For various years, medicine has persisted in trying to distance the “responsible” substance for an environmental allergy. For example, by avoiding certain aliments in the case of food allergies, or by attempting to clear up the surroundings in the case of dust mites and mould allergies.
In this way, it is frequent to see many kids, who are allergic to dust mites but breath pretty well in their own home, where an extreme degree of cleanliness is in place, spending in the A&E their first night supposed to be at a friend’s home or in a holidays hotel with carpet and damp walls.
Thankfully, there are solutions in place exploiting the newest theories of modern immunology, which a few years ago understood that allergic reactions are only the tip of an “iceberg” linked to the overall inflammatory status of the organism; if a single allergen (dust mites, pollen, mould) has a real direct responsibility for the whole reaction, the best way to heal is to trigger the immunological tolerance back, in order to become “friends” again with the allergenic substance, regardless if that’s pollen or a specific food.
The hyposensitizing vaccination (in other words, an anti-allergic remedy that shares nothing with other types of vaccination such as the anti-hepatitis one, the flu jabs and so on) is able to act on the immune system the outside, aiming to trigger tolerance. The low dose type may be used either for food-related reactions, or for the treatment of respiratory allergies, with great efficacy: this is one of the most interesting and innovative therapeutic approaches of the last few years.
In our Milan centre (SMA), we have been following for years numerous patients suffering from allergy-related pathologies by using this type of procedures, whose efficacy has been also reported internationally.
Cases of food allergies, food-related inflammation or respiratory allergies (such as conjunctivitis, asthma, rhinitis, keratitis, snoring etc.) are treated by following specific therapeutic programs that are able to improve or cure these conditions, in a natural pathway towards healing.
In practice, one can select a specific low dose of the food or respiratory allergen (today, we use bespoke formulas produced by Anallergo, an internationally renowned company in allergology) and start the daily administration of the remedy, in order to achieve recovery of the tolerance.
By dosing the amount of allergen and by modulating the route of contact between allergen and immune system, different results may be achieved. On one side, high doses of the substance induce a sort of “paralysis and stand-by” of the system: in other words, these block any immune reaction but only towards that specific allergen, without affecting other concurrent causes. On the other side, low doses of allergen leads towards a different regulation of those cells responsible to trigger the reaction: that is to say, an upstream action is therefore possible, modulating and keeping an active control on the body reactivity, sometimes towards all the active allergic events of the organism.
All this means that every low-dose formula is able to prevent any acute allergic events efficiently and to allow the body re-education towards tolerance of the surrounding environmental stimuli, also including other allergens responsible for the allergic symptoms. In practice, today we know that the low dosing does not only act on the B-cells (those one producing antibodies), but also on the regulatory T-cells (Tregs), those responsible to regulate all the allergic reactions happening in the whole body. It is as if we are hitting straight into the control centre without stopping at the periphery.
In the traditional clinical practice, allergology has always supported the high-dose tolerance induction, disregarding the low-dose version. However, a few recent studies highlighted the possibility for this type of intervention to become an extraordinary mean to regulate the immune system, in particular if accompanied with therapies aimed at reducing food-related inflammation and the individual immunological threshold levels.
The low dose tolerance when treating hypersensitivity
It is well known that high-dose immunotherapy for food-related or respiratory-related allergens may present some levels of risk for any allergic subject.
The possibility to act through low-dose tolerance induction makes the path of hyposensitivity much more accessible and safe; by now, more and more cases have been reported of successful treatment based on this peculiar procedure, even of serious allergic forms.
Today, there is a chance for tolerance induction towards multiple food allergens, to be undertaken in a progressive and gradual manner, which is considered to be effective and safe to treat multiple concurrent food-related allergies (Begin P et al, Allergy, Asthma & Clinical Immunology 2014, 10:1 doi:10.1186/1710-1492-10-1).
The mechanism of action of the low-dose tolerance induction has been proved to be efficacious also for serious forms of food allergies, such as the one towards egg, peanuts or those towards milk; people at high risk of anaphylactic shock have been helped to heal from their condition and to start eating again those aliments previously listed as dangerous.
In particular, I would like to highlight what published already around the topic of peanuts tolerance on my book “Like a pressure cooker”, written in collaboration with my co-worker Dr Gabriele Piuri.
[…] gradually reintroducing the allergenic aliment, by starting from extremely low doses and by increasing them consequently, leads to complete healing, in most of the cases. This approach has been defined as low dose hyposensitization, or oral tolerogenic immunotherapy. The same principle has been applied to tackle peanuts reactivity: two studies published in 2009 on the Journal of Allergy and Clinical Immunology documented the efficacy and the safety of the hyposensitization using increasing doses of peanuts (Jones SM et al, «Clinical efficacy and immune regulation with peanut oral immuno- therapy» J Allergy Clin Immunol 124, n. 2 (aug. 2009): 292-300), which are able to trigger one of the most serious and disabling forms of allergy present in the US (Hofmann AM et al, «Safety of a peanut oral immunotherapy protocol in children with peanut allergy» J Allergy Clin Immunol 124, n. 2 (aug. 2009): 286- 91).
In practice, allergic kids were treated with 50 mg of crushed peanuts dissolved in milk, in juice or in yogurt. Gradually, the dose was increased but always diluted in another food and administered orally. Kids treated for tolerance recovery had a few modest reactions at the beginning of the treatment, but overall they tolerated the reintroduction protocol without negative side-effects, becoming able to safely take in doses of peanuts much higher than those caused by casual contact or ingestion. […]
I still remember my initial experience with low dose hyposensitization treatments to tackle birch allergy. It was often frequent to offer a double treatment to subjects with multiple concurrent respiratory allergies (for example, to birch and grass): first, one to tackle birch allergy, then one towards grass allergy, because betulaceous pollen is seasonally released before the more diffused graminaceous one. I often noticed that among those patients starting the hyposensitizing treatment to birch, many continued the same type of intervention also during the graminaceae season, still achieving great results in controlling symptoms usually produced by types of pollen towards which they were not undertaking a specific therapy.
These findings led us to understand that, since the birch pollen season had ended, an accessory inhibition must exist towards similar antigens (as it may happen between fatty acids commonly present in various foods, or in certain cases of food-related cross-reactivity) or even towards very different ones.
Not only respiratory allergies
Recent scientific studies (among which it is worth indicating those performed by Drs Attilio Speciani, Marco Fumagalli and Giampiero Patriarca) confirmed that using this type of treatment led to a significant improvement even in clinical manifestations such as nickel sulphate-contact dermatitis (i.e., the one often affecting hairdressers during their job, or typical for those people suffering from reactivity to cheap jewellery).
Among all the benefits, this treatment allows a varied diet and a freer contact with all the objects containing this extremely diffused substance (nickel sulphate). Therefore, we are talking of an extremely versatile and riskless mean that should become integral part of the cultural baggage of every allergologist and every general practitioner, in order to meet today’s need for an expansion and diversification of the existent therapeutic options to allergies.
Although the hyposensitizing therapy has been used so far mainly for allergies and intolerances, new avenues and prospects opened up around novel applications of this therapeutic instrument, especially for numerous autoimmune diseases, for rheumatoid arthritis, for multiple sclerosis, for diabetes and so on, as highlighted since the New York Academy of Sciences meeting on oral tolerance, held in New York city in March 1995.
These are pathologies, whose current treatment options have been almost exclusively based on using cortisone-based drugs, immune suppressants or highly toxic molecules such as cyclosporine. Today we know that treating pathologies like rheumatoid arthritis, and many other autoimmune disorders, may surely be possible through an adequate nutritional regime and the supportive action of suitable tolerogenic formulas.
Once new potential routes for immunity modulation, based on simple mechanisms of treatment and less prone to develop toxic side-effects, an extreme qualitative improvement is actually achieved. Thanks to this, it will be possible to prevent or cure certain dreadful pathologies in a much “softer” and effective way.
Similar results have been achieved also with people affected, for instance, by rhinoconjunctivitis and/or asthma, usually controlled by pharmacological means.
The use of low dose vaccine-based formulas for mites or mycota (which are perennial, persistent allergens) produced very important results on chronic respiratory inflammatory pathologies and on serious ocular reactions such as keratitis or recurrent keratoconjunctivitis. In comparison to a generalized pro-tolerance action, the choice of a vaccine for dust mites becomes often an “unexpected” support to tackle cases of allergic dermatitis or eczema.
The same results are achieved with nickel, for example: as documented in various studies presented during the European Academy of Allergology and Clinical Immunology congresses in Berlin (2001) and Birmingham (1998), people suffering from serious forms of nickel-related dermatitis (both by topic contact and by ingestion) may benefit from a tolerogenic dose, able to lead towards the resolution of the problem and its supervision.
Currently, any preparation containing eggs or peanuts should not be tested, outside a safe and controlled place, on subjects with high specific IgE values (even if we are not aware of the existing type of specificity), who have not yet reintroduced that aliment in their diet after a clear anaphylactic reaction. Today’s practical therapy should be tailored by expert doctors. Twenty years ago, it was commonly thought that tolerance was not inducible anymore, while today we know that even the most seriously affected allergic person has the possibility to heal and go back to total or partial tolerance, thanks to techniques similar to children weaning.
We can certainly say that today’s clinical practice was born from the observation (already experienced in the 80s) that allergopathies should be considered globally regulated disorders, and that has allowed to move towards techniques and formulas directed to this purpose.
Moreover, very recent scientific findings are confirming today this new type of concept and are opening up new additional avenues to treat allergies and to rebalance our tolerance, both towards food and respiratory allergens.
Today’s possibility to integrate, in a balanced fashion, different existing types of knowledge (analytic and holistic ones) is leading to operational possibilities previously unimaginable.
Duration of the hyposensitizing therapy
To list a few examples, nickel hyposensitization lasts usually between 6 and 12 months. For some food substances, the duration lasts between 3 and 12 months. For respiratory allergens (for instance, members of the graminaceae family) the type of therapy is usually seasonal (with an early start 2-3 months before pollination and the termination coinciding with the season’s end), but a significant percentage of individuals appear to respond positively also to a use concurrent to pollination. In the case of perennial allergens (such as mites, mould, candida), the therapy may also be continuing over time. Nevertheless, it is typical to suspend the course after 12-18 months of treatment in most cases, in order to evaluate the results.
The simultaneous use of certain supplements with anti-allergic action (such as blackcurrant oil, perilla oil, both present in Zerotox Ribilla, quercitin, Zerotox inositox (containing inositol), Oximix 3+) may have a strong positive impact on tolerance recovery and healing.