Frustrated with the limitations of traditional immunotherapy, a few doctors (most of them known as clinical ecologists) are trying to revive a system of allergy testing and immunotherapy developed several years ago and collectively known as serial dilution titration and neutralization therapy. This variation of standard immunotherapy still involves lots of time in a doctor’s surgery, considerable expense and allergy injections. In some ways, however, it may make up for a few of the shortcomings of traditional immunotherapy.
Serial dilution testing: what they can and cannot tell, is done on the skin (although a few doctors use drops of the test extracts which can be placed under the tongue in people who are not fond of needles). Doctors test for several common allergens, plus any others to which the individual seems to be particularly sensitive. In that respect, the test is similar to standard tests. However, the individual is not necessarily tested with one absolute amount of each test extract, but possibly with a series of up to fifteen or twenty increasing dilutions, one every ten minutes or so. The size of any weal and the nature of symptoms are noted. Doctors experienced with serial testing use the dose which does not produce symptoms – the ‘endpoint’ – as a guideline for choosing the optimal dose for this therapy. Again, the dose that is too small to produce a reaction yet large enough to prevent reactions is considered optimal. Doctors feel that, in this way, they can get a better picture of not only what a person is allergic to, but also how he or she reacts as an individual. What’s more, they claim that the treatment dose can be used to neutralize, or turn off, a reaction. The therapeutic dose usually turns out to be much smaller than that employed in standard immunotherapy, and takes only one or two testing sessions to achieve. That compares with a period of about six months of such experimentation to reach maintenance doses in standard therapy. Once the correct treatment dose is arrived at, doctors using neutralization claim that some people gain immediate relief.
One big difference between the two therapies is that some doctors using neutralization send patients home with premixed doses of extract to help them tolerate foods and inhalants to which they are allergic. That’s rare with standard therapy except for carrying emergency vials of adrenaline to be used in case of a severe bee sting reaction or other serious symptoms.
Another major difference is that neutralization is used to treat sensitivities to car exhaust, tobacco smoke, formaldehyde and other hard-to-avoid chemicals, although shots for those do not work nearly as well as injections for conventional allergens.
‘People always ask us for injections against air pollution,’ says Constantine J. Falliers, a traditional allergist and editor of the Journal of Asthma. ‘Well, we have no such thing.’
Many doctors using neutralization feel that, unlike conventional therapy, it can be successfully used to treat food allergy, holding out hope to the many people who are allergic to wheat, yeast or other ubiquitous dietary items.
Standard immunotherapy and neutralization seem to work in approximately eight out of ten people on whom the particular method is used, and both are relatively safe – they’re used without reservation on the young, the old, the pregnant -and even in people who are suffering a cold or the flu. For the individual who’s endured years of standard immunotherapy without relief of symptoms, neutralization certainly holds promise.