Your success with LDI (low-dose immunotherapy) rests very heavily on how well you communicate your responses to me and much of this document is dedicated to coaching you in that regard. It is also helpful to try and explain as much about LDI as possible so that you may better understand what I need to know to make good decisions about what the next step is going to be. I’m sorry this is so long; but I’ve spent so many hours trying to explain all this to hundreds of our patients over the past several years, I believe this will save us all a good deal of time in the long run and greatly improve your chances of success.
How LDI Works
LDI is used to restore immunological tolerance. Immune reactions are complex. We have a part of the immune system that is protective and treating invaders. We also have a system that is preventing the continuation of a reaction once they are no longer needed. For many people with Auto-immune disease, “Chronic Infection,” Allergies, Intolerance, Sensitivity, and other chronic conditions the issue is a loss of this immunological tolerance. LDI can restore tolerance without reducing your immune systems ability to fight infection.
LDI is not treating a disease; it is treating your immune response. It is restoring a normal immune response and quieting on an over-reactive response. In the case of the types of conditions treated with LDI, the immune response has been locked into an inflammatory cycle it cannot stop. Like a dog chasing its tail, it cannot catch up. LDI will signal the body that this cycle is no longer needed. This is NOT an immune suppression; it is a normalization.
How is it different from regular Allergy Shots or Sublingual Allergy Therapy (SLIT)?
These types of treatments are designed to create blocking antibodies. In that sense, they stimulate your immune system. In the case of environmental allergies, they are generally caused by IgE antibodies in your system. These IgE antibodies react with the allergen (i.e. pollen) and that results in a cascade of events that leads to your allergy symptoms. The Shot or SLIT results in the formation of IgG antibodies. These antibodies get the allergen before the IgE and block the IgE from interacting with the allergen and thus block the cascade that results in your allergy symptoms.
LDI on the other hand results in Immunological tolerance. Tolerance is the immune systems ability to distinguish friend from foe. It is the job of the immune system to do nothing the vast majority of the time. That is why we do not have raging battles in our gut due to the bacteria that live there, to the food we eat every day, and to most things we touch. In the case of many of today’s most challenging “Chronic Condition” the infection is long gone; it is our immune response that is still acting as if we have an infection. This is true for “auto-immune disease”, and other things currently labeled as Chronic infection. This idea of tolerance is not as simple as it seems. LDI will not reduce your immune system’s ability to fight infection. In fact, by reducing the “distracting” reaction your immune system is engaged in it will help your system focus on the real invaders.
The most difficult part of treatment is Dose Titration.
LDI requires a careful dose titration. Generally, we titrate from the most dilute antigens to more concentrated. The speed we can do it dependent on you. If your chronic illness has left you in a weakened and fearful state, you may be intolerant or unwilling to be exposed to “flairs”. On the other hand, your personality may be “no pain no gain” let get this done. Only you know.
For anyone with a chronic condition, they may frequently have an over-reactive Limbic system. That means that your defensive systems are on a “hair trigger”. Any novel exposure, thought, feeling, smell, taste, sound, etc. can be interpreted as a threat, and your limbic system goes into overdrive. This results in a Fight or flight response. The fight or flight response is an amplification response that must be stopped by the body. In chronic illness the ability to quell this response if often dampened dramatically. What all of this means is that many people with chronic illness can have dramatic swings in their symptoms due to what would otherwise be a harmless stimulus. This is one of the biggest difficulties with titration of LDI. People have wide symptoms swings on any given day. So being able to report “I am Better, worse or the same”, is not so simple. (By the way, we have a separate program for Limbic retraining.)
A very important bit of information during titration of your LDI does is to determine if the totality of your symptoms complex is Better, Worse, or the Same. If your symptoms have been wiggling up and down or swinging dramatically, and they still are, then there is NOT CHANGE. LDI is not a therapy that results in gradual improvement. LDI results in no help until we find the correct dose and then there is usually significant help. What we try to avoid is the “HARD ENDPOINT” of a Flair. The bad news is that a true flair can last up to 7 weeks. The good news is that we have found the titration endpoint. We know that your true LDI dose is someplace between the Flair dose and 1 to 3 does prior.
If we are titrating in the usual way, dilute to concentrated, we can move up by one (or sometimes 2) dilutions every 10 days. If we believe that you have had a flair we will need to wait 7 weeks for your immune system to reset and start from there. For the most sensitive people, we need to start with a very dilute antigen set. Then we titrate up slowly. If we start at say 30c and go up every 10 days it will take 150 days or more to get to 15c, and 240 days to get to 6c. There is no way to predict what YOUR final dose is going to be other than clinical experience.
Some patients wish to go as fast as possible. In those cases, we can start at a mid-dilution if there is no reaction, we can skip a few. If still no reaction, skip a few more. At some point, we will either luck out and have an improvement, or you will have a flair. If you flair, we then know that YOUR dilution is between your last dose and this flair dose.
On the other hand, many people with chronic illness simply are in too weakened a state to consider this and so we must do our best to support you as we go through the slow laborious process of titration.
What does a course of treatment look like?
After an interview and discussion, we will determine our best ideas about the starting dose. There is no “smallest dose possible” these are dilutions and can always be diluted more. If you wish the smallest practical dose, we will start at a place I and my colleges have never seen a reaction. The problem is that this may result in more time to get to your actual dose. I try to accurately assess that first dose and give 3-5 dilutions above it to be reasonably certain we do not cause a flair. If we do cause a flair on the first dose, we will need to wait 7 weeks and start more dilute.
What is a flair?
A flair is a worsening of your symptoms. LDI will not damage your system, and the flair will go away within 7 weeks. If you rate your general sense of well being on a scale of 1-10, with one being bad and 10 being great, you can expect a mild flair to lower your score by 1-2, a moderate flair to lower your score by 3-4 and a sever flair (vary rare) can lower your score by 5 or more.
If you are having “flairs” to every dose, you will need to consider our Limbic retraining program.
Once we have determined the starting dilution – we will then have you take a dilution once every 10 days.
When you are getting close to your correct dilution, you will likely have a short-lived improvement in your symptoms. This improvement should be well outside of your normal daily swings. If your typical daily swing of symptoms ranges from a 3 to a 5, I would expect the LDI improvement to give you 7 or so. It should be recognizable. If we overshoot, you will have a flair. As noted above that is both good and bad. Bad because we have to wait 7 weeks, good because we know where we are.
How to report your symptoms:
1. Name the antigen or antigen mix you are on.
2. Dates of the 3 most recent doses. (use the word for the month like June 5, 2020, not 6/5/2020 because that could be June 5 or May 6 depending on your convention)
3. Dilution of the 3 most recent dose (i.e. 10c, 9c, 8c).
4. Then the hard part. Given your typical daily swings in symptoms are you generally Better, Worse or the same after this most recent dose. If you cannot tell, the answer is the same. A real and relevant change from your dose will occur abruptly and significantly shortly after you take the dose. If your symptoms were on the upswing before the dose that is not what we are looking for. Likewise, if your improvement happens more than a week after the dose that is also not what we are looking for.
If you had a change (good or bad), how long did it last? This tells me how close we are (good) or how far over we are (bad).
The goal is for a dose to last with very good symptom relief the full 7 weeks. Once we are at the correct dose you will likely need it at 7-week intervals for a year or sometimes more. Then you may be done or need occasional boosters.
Cost of LDI:
LDI is $350.00 per year for the first antigen or antigen mix and $100.00 for any additional antigen or antigen mixes. Additional costs include shipping LDI doses. If you need help with determining if the last dose was effective or not or if you are having other difficulties, a nursing visit may be needed and will also be charged. If the issues are beyond the nursing visit, you may need an additional doctor visit.
This is a link to my College Dr Vincent’s YouTube channel about LDI.