during the 2 weeks prior to LDA therapy. Do not stop it abruptly, or you’ll likely have withdrawal symptoms.
  • Do not have LDA if you are trying to get pregnant within 2 weeks of the injection.
  • Follow the rules for drugs known to interfere with LDA and Immunization.  (Listed elsewhere.)
  • Avoid alcohol for 10 days after treatment.
  • Avoid stimulant drinks like coffee, tea & cola during critical 3 days-helps listed elsewhere.
  • You may exercise normally during LDA, but avoid fatiguing exercise, extreme heat  and sunburn for 3 days after LDA.
  • Sunbathing more than 5 days before may be advantageous (increased vitamin D production).
  • Do not use the sauna.
  • Do not wear makeup during critical 3 days.
  • May use ChapStick® or other lip balm during critical 3 days.

 

Level 2 & 3 must also include guidelines for Level 1 and section that follows.

  • Do not use ChapStick® or other lip balm on day of LDA.
  • Do not put ointments, creams and lotions on the site of the injection(s) on the day of treatment.
  • Use unscented soap on the day you receive LDA or the night before.
  • Do not wear perfume, scented agents, or essential oils to the office on the day of LDA.  (This includes homeopathic creams and ointments that can contain agents for concerns.)
  • Use unscented shampoo & conditioner
  • Use pure baking soda to brush your teeth.  Do not use toothpaste.
  • Sexual activity may be a problem for women since they risk being sensitized to their partner’s semen.  Especially true for eczema sufferers;  Avoid critical 3 days around LDA therapy
  • Limit exposure to animals, perfumes, aerosols, sprays, painting, etc.

 

Level 3 must also include all guidelines above and section that follows.

 

 

 

 

 

 

 

 

LEVEL 1 PATIENTS

GUIDELINES – SEASONAL HAYFEVER ONLY

  • Adhere to “Preparation for LDA Treatment” Guidelines listed. You do not need to follow LDA diet if your problems are only hayfever.  See questionnaire Pg
  • Limit contact with your pets, especially cats.  Do not sleep with them either.
  • Danger:  You may become sensitized to your pet.  If you know you are allergic to your indoor pets, especially cats, you should not stay in the home during the critical 3 days.  Wash your hands if you handed your pet.  If sensitization occurs, it can be reversed with the next LDA but stricter guidelines must be followed.
  • If your home has residual water damage, you may want to stay somewhere else during the critical 3 days.  If you smell dampness or musk, stay someplace else.
  • Avoid indoor molds at the time of treatment. Don’t worry about outside mold.
  • Limit exposure to pollens.  Reactions to outside pollens (near a pollen season)  after LDA treatment may mean time needs to be extended between injections.
  • Feather allergy requires that you do not sleep with a feather pillow or down comforter for at least a week after LDA.  Use a cotton or foam pillow.
  • Avoid yard work critical 3 days.
  • IMPORTANT NOTE:  SEE “Foods, Pollen and Mold Cross Reactions” for dietary advice.

Tree Pollen – sufferers Must NOT eat the following for several days after LDA:

nuts, fresh apples, oranges, raw carrots or celery

Mold -Spores from different species may cross react with LDA-avoid for 10 days after LDA:

Tea, cheese, fermented or aged foods, mushrooms, alcohol

If desensitization is unsuccessful, antifungal regime may be needed before next treatment.

LEVEL 2 & 3 PATIENTS GUIDELINES

GUIDELINES –(2) FOOD WITH OTHER MORE COMPLEX PROBLEMS

Instead Of or In Addition To Seasonal Allergy

  • Qualifying Patient for this section:
    • has intestinal, food issues or autoimmune disease, may or may not have pollen allergy, and do not have significant chemical sensitivity
    • had sub-optimal response to LDA Level 1 regimen, you must strongly consider following Level 2 or Level 3 guidelines.  Discuss your issue with your doctor.
  • Adhere to “Preparation for LDA Treatment” Guidelines listed.
    • Take multivitamin/mineral supplement approved for LDA-Stop For Critical 3 Days.
    • Add  20-30 mg more  zinc 7 days before & 3 weeks after LDA- Stop For Critical 3 Days.
    • Add 200 mg more magnesium citrate or glycerinate (preferably) for a 7 days before & 3 weeks after LDA.  Stop for Critical 3 Days.
    • Use appropriate bowel preparation if determined necessary by your doctor. Stop for Critical 3 Days.

Critical Three Days

  • Follow the Basic LDA diet below
  • Follow the General Preparations for LDA treatment

After LDA Administration

  • Avoid food that have caused you significant symptoms in the past for three weeks after LDA.
  • Optional:  Folic Acid 10mg daily may be taken to attempt to enhance the erect of LDA for 30 days after LDA (possible effect:  possible nausea, so take with meals.
  • Vitamins & Minerals– could possibly improve the effect of LDA by affecting the T-cell receptor sites the LDA is targeting.  Work with your doctor to determine which supplements you should take.  Considerations should be considered cautiously.

Level 2 & 3 Patients

 

THE BASIC  LDA DIET- “Critical 3 Days”

These Are “The Only Safe Foods” And The “Only Foods That Should Be Eaten” Within

The Critical Three Days (Day Before, Day Of, Day After LDA Therapy).

GROCERY LIST- Read Guidelines for Your Treatment

Absolutely NO:

  • Herbs
  • Alcohol
  • Medications**
  • Supplements**
  • Margarine
  • Coffee, Tea, beverages
  • Chewing Gum

Children under 8 yo may have food withdrawal & may experience nausea or vomiting.  Call the doctor’s office

Lamb , Rabbit, Venison (only if eaten rarely)

Fresh fish (may not be good idea for eczema, anaphylaxis patients)

Sweet potatoes or yams

Tapioca flour, powder, plain

Parsips, rutabagas or taro root

Carrots cooked

Celery cooked

Cabbage cooked

White potatoes (may be a problem for some patients)

Lettuce (cooked or raw-outer leaves only)

Rhubarb

Pure Baking soda- no additives

Sea Salt- not iodized

Bottled, filtered or purified water, flat or fizzy for drinking and cooking-drink as much as you can.

**  except for medications & supplements specifically ordered by the doctor.

Bob Red Mill
Potato Flour    6.5#  $20.37   ∞Ж ∞  Potato Starch  6.5#  $12.05  ∞Ж ∞  Tapioca Starch  5.5#  $12.43
Ж ∞Flour blend is 1/2 potato flour, 1/2 tapioca flour, 1/2 potato starch OR sweet potato flour

 

LEVEL 3 PATIENTS GUIDELINES ONLY

GUIDELINES –(3) PATIENTS WITH SIGNIFICANT CHEMICAL SENSITIVITY

Instead Of or In Addition To Seasonal Allergy

  • Follow all instructions for Level 1 & 2
  • Follow the remainder of this booklet’s guidelines as closely as possible for at least the first couple of injections.  Do as well as you are able without disrupting your life.
  • After 6-8 injections, you may not need to adhere so strictly to the guidelines.
  • Mild exposures to chemicals should not affect the LDA.

12 Hours Before And 2 Days After Lda (Preferably 3 Days After)

  • Do not read newspapers, glossy magazines or new books.
  • Do not use insecticides with vapors that might be inhaled such as sprays, aerosols.  Use traps or bait if necessary.
  • For flies, use ordinary flypaper that is resin-coated that contains no insecticide.
  • Boric acid may be used for other insects under skirting or molding, if possible.

Critical 3 Days:

  • Use no aerosols, spray polishes or perfumed sprays—no sprays!
  • No chemical deodorants; use mineral rock crystal such as The Body Crystal® or dust with baking soda.  Other times use “natural” non-aerosol deodorants without aluminum compounds. Look in health food stores.
  • Do not use makeup.  If  you do, you run the risk of sensitizing to the makeup.  If you choose to use it, keep to a minimum, not perfumed and don’t wear near the eyes.
  • No bath oil, liquid soap, dishwashing or laundry liquid/powder especially on the hand of injection arm.  Use plastic or vinyl gloves—NOT latex.
  • No hairsprays, mousse, nor conditioners or hair oils.
  • Avoid tobacco smoke
  • Do NOT do laundry on the day of treatment.  If you do, use safe products like Downy Free and Cheer Free or other natural “unscented” natural detergent.

For One Week After:

  • After the Critical 3 Days, you may use a hypoallergenic  lotion if necessary but avoidance is best.  Some patients have a problem if used during the week after.
  • Eczema patients may have a problem with these restrictions,  Discuss with your doctor.

Two To Three Weeks After LDA

  • Avoid new carpets, new vinyl wallpaper, smelly plastic sheeting and new furniture.
  • Avoid smelly or new paint.
  • Avoid insecticides that produce vapor or might be breathed in such as aerosols, sprays, etc.
  • Avoid situations where you can’t control your environment such as parties, church, department stores, and the like.
  • No medicated shampoos for 2 weeks after LDA.

For One Week Before And Two Weeks After LDA

  • No permanent waving, hair coloring or other extensive hair treatment.  Avoid salons!!!

Transportation-Generally fairly brief exposures seemingly have little effect on even severe chemical sensitivity patients.

  • Don’t ride or sit next to a person who is a smoker, wearing perfume, or heavily scented.
  • Avoid traveling in new cars; it’s preferable to travel in an older car with circulation system.
  • Air travel should be protected by a chemical type respirator especially during the times of the plane taking off and landing.

Chemicals at Work-For Patients Sensitive to Chemicals

Work hazards are usually already identified by the patient but as a review, avoid the following exposures:

Perfumes, cigarette smoke, sick buildings, industrial complexes that produce products, chemical ordors, print shops, foundries, welding, soldering, etc.

Other hazards might be a small enclosed area, new computer, a fax machine, blueprint machine, laser printer or copier are all best to avoid for at least 24 hours but two days would be better for the first three injections.  Try to take your injection at the end of the week.

A brief exposure doesn’t usually mean enough of the chemical has been absorbed to upset the LDA antigens.  No need to panic!!

 

 

 

LDA:  Immediate and Local Reactions & Side Effects

Most reactions to LDA consist of local redness and swelling but you should not be alarmed. The dilution of allergens contained in LDA is so small a true acute generalized allergic reaction is extremely remote and has never occurred.

Immediate reactions to the inhalant component of LDA (I or IC), with swelling of the entire forearm, do occur rarely.  More rare is the possibility that the whole forearm may become swollen. While a reaction may be significant after LDA, it is associated with a good immunological response. What constitutes “a severe reaction” is determined by the doctor.

  • Local reactions should not be treated.
  • If severe, call the doctor.
  • The only action you should take is applying a cold compress.  DO NOT USE ICE!
  • Do not take any unauthorized medication, over the counter or otherwise.
  • Decongestants and antihistamines should not be used for 3 weeks after a LDA injection.
  • Continue to use the arm normally.

Local reactions rarely persist more than 3 days and should subside noticeably by the fourth day. The site(s) of the injection(s) may become inflamed off and on for 3-4 weeks after an LDA injection which probably indicates exposure to allergens in the LDA mixture.

  • If local reactions are recurrent and significant, a preparation of low dose of prednisone may be helpful.

Delayed Reaction is the temporary return of allergy symptoms being treated.  While unpredictable, delay reactions are not uncommon with LDA. They may start between 2 hours and 5 days after a treatment. They usually last a few days but very occasionally up to 3-4 weeks, and rarely for up to 2 months.  If they occur, these reactions happen usually after the first LDA treatment and diminish with successive treatments.  However, a delayed reaction may develop after any dose of LDA, but subsequent doses may often cause no reaction.

These temporary symptoms almost never require more treatment, although they may seem worse than the original illness. Do not be alarmed if you experience “flu-like” symptoms for a few days after your LDA treatment or  an allergic response not common to you.  The usual symptom is a stuffy or runny nose or hives all of which are likely to be mild and transient.   Some people develop a headache with a few days after LDA.  Delay reactions are usually a good sign since they are generally followed by a favorable response to treatment.

  • Ask the doctor how to treat a headache.  Do not use aspirin or any other pain reliever.
  • Tofranil® may be tried.
  • Avoidance of the consumption of the offending allergens (if known).

Delayed or Immediate Depression is rare, but has been known to occur after an LDA injection. Usually it begins 1-3 days or several weeks after an injection persisting from 3 days to one month.  It rarely would last longer.   If you develop depression, discuss it with the doctor.

Moderate to Severe Food Allergy or Intolerance Food Guidance

Failure to adhere to the BASIC LDA DIET during the critical 3 days can cause sensitization to the allergens of the food eaten. You should definitely avoid the foods to which you know you are intolerant or allergic (foods that have caused symptoms any time you’ve eaten them in the past) for the three-week period following LDA.  Exposure to these foods after LDA may be harmful.  Patients who do not follow this guideline run the risk of sensitizing to a wide variety of foods, pollens and molds.

The Foods For The LDA Diets Have Been Very Carefully Selected To Avoid

Cross-Sensitization To Multiple Allergens.

Except simple hay fever patients and some children with autism, all patients should follow the LDA diet strictly for the first several LDA treatments, especially if they have food allergy.    Later on, it might be ok to try to add a few foods to the diet.   If the LDA does not work as well, then you must switch back and follow the diet.

Extremely Food-Intolerant Patients-While the LDA diet contains every food that has been shown to be safe with LDA, some extremely food-intolerant patients are sensitive to some or all of the foods on the diet. These patients have no choice but to fast the critical 3 days for the first few injections. Once LDA enhances food tolerance, patients who have had to fast are usually able to eat at least some of the LDA diet foods. There have been no reports that fasting is an issue for any patient.

 

After the Critical 3 Day Diet-Most patients with food sensitivities must simply avoid the foods to which they know they are allergic or intolerant as much as possible for the three weeks after LDA. This does not mean foods that may just have been positive as a result of a blood test, and the patient has never tested (challenged after 6-7 day elimination)- Avoid only foods that are known to cause symptoms when eaten.

  • If you don’t have major food problems, begin adding regular foods after the critical three days.
  • If you do have severe food problems, for the next 5 days after the 3-day LDA Diet, continue the LDA Basic Foods and add small amounts of a wide variety of “rare” foods; ones which have not generally caused symptoms in the past, or foods rarely or never eaten.
  • The amounts of added foods can be increased over the next week. After that time, regular foods may be added back and should be tolerated much more easily. This process is necessary for only a  very patients.  As time goes on, the necessity for avoidance of foods lessens.
  • Reminder: all patients must be certain to avoid alcohol for 10 days after LDA.

Unmasking, rotation Diets and the Very Mixed Diet – The primary side effect of LDA for food sensitive patients may be “unmasking”. With LDA immunotherapy, things you think you know about your foods, both “safe” and “unsafe,” may change.  Allergens may cause significant and multiple reaction responses at varying degrees all at once shifting the level of wellness to unwell.  The cause often remains obscure to the patient until the allergens are removed from the diet, then reintroduced.  When reintroduced, the allergen causes an obvious negative reaction.

 

Stick with the program, do your best to make it work,

and LDA should work for you.

 

What To Look For 3 Weeks After LDA

  • After 1-3 days, foods eaten prior to LDA in large quantities, even possibly rotated, will sometimes make you ill if you attempt to eat the same large quantities. This is an example of “unmasking”, and LDA can cause it to happen.
  • Patients who have “unmasked” to foods may complain that they have “lost” foods or have “become sensitive” to foods after one to three LDA injections.  The symptoms can last for 1-3 weeks.
  • Patients who experience unmasking may need to vary the diet with large varieties and much smaller quantities of low-allergenicity foods, usually until the second or third LDA injections.
  • Unmasking almost always stops occurring after about the 6th injection.
  • Although “unmasking” is not common, the best suggestion to deal with unmasking caused by LDA is the Very Mixed Diet (VMD). This consists of eating very small quantities of multiple foods, usually on a daily basis.
  • Very sensitive patients are advised to eat 1 tsp to Tbls amounts at each meal to large number of low-allergenicity foods they seem to tolerate.  Rotation will not work for these patients as they use up all their food options.
  • Copies of the VMD booklet are available from the author, Nikki Dumke, at Allergy Adapt, 1877 Polk Ave., Louisville, CO, 80027.
  • CAUTION:  If you persist in eating large quantities of your previously “safe” foods that begin to cause you to have symptoms after a few injections of LDA, you would likely continue to have symptoms. This will often delay or destroy the desensitization to those foods that LDA would normally produce. Change your diet and your thinking temporarily and the problem will go away.
  • Get away from the idea of eating mono diets or large quantities of foods in rotation. Remember, after even one LDA injection, your food tolerance begins shifting so foods you thought were safe may no longer have the same affect.
  • OVERVIEW:  It Is Critical That You Do Not Stop LDA should have an adverse reaction to one of the first few injections.  As LDA gains effect with additional treatments, you should be able to eat larger quantities of most all varieties of foods. If you had to rotate foods before you began LDA treatment, rotation should become less and less necessary.  Do not eat large quantities of single foods even in rotation within the three weeks after LDA as it could interfere with LDA and make you ill.  For most patients, after six to eight injections or so, the full effects of LDA may not begin until about three to four weeks after the shot. In the 3 weeks preceding that, foods may upset you but will be safe after that 3 week period. Also, in the first week or two, you may feel you experience odd symptoms after LDA, since patients can experience almost any symptoms conceivable while the T-cells are maturing. These odd symptoms may occur after almost any injection, even if you’ve had a dozen or so. They are temporary.

Boosting Tolerance Begins after 2-4 LDA treatments.  At 3 weeks after LDA injection,  add small amounts of foods to which you were previously sensitive to encourage tolerance.  If you have a significant reaction to a particular food, wait until the next shot to challenge that food only and try other foods that may result in a better response.  If you continue to avoid foods, you may never desensitize to them. It may be necessary to avoid foods prior to the 3 weeks after LDA that you know caused previous significant reactions, such as gluten or milk protein foods, so that LDA can maximally boost your tolerance over time.

 

ONCE LDA HAS TAKEN FULL EFFECT (PROBABLY TWO YEARS FOR MOST),

YOU MAY BE ABLE TO EAT AS MUCH OF ANY FOOD AS YOU WANT.

Stimulant Beverages cause more issues than many food-sensitive people believe.  They feel tea, cola beverages and coffee do not upset them, but all contain important allergens, such as caffeine and the methyl xanthine group of chemicals.  These chemicals must be avoided during the critical 3 days.   Severe withdrawal headache occur when caffeine is stopped abruptly. The only thing that is allowed, should this happen is caffeine compounded in tapioca starch.  To avoid this situation, reduce the consumption of tea, cola, coffee and all caffeine-containing beverages, perhaps switching to decaffeinated types, and stop altogether several days before LDA.

Vitamin C could interfere with LDA so reduce your intake to less than 500 mg. of Vitamin C daily for the 3 weeks after LDA. The dose may then be increased up to 1-3 grams per day.

  • IV (intravenous) and/or IM (injection) therapy with Zinc, folic acid, vitamin-B complex, magnesium, B-6 and perhaps others may enhance the response to LDA.  Most patients who receive this type of adjunctive therapy seem to note a difference (not recommended for children under the age of 12.)
  • IV therapy is generally given once, usually on the day of LDA treatment; the IV drip process can take up to an hour. Patients often feel better initially and have less fatigue. As this is an added cost, IM injections of B’s would be the least expensive option. If interested ask the doctor.

Gluten Sensitivity that is a true gluten sensitivity that is significant, LDA will not desensitize you to foods containing gluten as the physiological mechanism for gluten is different from other foods. Fortunately, most patients with sensitivity have problems primarily with wheat and not necessarily with gluten. Gluten sensitivity is increasing in the population.  If after two years of treatment with LDA, you find you cannot eat wheat and other grains containing gluten, it is likely you never will.

 

The Gut, Candida, Dysbiosis & LDA- Gut Preparation and Antifungals may be necessary for some patients who have a true allergy or immunological interference from the group of candida organisms. Available tests to detect candida are inadequate. The only true test for “Yeast Syndrome” is described by Dr. William Crook in  “The Yeast Connection”.  A trial of an antifungal (nystatin, Diflucan, Nizoral, Spornax or amphotercin) for a period of time to see if it improves one’s symptoms verses going on an “anti-Candida” diet alone, which may well improve one’s symptoms due to food intolerance, is the only way to determine yeast sensitivity.  True candida problems can interfere with the LDA treatment. Prior to your first injection, your physician may want to know if you respond to an antifungal medication. If you do respond, or you know you have responded well to an antifungal in the past, an antifungal may be given to you prior to the first several LDA injections.  Antifungal therapy may cause the bacterial and fungal organisms die and release toxic products into the bloodstream that increase for 2-3 days.

If you are supposed to take an antifungal prior to your LDA treatment, you must follow these guidelines:

  • Antifungal medications should ideally begin 7 days prior to LDA (taking them longer increases the risk of resistant organisms).
  • Some patients continue this therapy after an LDA injection. If so, you must resume the treatment within 24 hours after the injection or you will need to wait for 3weeks before starting antifungal again.
  • Take your prescription for the 7 days before and, if advised, the day after receiving LDA.   Skip the day of LDA.
  • If you take Diflucan, Nizoral or Spornax, it’s paramount, except for the critical 3 days, also take milk thistle, 450-600 mg daily.  Continue it for a week after stopping the medication. This helps the liver detoxify the antifungal medications.

Asthma, Eczema, ADHD

Asthma- It will be very difficult to avoid inhalers if you have significant asthma.  Ideally large doses of these inhalers should be avoided for the full 3 weeks after LDA.  Often a substitution of theophylline compound may reduce the need for inhalers during this period. Moderate doses of inhalers for asthma (e.g. 2 puffs three times daily both inhaled bronchial dilators and inhaled steroids) likely should not cause severe interference with exception of the  day before LDA, the day of LDA and 2 days after LDA.

Prednisone Use- How this is usually mediated is by taking a short course or “burst” of prednisone beginning 2 days prior to LDA therapy, in a decreasing dose format. Prednisone under 40mg.doses will not interfere with LDA, even when taken on the day of the injection.

Theophylline Use does not interfere with LDA, and may be taken during the critical 3 days if necessary.  Theophylline is far preferable to inhalers during the critical days around LDA. The doctor will discuss this schedule with you if needed.

Tilade, Seravent,Leucotriene Inhibitory Drugs, the newer-longer acting- inhalers, interfere quite severely with LDA, and should be discontinued at least 7 days prior to LDA, and ideally not resumed until 3 weeks after LDA.

Prednisone Schedule-All asthmatics would be well advised to follow the schedule for the first two to four LDA injections. After that time, it is often not necessary.

Fortunately, once LDA starts working, the need for these medications is usually diminished or eliminated anyway, especially for younger patients. Diet is often a major factor in asthma, and strict dieting or fasting is often extremely helpful in controlling symptoms.

NOTE: Do not use Prelone syrup, which contains sugars, colorings and additives.

Eczema-LDA works extremely well for eczema. During LDA treatment there will likely be number of “ups and downs” up with the first 3 to 6 injections, depending on the frequency of   shots. Once the LDA treatment has become established, fluctuations become much less. Some patients must have patience, as some varieties od eczema are slower to respond. Exacerbations after an LDA injection are not uncommon and may occur even after response has been consistently good.

Prednisone Pretreatment may be necessary for patients with significant eczema, at least for the first 2 to 4 injections

Hyperactivity (ADHD, ADD) responds quite good to LDA.  Initially it may make hyperactivity symp-toms worse after an injection – especially the first  2-3hours &  4-72 hours after.

Ritalin, Concerta, Stratera, adderall & such drugs for ADHD,  should be discontinued ideally 4 days before the 3 weeks after an LDA injection. LDA may not begin to take effect until the 6th injection in the ADHD patient, although some significant response generally occurs much sooner. Patience will be rewarded, as the success rate can be expected to be 80% or better, especially for patients who have any obvious allergy or food intolerance.

NOTE:  We know very well that sometimes this is not possible. Patients should try LDA in any case. The worst it could do is fail.

DIET is a very important role in the cause of ADHD so care must be taken around the time of the injection. Diet work should be done to determine significant offending foods prior to the first injection. These foods should become more tolerable as therapy continues, but when injections wear off (as the first several will). it will be important that these foods be eliminated until the next injection, in order to maintain tranquility. Sugar in any form is usually the most common offender, with preservatives, food coloring and specific foods next.

AUTISM children have considerable success with LDA. If your child has any type of autistic spectrum disorder, LDA may well change your lives. This is especially true if your child has intestinal issues (diarrhea, constipation, “gut” problems of any kind) or obviously reacts badly to any food or foods that you have identified (don’t rely on food testing with a blood test- not very accurate).

The main issue in treating autistic children is the LDA Diet. Many simply cannot (or will not) do it. There is at least one physician using LDA who has treated many autistic children without using the LDA diet, and feels his success rate is significant.  For now is we are being advised to encourage parents of autistic children to try LDA with the diet, but if it’s just not possible, do LDA without the diet, but avoiding wheat and dairy (and all gluten if possible).

LDA RECIPES

It’s not much but it is something!  Limited foods are essential during the Critical 3 Days and this is what you have to work with.  It is far easier to make these recipes up ahead than to wait for the time of diet.

LAMB STEW   (May use other meats from ADL Diet)

Cut lamb into chunks

Do NOT USE OIL as you brown in skillet.  There is plenty of fat on lamb to prevent it from sticking if you rub a piece of lamb fat on the skillet first.

Toss browned lamb into pot with cut up vegetables (carrots, potatoes, sweet potatoes, celery, cabbage and/ or lettuce.

Cover with bottled water and bring to a boil.

Mix about 2 Tbls tapioca starch into ½ d bottled water.  (not needed if you use potatoes or yams)

Add thickener to stew, cover with lid  and allow to simmer  until tender.

Add extra water, if necessary, to get desired consistency.

CROCK POT LAMB STEW

2 lb lamb cut into 1 inch cubes

5 carrots (about 1 pound) cut into 1 inch pieces

5 stalks celery, cut into 1 inch pieces

3-4 potatoes, peeled and cut into 1 inch cubes

½ cup tapioca

2 tsp sea salt

2 ¼ cup pure water

Combine lamb with vegetables, tapioca, salt and water in a 3 quart crock pot.  Stir the mixture well to evenly distribute the tapioca.  Cook on low for 8-10 hours or high for 6 hours.  Makes 6-8 servings.

VEGETABLE STEW- same as lamb minus the lamb.

VEGETABLE SOUP-same as stew except vegetables smaller and not thickened.

FISH STEW-substitute raw fish in with vegetables and cook like lamb stew.

LAMB MEAT LOAF

1      lb  ground lamb, as lean as possible

2     cups grated potatoes

½    cup celery, chopped fine

½    tsp sea salt

1      Tbls tapioca starch or potato starch

Preheat oven to 300 degrees.  Combine all ingredients.  Add a little water if the mixture seems too dry.  Turn into loaf pan and bake at 300 degrees for about 1 hour or until done.

 

LAMB STIR-FRY

Cut lamb in thin strips.  Rub lamb fat on hot skillet to grease.  Brown lamb, adding salt as desired.  Remove lamb from pan, add a little water and chopped vegetables (carrots, celery, cabbage).  Stir-fry until done tender crisp, adding salt as desited.  Stir lamb into vegetable mixture.

Serve as is or over potato starch noodles.  Be sure the noodles are 100% starch.

CABBAGE ROLLS

Brown Lamb meat loaf mixture in a pan on stovetop.  Roll approximately 1/3 cup meat mixture in a blanched cabbage leaf.  Blanch cabbage leaves by boiling for 1-2 minutes.  Place in covered glass dish at 300 degrees for approximately 30 minutes or until done.

SHEPHERD’S PIE

Boil 4-5 cups LDA vegetables in small amount of water until slightly tender but not done.  Salt to taste.  Thicken with tapioca starch (approximately 1 Tbsp dissolved in water).  Simmer 5 minutes.  Turn into casserole dish.  Add lamb if desired.

 

 

FISH PATTIES

I medium potato, boiled and mashed

2      Tbls. Tapioca starch or potato starch, dissolved in a little water

2/3 cups  flaked cooked baked fish

½             stalk celery–chopped fine

Salt as desired.  Fry with water.

NON-FAT POTATO CHIPS-slice white potatoes thinly, sprinkle with salt and place on racks. Broil/bake until golden brown and crispy; may need to turn.

POTATO NOODLES-cook until desire consistency, Add to soups, or serve with vegetables, fish and lamb.

SWEET POTATO YAM PARFAIT- Buy sweet potatoes and yams.  Bake in covered dish at 300 degrees until soft when stuck with a fork.  Peel and whip each individually, add bottled water as necessary to produce a smooth, pudding-like consistency.  Salt to tast.  Layers in a tall, clear glass and garnish with a bit of lettuce leaf.  Enjoy!

PIGS IN BLANKETS

Cut whole carrots crosswise into 2-3 pieces.  Steam/boil/broil until tender.  Steam/boil cabbage leaves until tender.  Salt as desired.  Roll pieces in cabbage leaves.  Secure with toothpicks.

CARROT SOUP

Boil carrots in salt water until tender.  Pour ¾ of the carrots into a blender and puree.  Variations:  Biol celery, cabbage, and potatoes to add with remaining carrots.  Add carrot puree.

CARROT JUICE/CELERY JUICE/CABBAGE JUICE- Use any vegetable juicer to extract juice from raw vegetables.  Bring to a boil.  Serve hot or cold.  Do not use raw juices.

RHUBARB RELISH

Chop rhubarb finely.  Boil until tender.  Dissolve 1 tsp tapioca starch in ¼ cup water and add to pot with rhubarb;  simmer until thick.  Serve with lamb, fish or over sweet potatoes.

Variation:  Mix rhubarb relish with finely chopped, cooked sweet potatoes.

RHUBARB CONCENTRATE

1       lb rhubarb

2cups pure water

Clean rhybarb and cut into ½ inch slices.  Place in a saucepan with water.  Bring to boil and simmer, covered for one hour.  Pour mixture into a strainer or colander, place over a bowl and let stad about an hour to thoroughly strain the liquid from the rhubarb slices.  Reserve the slices for jam below.  Use the liquid to make rhubarb tea, below, or as the acid component in leavening for baking.  Refrigerate the concentrate to use with a few days, or freeze.

RHUBARB TEA

Rhubarb concentrate above

Bottled water

Put 6-8 tbls.  concentrate into a 10 oz mug and fill with boiling water to make tea.  One batch make about 6-8 cups of tangy tea that tastes somewhat like rosehip or hibiscus tea.

RHUBARB JAM

Prepare rhubarb as for rhubarb concentrate above.  After straining off liquid, puree the rhubarb in food processor or blender until smooth.  A  tangy spread to use on tapioca wafer, sweet potato crackers or other.

WHITE SWEET POTATO TORTILLAS

1 cup white sweet potato flour

¼ tsp sea salt

½ cup pure water

Make as for cassava tortillas  

The following recipes were contributed by Nicholette Dumke, author of “More Allergy Cooking with Ease.” And “The LDA Patient’s cooking and Life-style Guide.” Copyright 1994 .  For more information about allergy cooking or how to obtain her books, contact:  Allergy Adapt, 1877 Polk Ave., Louisville, Co., 80027.  T:  303-666-8253.

WHITE SWEET POTATO CRACKERS

1 cup white sweet potato flour

1 ½ tsp white sweet potato baking powder

1 ¼ tsp sea salt

5/8 cup (1/2 cup plus 2 Tbsp) pure water.

Combine flour, baking powder and salt in a bowl.  Stir in water until completely mixed.  Sprinkle white potato flour on a baking sheet.  Put dough on the baking sheet, sprinkle top of it with more flour and pat or roll it out to about 1/8 inch thickness, dusting the top with more gour as needed while you are rolling it out.  Cut into 1 ½ inch squares.  Sprinkle with additional sea salt if desired.  Bake at 350 degrees for 10-14 minutes.  Remove the crackers from the baking sheet with a spatula and cool on a wire rack.  Makes about 3 dozen.

Tapioca Crackers

1 ¼ cup tapioca flour (may add 1/4 cup potato starch and potato flour-just enough water to form a ball in your hand-break off pieces onto cookie sheet and bake as below)

¼ tsp sea salt

½ cup plus or minus 1 Tbls pure water

Combine flour and salt in bowl.  Stir in about 3/8 cup of water.  The dough is difficult to mis; you may have to stir it and then let it rest a few seconds, then stir again and etc.  Add remaining 1-3 tbs of water, one at a time until dough is of a consistency that cracks when stirred, but liquefies readily when left alone.  To bake the wafers, use a dark or dull finished baking sheet rather than a shiny one if possible.

Drop teaspoons full of dough about 2 inch apart on the baking sheet and let the dough spread out.  If your baking sheet is too small to hold all the batter, put the rest on a second sheet rather than let set in the bowl.  Bake at 375 degrees; 20-30 minutes or until they begin to turn golden on the bottom.  If they stick, let them bake 2-3 minutes longer.  If they still stick, pry them off with a spatula.  Sticking indicates the mixture is too moist.  Allow cooling at least 2 hours before packaging them up.  Makes about 1 to 2 dozen wafers.  These are best eaten fairly fresh as they tend to get hard to chew if stored too long.  This is a rewarding but difficult recipe in getting the right consistency.  You may have to try a few times to get it right.

 

HOMEMADE POTATO BALLS INGREDIENTS:
1 cups mashed potatoes
1 medium shredded carrot or ½ small parsnips, or ½ small rutabagas

1 Tbls sweet potato flour (optional)

Salt to flavor
Directions:

  1. Preheat oven to 400 degrees F.
  2. With a fork, combine the mashed potatoes and shredded.
  3. Form the potato mixture into about 2 dozen miniature balls.
  4. Place potato balls on lightly greased cookie sheet and bake for 10-15 minutes, or until lightly browned.
  5. Let cool fully

BAKED PARSNIPS

Ingredients:

  • 2 1/2 pounds parsnips
  • 3 tablespoons lamb broth
  • salt

Preparation:

Peel parsnips, quarter, and remove any woody cores. Parboil the parsnips for 15 minutes. Place in an ovenproof dish. Add broth on top of parsnips and sprinkle with salt.  Bake for 30 minutes at 350°.
6 Servings

RUTABAGA FRIES

Prep Time: 5 minutes

Cook Time: 15 minutes

Ingredients:

  • Rutabagas
  • Salt

Preparation:

  • Preheat oven to 425 F. 1) Peel rutabagas with a paring knife and slice in 1/4″ rounds. If you like, you can do them in strips – they will cook a little faster, but you have to watch them carefully or they’ll burn.
  • Put them on a nonstick broiling pan.
  • · Cook about 12 minutes, turning twice. Take out when golden brown and tender. Immediately sprinkle with salt.

 

Tapioca Pearl Veggies

Tapioca pearls – 1 cup (soak overnight)
Boiling water – 1 1/4 cups
1 cup (your choice of minced mixed vegetables)
salt to taste

  • ·
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Mom’s Tapioca

8 tbsp. pearl tapioca

1/4 tsp. salt
1 qt. rhubarb tea
Soak tapioca in a little water overnight in crock pot.  Add 1/4 teaspoon salt. Boil 1 quart rhubarb tea and pour over tapioca while still hot.  Cook on low until tapioca is done and liquid is diminished to desired consistency.

SWEET POTATO TREAT

Ingredients:

  • 1 Large Sweet Potato, washed & dried

Instructions:

  1. Preheat oven to 250° F
  2. Line a baking sheet with parchment paper.
  3. Cut off one side of the sweet potato lengthwise, as close to the edge as possible. Cutting the side of the potato first allows you to then turn the potato onto this flat surface that you have just created. Having a stable area to rest the potato will make it easier to cut the potato into slices. Don’t discard that first piece, it comes out just as yummy as the rest!
  4. Cut the rest of the potato into 1/3″ slices, no smaller than 1/4″.
  5. Place them on the prepared baking sheet.
  6. Bake for 3 hours, turning half way through.
  7. Cool completely on a wire rack.

Storing – Although these treats are dried, you will want to keep them in the refrigerator for up to 3 weeks. You can freeze them for up to 4 months.

Tips & Techniques

Choosing a Sweet Potato – You want to find a potato that is as uniform in shape as possible. This will aid in the drying process as the pieces will be similar in shape and will cook through at the same time. Also, try to find one that has fewer blemishes or bruises.

Peel the Sweet Potato- rinse with purified water

Knife Skills – If you are a pro with a knife, you may not need to cut off one side to stable your potato. If that’s the case, then by all means skip that step. However, for those of us who are more handy with a pastry bag, than a knife, having a stable surface makes all the difference.

  • Cutting Even Pieces – One way to ensure your pieces are as even as possible, is to first rest your knife where you would like to cut. Then press down gently across the entire length of the knife. Make a slight cut, then press firmly on your knife from one end to the other, and cut all the way through.
  • Degree of Chewiness – Baking for 3 hours results in a soft, but chewy treat. If you prefer more of a crunch, then bake for an additional 20-30 minutes. When you take the sweet potatoes out of the oven, they may at first appear to be too soft. Let them cool completely on a wire rack before you decide whether or not to bake them longer. This is because they will continue to dry or harden while cooling.

How to Contact Us

Contact info

CENTER FOR ENVIRONMENTAL MEDICINE

10748 NE Halsey Street
Portland, OR 97220-3961 USA

Tel.: (503) 261-0966
Fax: (503 252-2691
Tel.: (360) 690-0017