Low Dose Allergy Treatment (LDA)

Low Dose Allergy Treatment is a form of enzyme potentiated desensitization (EPD).
This is a very low dose or homeopathic allergy treatment method.

What LDA is and how it works:

“EPD” or “Enzyme Potentiated Desensitization” was developed from a chance observation by Dr. Frantisek Popper, an Ear, Nose, and Throat Physician working in London in 1959. He found that “Hyaluronidase” injected into the nasal mucosa of patients with nasal polyps sometimes relieved sneezing. Then Dr. Len M. McEwen of London in 1967 showed that the enzyme “beta glucuronidase” derived from hyaluronidase had desensitizing activity. Beta glucuronidase mixed with a tiny dose of allergen or antigen could desensitize humans and animals.

Low Dose Allergy treatment or Enzyme Potentiated Immunotherapy produces tolerance to allergens at the cellular level.

The precise “ultra low doses of allergens” required for enzyme potentiated desensitization with the enzyme beta glucuronidase have led some authorities to consider LDA to be compatible with Homeopathic principles.

Beta glucuronidase is now recognized as a natural biological response modifier and under normal circumstances is likely to be a significant physiological up regulator of the lymphocyte immune system.

All present evidence is that LDA restores/ reinforces the natural active cellular immune tolerance to specific environmental antigens (allergens), which has broken down in allergic disease.

The Safety of Low Dose Allergy Immunotherapy: LDA uses a natural pathway of immune modulation at a strength less than that which occurs in nature. The treatment would be expected to be exceptionally safe. In a United States study, repeated ear infections in children responded to LDA better than any other condition. Many double-blinded studies have proven the effectiveness and safety of the LDA (EPD) treatment. LDA is discussed as “EPD” or Enzyme Potentiated Desensitization in current medical textbooks including the medical textbook “Food Allergy and Intolerance” by Dr. Jonathon Brostoff et al.

LDA allergy treatment in hundreds of patients over the last 20 years. The enzyme beta glucuronidase and the ultra low dose antigens required for treatment were first produced in England by McEwen Laboratories and they became FDA approved for use in this country under an investigational protocol that Dr. Robbins participated in for over ten years. When it became unavailable from England, we were able to obtain it from College Pharmacy under the direction of Dr. W.A. Shrader in the U.S. Dr. Albert Robbins is one of the original investigational members of the American EPD Society and took the original courses given by Dr. Len McEwen in London, England as well as those currently sponsored by the American Academy of Environmental Medicine…(AAEM.com)

Simple inhalant allergy treatment with Low Dose Allergy Immunotherapy:

Pollen, dusts, molds, and animal danders can be treated with a minimum of preparation.

Other Non-atopic (usually non IgE mediated) allergic conditions require more preparation:

Asthma, migraine, irritable bowel syndrome and crohn’s, urticaria, allergic arthritis, genitourinary allergy, neurologic allergy, food allergy, and chemical sensitivity all may require more sophisticated evaluation for treatment.

Precautions required for best results: To promote the maximum beneficial effect of LDA, these are the important recommendations:

Improve environmental controls beginning two weeks prior to the LDA injection. Avoidance of cats, dogs, and clean up of a dusty or moldy house. And it is important to stop using all fragrances and fabric softeners.
Improve nutrition and diet beginning two weeks before the LDA injection. A low yeast diet and/or a rare foods diet may be recommended and prescribed.
Eliminate any hidden infections prior to injection
Eliminate any hidden yeast infections (using gut preparation) prior to LDA injection. Elimination from the gut of hidden yeast infection with Diflucan or Nystatin/Amphotericin is the minimum precaution especially in treatment of food allergy.
In most patients it will be wise to prepare for LDA with Fluconazole or Itraconazole. A yeast free diet alone is not adequate to eliminate vaginal Candidiasis.
Bismuth eliminates yeast and Heliobacter from the gut and should be used in the gut preparation.
Use the special nutrient protocol that enhances the effect of LDA after the injection
Zantac used prior to the LDA injection may potentiate the benefit of the injection in food allergic individuals
You are not to take an injection of LDA if:

you are in the first five days of a cold
you are pregnant
you have just been immunized
you have had dental work within 7 days
you take pain killers or aspirin within 3 days
you are on singulair, cod liver oil, evening primrose oil, or vitamin C…..ulcer drugs like zantac or tagamet…(*although tagamet and zantac may enhance the effect of EPD if taken prior to the injection…
you are on asthma inhalers
you are on diet pills
you have cold sores
After the LDA injection you must:

Avoid Aspirin, anti-inflammatories, and Acetaminophen for 3 weeks.
Avoid alcohol for 10 days.
Avoid immunizations and dental treatment for two weeks.
The Basic LDA Diet (unnecessary with only inhalant allergy injection):
consists of avoiding the foods you usually eat… for three days-the day before, the day of, and the day after the EPD injection…

These foods are allowed-sweet potato…….yam…..cassava…..sago….lamb……fish not usually eaten….….cooked cabbage….celery…lettuce….rhubarb

When to take LDA Injections:

They are given every three months: April 15-May 15; July15-August 15; October 15th to November 15; and January 15-February 15

For pollen allergies the best time for an inhalant injection is prior to ragweed season

Insurance coverage and acceptance in the medical community: LDA is currently not covered by American health insurance carriers.

Multiple Chemical Sensitivites Update

In August, 2006 I attended a “Case Definition Workshop” for Multiple Chemical Sensitivities in San Francisco hosted by the Chemical Injury Information Network (CIIN.org)
The purpose of this important international conference was to bring together experts from many different scientific disciplines worldwide to share their insights and understanding of the diagnostic and treatment recommendations for sufferers of Multiple Chemical Sensitivities, and also to establish a case definition for MCS that would be accepted by the medical community.

The goals of this important conference were met and we accomplished much. We are still awaiting the final draft of the recommendations.

Physicians typically diagnose MCS by taking a health history, performing a physical examination and investigating whether symptoms come and go in response to chemical and other environmental exposures. To determine if an individual’s symptoms are the result of chemical exposures in the work, school, or home environment, an environmental/occupational exposure questionnaire is utilized to determine if symptoms increase or decrease in different indoor and outdoor environments.Generally, physicians who practice Occupational/Environmental Medicine are in the best position to diagnose and treat individuals with MCS.

The Multiple Chemical Sensitivity Syndrome raises many questions for the medical and scientific community. And it alerts us to the need to explore and become more aware of the tremendous role and impact that environmental chemicals have on human health in the 21st century.

The MCS case definition workshop in San Francisco in August, 2006 was attended by scientists and physicians from the U.S., Canada, Great Britain, Italy, Spain, Japan, and Australia. Allergists and Immunologists, Neurologists and Psychologists, Molecular Biologists,Social Scientists, Occupational and Environmental Physicians, Toxicologists, Attorneys and many chemically sensitive and chemically injured patients attended.

I have updated my viewpoint on MCS because it is has become a serious but poorly recognized silent epidemic. Both the Yale Occupational Medicine Clinic in New Haven,Connecticut and the Mount Sinai Occupational Medicine Clinic in New York City increasingly diagnose and recognize this serious environmental illness. Over 20 states have proclamations signed by their Governors making May,2007 MCS Awareness Month throughout the U.S.A.

It is my opinion that with the serious threat of chemical, biological and nuclear warfare, proper recognition and better understanding of chemically induced illnesses and chemical sensitivity disorders should be of the highest national priority.

I personally believe that we are currently in the midst of an epidemic of chemical induced MASKED illnesses. We are seeing more and more chronic illnesses that are either caused or aggravated by modern environmental chemical exposures. Many chronic illnesses respond to an environmental medical approach with an understanding of MCS as part of that masked illness. We may be at the cusp of a paradigm shift in the recognition of “modern Environmental illnesses.” Yet most physicians are failing to recognize and diagnose MCS (and its significance) for various controversial reasons.

The medical and scientific community may be under significant pressure to minimize recognition of MCS and its impact due to political and economic pressures from the chemical industry and insurance companies. This serious major medical controversy places the Occupational/ Environmental physician and the suffering environmentally ill patient in quite a difficult position.The physician is placed on the defensive when forced to justify his diagnosis of MCS and treatment recommendations to the medical community. The patient must defend him/herself against accusations that he/she is suffering from an “imaginary’ nonexistant illness. This controversy must be resolved, since various medical societies have issued “evidence based position statements” that advise physicians to negate the recognition and treatment of MCS at this time.

Based on my clinical experience, I suspect that large numbers of adults and children in our population are chemically sensitized and completely unaware of the seriousness of this problem and its implications. Without proper diagnosis of MCS, many chemically sensitized patients are treated with symptom relieving medications that may make them worse. Failure to make the proper diagnosis leads to improper treatment and progression of the disease.

In the modern world increased exposures to a wide variety of chemical agents have found their way into our air, food, personal care products, indoor and outdoor environments and our water supplies. The widespread use of many thousands of modern chemical agents carries the health risk of making a certain segment of our population more susceptible to chemical sensitization and the potential adverse health effects of becoming “sensitized” . The scientific community has the ethical responsibility to inform the population about what we know and what we don’t know and to appropriately warn our population.

There were three major areas of agreement at the 2006 “MCS Case Definition Workshop” in San Francisco:

    1. Physicians require a “Case Definition” for proper recognition of Multiple Chemical Sensitivities.


    1. Once the illness is diagnosed and recognized by the physician, the patient must be taught how to avoid incriminating environmental exposures and how to “UNMASK” the illness.


  1. More research is necessary to determine the various causes and treatments for those with MCS.

It is extremely important for physicians to diagnose the MCS problem in its earliest stages in order to prevent the progression of illness and the development of serious impairment and disability. If allowed to progress unknowingly, Multiple Chemical Sensitivities can devastate an individual’s quality of life.

The major classes of exposures that appear to initiate the MCS phenomenon include exposures to pesticides, working in sick buildings, living in toxic communities, occupying mold or moisture contaminated homes, working in the chemical industry, being exposed to formaldehyde products, new furniture products, new building materials and exposures to latex.

Multiple drug exposures and multiple drug allergy or medication intolerance may also initiate the phenomenon of MCS.Smokers may also be at high risk.

Psychosocial stress, heavy metal poisoning and hidden infections may also play a role in initiating MCS. Genetic, immunologic, and nutritional factors may play a role in making one more susceptible to developing MCS (Zenz, Occupational Medicine).

There appears to be a “Spectrum of Chemical Sensitivity Disorders” according to Ashford and Miller who authored the book recommended by the AMA: “Chemical Exposures, Low Levels and High Stakes.” This is comparable to the spectrum of infectious diseases; they are all similar, but each case of MCS may require a different individualized treatment.

The mechanisms of injury in MCS may involve the brain and nervous system with neuronal damage. Evidence is accumulating according to Martin Pall, PhD, that the nitric acid-peroxynitrite biochemical cycle is affected. Neuronal or brain inflammation may be a major factor in symptom production.

Neurogenic inflammation appears to be the fundamental problem in both upper and lower respiratory hyperreactivity associated with MCS according to William Meggs, M.D. author of “The Inflammation Cure.”
Asthma patients may be chemically sensitive.

Immunologic hyperreactivity may play a role in many cases of MCS.
It is currently recognized that allergic reactions are not confined to type I-IgE mediated reactions. All four types of Gel-Coombs allergic reactions are capable of triggering hypersensitivity reactions throughout the body explaining multisystem symptoms. Formaldehyde sensitivity occurs by way of hapten formation. The human body is very complex. The immune system plays a major role in many diseases of dysregulation including autoimmune diseases and autonomic nervous system dysfunction.

Damage to the body’s biological defense systems from toxic or allergenic chemical exposures can occur at the cellular level damaging cell receptor sites on cell membranes; genetic damage may also occur. Pesticide exposures are capable of damaging enzyme systems responsible for muscular, neurological, and behavioral controls. Once the body’s defense systems are damaged, minimal environmental exposures once previously tolerated may result in major symptoms.

A new protocol for an antioxidant nutritional treatment of chemically injured MCS victims has been developed by Martin Pall, PhD. AllergyResearchGroup.com has developed these nutrients for the chemically sensitized.

“The Inflammation Cure” by William Meggs, M.D. is an important book for all those who suspect they may have MCS. This book explains what is currently known and is very important for educational and treatment purposes.

There are many treatments that environmental physicians (members of the American Academy of Environmental Medicine) utilize to treat those with MCS.

People with MCS report that avoiding exposures to environments, chemicals, foods and drugs that trigger exposures is an important first step.

The following are a list of “some” available treatments for various aspects of MCS that I have utilized with some success in some patients:

  1. Optimal Dose Allergy (neutralization) Immunotherapy or Maximal Tolerated Intradermal Dose (MTID)-treating all hidden allergies
  2. Low Dose Allergy Treatment-or enzyme potentiated desensitization
  3. Individualized Nutritional prescriptions-based on nutrient testing
  4. Various Antihistamines including imipramine, doxepin, and astelin
  5. Heparin drops and intravenous
  6. Histamine drops and injections
  7. Leukotriene inhibitors-Singulair
  8. Neurontin-an antiseizure medication
  9. Antidepressants like prozac and lexapro
  10. Clonazepam wafers for reactions
  11. Trisalts and alka seltzer gold
  12. Glutathione injections
  13. Intravenous Nutritional Support including vitamin C and magnesium
  14. Vitamin B injections
  15. Individualized Exercise prescriptions
  16. Environmental controls for the home, office and personal care products
  17. Chemical free(no pesticides or artificial sweeteneres or sulfites) foods and water
  18. Antifungal therapy where indicated-treating hidden mold allergy and fungal infection
  19. Correcting any hormonal and thyroid imbalances
  20. Eliminating any hidden infection
  21. Evaluating and treating for toxic poisoning or injury
  22. Osteopathic Manipulation
  23. Appropriate comprehensive evaluation to rule out other serious illnesses like cancer, autoimmune diseases, diabetes, heart disease, mental illness,genetic diseases, Gilbert’s disease
  24. Gamma Globulin
  25. Lifestyle Education and counseling

For further information visit Allergycenter.com

By Albert F. Robbins, D.O., MSPH, FAAEM

What Medical Services & Conditions Do Allergy Doctors or Centers Provide & Treat


  • Allergy Testing and Treatment: M.I.T.D. and Neutralizing Dose.
  • Environmental/occupational medical evaluations for acute and chronic illnesses.
  • Environmental intolerance/multiple chemical sensitivity evaluation and treatment.
  • Environmental and nutritional approaches (non-drug) to chronic conditions.
  • Toxicologic/chemical injury evaluation and treatment.
  • Preventive medical approaches to chronic illness.
  • Intravenous nutritional therapies.
  • Osteopathic Manipulative Services.

Other Special Services Include:

  • Independent Medical Examinations (IME’s) in environmental and occupational exposure injuries.
  • Expert Testimony for occupational and environmental exposure cases, specifically relating to cases involving chemical toxicity, indoor air pollution, sick building syndrome, and chemical sensitivity.
  • Indoor air quality environmental/occupational building and home investigations and recommendations.


Allergic Rhinitis

Allergy affecting the nose is the most common form of allergic disease affecting about a third of the population. When severe and annoying it requires proper treatment. Pollens, dusts, molds, animal danders, foods and fragranced chemical cosmetics are common causes. Some individuals require Allergy Immunotherapy (allergy shots) to cure the condition. Seasonal problems may benefit from medication and environmental controls. There are very safe medications currently available including intranasal steroids, nonsedating antihistamines, and Singulair. For year round chronic sufferers it is always important to determine if there is a chronic hidden infection. Nasal cultures are recommended for bacteria and fungus.


This condition usually presents with symptoms of wheezing, cough shortness of breath. It is sometimes triggered by exercise. Cough variant asthma may present with just a chronic cough. Spirometry or breathing tests are advised for proper diagnosis. This is a simple test done in the office. Dust mite is the most common cause of allergic asthma. It is aninflammatory condition involving obstruction of the airways and usually responds well to an Environmental approach to treatment. Many asthmatics are very allergic and environmentally hypersensitive. It is important to determine what your allergic triggers are in order to treat it.. RAST Blood testing for allergy evaluation is recommended. All asthma patients should avoid fragranced products and fabric softeners. All patients with asthma should read the book “The Inflammation Cure” by Dr.William Meggs. Newer medications for asthma include antiinflammatories, bronchodilators and antihistamines.

Eczema and skin rashes

This atopic (allergic) rash can be caused by any contact allergen, food or inhaled allergen. In children foods may be a major factor. Hidden fungal allergy or bacterial infection may contribute to symptoms. RAST Allergy blood testing is recommended to determine what one is allergic to.Newer nonsedating antihistamines and environmental controls are usually helpful. Allergy immunotherapy may help dramatically. Enzyme potentiated desensitization has beeen very helpful in selected cases.

Urticaria or Hives

Hidden infection and parasitic infection should be evaluated for. Many drugs can trigger hives including antibiotics. Molds are common cause of hives. Foods, house pets, chemical gases, insects bites, laundry detergents and fabric softeners can cause hives. Allergy evaluation is recommended for chronic hives. Treatment involves treatment for any hidden infection (sometimes fungal or parasitic), environmental restrictions, elimination diets, and antihistamines. Sometimes immunotherapy including Low Dose Allergy treatment is beneficial.


This is a more generalized swelling of the body and the throat can close up. The whole body can swell. This can be lifethreatening. It is important to determine the cause. Drugs are common causes of both angioedema and urticaria.

Allergy of the Nervous System

Allergy may be a major factor in all types of recurrent headaches and migraines. Behavioral problems including hyperactivity, irritability and restlessness, fatigue, weakness, achiness, cognitive dysfunction, coarse tremor, and tics may all be manifestations of allergy. It is even possible for seizures to be a manifestation of an allergic reaction. Chemical, food and

mold allergens are common causes of neurolgical allergy symptoms. A trial of avoidance of certain foods and chemical exposures sometimes gives dramatic relief of symptoms. I usually advise removal of all smelly chemicals from the home including fabric softeners, perfumed products, air fresheners, and smelly chemical cleaning agents. Cat allergy can also trigger migraines and neurological allergy symptoms.

Gastrointestinal Allergy or Irritable Bowel Syndrome

This is an area of neglect in modern medicine. Food allergy is a common cause of gastrointestinal symptoms as well as vague symptoms of fatigue and irritability. Cow’s milk is the most common cause of topical gastrointestinal allergy. Cold sores inside the mouth as well as reflux symptoms, heartburn, gas, bloating , bad breath, diarrhea, rectal itching and constipation can all be caused by hidden food allergy. Skin testing for foods commonly eaten is recommended. Usually foods commonly eaten and craved are suspected allergens.

Eye Allergy

This can be caused by pollens, foods molds, dust chemicals and animals. Contact lenses can be a cause.Medications are helpful but it is important to determine the cause to eliminate the problem. Itching of the corners of the eye are usually due to pollens, animal danders and dust. Itching of the whole eye is usually caused by foods. Eyelid irritation is usually caused skin care products, eyeliners , scented cosmetics and hair care products.

Mold Allergy

Mold sensitive patients usually have multisystem symptoms including nervous system hyperirritability, cognitive dysfunction, fatigue, and headaches. Moisture contaminated buildings and high mold allergen exposure can cause increased intolerance to perfumes and related chemical products (see article on Candidiasis and Allergy). Severely mold allergic individuals should have their homes evaluated for hidden mold exposure problems. Environmental controls are recommended. Mold sensitive patients should minimize the use of mold related foods. Molds not only produce allergens but also produce toxins and release chemical smells that have the ability to sensitize. More information on molds can be obtained through our office. Ask for our free handout entitled “Health Effects of Molds”

Pollen Allergy

Most pollens are seasonal pollinating once or twice per year. People claiming to get frequent colds in the fall (ragweed) or in the spring or summer (grass and trees)may have pollen allergy. Maleleuca pollen is common in South Florida. A simple blood test or skin test can determine if you are pollen sensitive. Allergy desensitization is very effective and safe utilizing our low dose treatment method. Certain foods are related to certain pollen allergies and in pollen season one should avoid those foods.. Ask for our free handout entitled “Concomitant Food Allergy.”

Allergic Fatigue

Most people are completely unaware that fatigue is a cardinal symptom of chronic allergy. Along with itching, day/night and seasonal variations and susceptibility to respiratory infections, fatigue is one of the most common allergic symptoms that is rapidly alleviated by proper allergy treatment which usually includes avoidance of incriminated allergic foods, and desensitization to inhalent allergens.

Genitourinary Allergy

Some doctors have referred to this as “bladder asthma”.Foods are the most common causes of genitourinary allergy. In the case of enuresis , the most common offender is milk followed closely by artificial colors. In recurrent cystitis and vulvovaginitis citrus fruits, black pepper, tomato, chocolate and cola are common offenders. Inhalent allergens may play a role in the very allergic child.

Allergic Arthritis

A significant percentage of arthritics suffer from atopic palindromic arthritis. Their joint pains are precipitated by food allergy reactions. Pork has a predilection for involvement of the joints. Pork has frequently been overlooked as a major cause of allergic arthritic pain. Joint pains are a late manifestation of of a food allergy reaction and may occur two to five days after eating a food. Other foods causing arthritis include beef, chicken, turkey , milk, wheat and corn.

Allergic Headache

Both inhalent and food allergies are often overlooked during the search for headache cause. Food allergy is the more common cause. Neck pains, achy legs, fatigue, insomnia, irritability, and pallor all increase the suspicion of food allergy. The most common foods causing migraine include milk, chocolate, peanut, pork, egg, coffee, and chicken. Cheese, chocolate, MSG, soy sauce, beers and wines are vasodilating foods and may cause headache. Molds and chemical fumes and smells can cause headache. Cat allergy can trigger headache.

Allergic Vulvovaginitis

Women who develop recurrent vaginal yeast infections and irritation of the genitourinary tract may have an allergic problem that can be treated with Candida immunotherapy, avoidance of perfumed products and a low yeast/mold diet. Education is the key to further progression of the disease. For further information ask for free handout entitled “AllergicVulvovaginitis”

Tourette Syndrome

This tic disorder may respond dramatically to an environmental approach which includes an allergy evaluation and treatment, environmental controls, stress reduction, a low allergy nutritional plan, elimination of any hidden infection. For further information go to Latitudes.org and read the book Tics And Tourettes by Sheila Rogers in which Doctor Robbins environmental approach is discussed.

Formaldehyde,phenol and Glycerine sensitivity

Treatment is available either through Optimal Dose Allergy immunotherapy or Low Dose Allergy Treatment . Ask for our free information booklets. Also AllergyResearchGroup.com has developed nutrient protocols for the chemically sensitive by Dr. Martin Pall

Cat and dog allergy

Sublingual allergy drops or optimal dose immunotherapy can be prepared to help you tolerate a dog or cat in the house. The ideal recommendation is to remove the animal from the home if you are allergic.

Viral or Herpes Desensitization

Utilizing very low doses of the influenza viral vaccine this treatment developed by Allergist Joseph Miller, M.D. can help to eliminate both type 1 and type 2 herpes infections and cold sores. It can also help the symptoms of Epstein Barr virus and Chronic Fatigue Syndrome.

Dust Allergy

Dust sensitive individuals should create an allergy free bedroom. Free information on how to do this can be obtained through this office. Carpet removal from bedrooms is recommended and encasing mattresses and box springs. Eliminate any dust collectors in the bedroom and clean all air conditioning vents and filters regularly.

NSBRI or Nonspecific Building Related Illness (Sick Building Syndrome)

There are many causes including poor ventilation and airflow, moisture contamination and roof leaks, poor air conditioning and air duct system maintainance, inadequate fresh air, improper remediation and chemical air pollutants. Individuals who become ill in sick buildings should avoid those buildings until they are determined not to be a health hazard.


Most individuals with frequent sinus problems have hidden allergies and should be properly evaluated. Hidden infectioncaused by bacteria and fungi are also common and require treatment. Many have fungal sinusitis. Cultures of the sinuses can be done for an accurate diagnosis. Allergies are the most common causes of recurrent sinusitis.

Optimal Dose Immunotherapy

This approach to allergy desensitization allows us to treat your allergies safely and effectively and gives us the option of teaching you how to take your injections at home. For further information ask for the “Goldilocks Allergy Treatment” article.Also for children we offer sublingual allergy drops instead of injections!

Preventive Medicine

We all need to practice preventive health strategies daily. A daily health plan is necessary to prevent the progression of any disease process. Doctor Robbins is board certified in Preventive Medicine and has expertise in Health Education and can advise you in developing a healthy lifestyle action plan. Yearly checkups are recommended.


Post Nasal Drip, Septal Deformities, and Natural Treatment for Allergy Sufferers

Most of us never notice the one to two quarts of mucus, produced daily by glands in the nose and throat, necessary to moisten and clean the nasal membranes, humidify the air, clear foreign matter that is inhaled and fight infection.  This is because the majority of it is swallowed unconsciously within the course of the day.  Sometimes however, a clogged, or dripping sensation from the back of the throat referred to as, “post-nasal drip” occurs causing mild irritation and discomfort.

What Causes Post-Nasal Drip? —Treatment Options

Abnormal Secretions—Excessively thick mucus secretions, or increasingly thin secretions can contribute to post-nasal drip.  Thick secretions may result from dryness due to overheated buildings in the winter, sinus infections, or nasal allergies.  These can be from foods such as dairy products.  Sometimes thin secretions can become thick and turn green or yellow because of bacterial infection in the sinus area.

Thin mucus secretions may contribute to post nasal drip as well. These can be due to certain spicy foods, pregnancy, cold temperatures, hormonal changes, allergies, or bright lights.  Some medications, such as oral contraception, or blood pressure medication may cause increased secretions in the sinus passages as well.

Swallowing—Sometimes muscles in the throat, mouth and esophagus fail to interact properly causing secretions to overflow into the larynx and breathing passages.  This can cause hoarseness, coughing, and throat clearing.

The following factors may contribute to difficulty swallowing:

  • Age—Muscles often lose coordination as we get older and lose strength.  This can make it difficult for secretions to easily pass into the stomach.
  • Sleep—Secretions gather since swallowing occurs less frequently.  Coughing and throat clearing is often necessary when waking.
  • Swelling or growths—These, (when obstructing the food pathways) can prevent the smooth passage of mucus secretions.
  • GERD (gastroesophageal reflux disease)— Causes the contents of the stomach to back up, spilling acid into the throat or esophagus. 

Effects on the Throat

  • Sore, irritated throat
  • Swollen tonsils, throat tissue
  • General discomfort, (lump-like feeling) in throat

Treatment for Post-Nasal Drip-Allergy Remedies

A physician must conduct a detailed ear, nose, and throat examination.  If necessary, x-rays, endoscopic procedures and laboratory tests may be conducted.

Treatment Options Based on Causes

Bacterial Infection—Antibiotics for short-term sinusitis.  Surgery for chronic conditions to open blocked passages.

Remedies for Allergies—Prevention and avoidance of known allergen.  Relief through antihistamines, decongestants, steroids, and allergy shots, (these may be sedating or non-sedating and come in the form of pills, liquids, sprays, or injectables.)

GERD—Elevating the head of the bed, eliminating caffeine and alcohol from the diet, and avoiding food or drink, two to three hours before bedtime.  Certain over-the-counter and prescription medications are available to help treat GERD as well.

General Measures—Drink more water, avoid caffeine and diuretics.  There are some mucus thinning agents available.  Using a nasal douche or neti pot may help drain the sinus passages as well.


The Neti Pot—Home Remedies for Allergies 

Although the practice of “saline irrigation” for allergy relief and the sinuses has been around for many years, there has been a resurgence of interest in the convention with the introduction of the “neti pot”, a teapot like container used to flush a saltwater solution through the nose and sinus cavities.  By leaning over the sink and pouring the saline solution into one nostril, the neti pot helps rinse away mucus and other irritants in the sinus cavity and nasal passages. 

Finding homeopathic remedies and “natural allergy medicine” solutions is important for many people, especially during times of high pollen such as during the spring and fall seasons.   

Historic Use of the Neti Pot

Many people with sinus allergies develop a chronic condition known as, “rhinosinusitis”.  This involves inflammation and sometimes infection of the sinus passages and cavities.  Many centuries ago Ayurvedic Indian medicinal practices utilized saltwater to flush the nasal cavities of ancient peoples to remove foreign debris, pollen, and excess mucus.  Practitioners of homeopathic allergy relief would irrigate the nasal cavities up to four times per day by delivering saltwater into one nostril and allowing it to readily drain out of the other.

Natural Allergy Relief-How it Helps

  • Reduces nasal congestion
  • Reduces headaches caused by sinus congestion
  • May decrease dependence on antibiotics that fight sinus infection
  • May decrease dependence on corticosteroid sprays used for nasal inflammation due to allergies
  • Considered safe and well tolerated

Safety Concerns

  • Should not be used for infants.
  • Physician should be consulted regarding regular use.
  • In certain cases, may actually create conditions for sinus infections.
  • May remove critical lining of mucus membranes necessary in sinus passages with overuse.
  • Sterile water must be used due to a parasitic amoeba, known as, “naegleria fowleri”, that has been linked to several deaths in neti pot users.

Natural Cure for Allergies—How the Neti Pot Works

A neti pot is a vessel that resembles a smaller version of Aladdin’s lamp.  When warm sterile saltwater is placed in the pot, the user tilts their head to one side and places the spout in the nostril that is elevated.  They then allow this to drain through the nasal cavities and through the other nostril.  Nasal irrigation should never be attempted using non-sterile water or seawater due to issues with contamination.   

Kosher salt is safe for use and prevents the discomfort of a burning sensation associated with a non-isotonic solution.


The Deviated Septum—Symptoms, Causes, and Treatment

A deviated septum can wreak havoc in the lives of both allergy and non-allergy sufferers, depending on the significance of the blockage created by the condition.

When the thin wall (nasal septum) between the nostrils is displaced to one side, this causes one nasal passage to be smaller than the other.  This can be significant, blocking one side of the nose and reducing the flow of air to the lungs.  Crusting or bleeding may occur as well, due to the effect of dry air flowing through the nose.  Obstruction of the nasal passages can happen also because of swollen tissues in the lining in the nose.


Many people live their entire lives without ever realizing they have septal deformities.  Some structural abnormalities do however cause troubling symptoms.

These may include:

Obstruction of the nostrils:  This may cause difficulty breathing, especially when allergies, a cold, or upper respiratory infection is present, which can already cause swelling or narrowing of nasal passages.

Nosebleeds:  The drying of the nasal septum may increase the risk for nosebleeds.

Facial pain:  One-sided facial pain may be caused by a deviated septum.

Noisy breathing while sleeping:  Infants and young children may breath loudly if intranasal tissues are swollen or if they have a deviated septum.

Over awareness of the nasal cycle:  Becoming overly aware of the cycle of obstruction from one nostril to the other may indicate a deviated septum.

Preference for sleeping on a particular side:  A strong preference for sleeping on one side, as opposed to another may indicate that breathing is impaired due to a narrow nasal passage.

Causes of a Deviated Septum

A birth condition caused during fetal development

Injury:  Injury during childbirth may cause a deviated septum in infants.  Accidents may occur in children and adults that cause trauma to the nasal structure.

Aging:  The normal aging process can exacerbate an already existing condition with the septum.

Acute Rhinosinosinusitus:  This can make a deviated septum worse because of swollen nasal tissues that will further narrow nasal passages and cause obstruction.


Treatment of nasal obstruction may include medications to reduce the swelling, or adhesive strips that may help open the nasal passages. To completely correct a deviated septum however, surgery is necessary.


Multiple Chemical Sensitivity

“ABSTRACT.  Consensus criteria for the definition of multiple chemical sensitivity (MCS) were first identified in a 1989 multidisciplinary survey of 89 clinicians and researchers with extensive experience in, but widely differing views of, MCS.  A decade later, their top 5 consensus criteria (i.e., defining MCS as[1] a chronic condition [2] with symptoms that recur reproducibly [3] in response to low levels of exposure [4] to multiple unrelated chemicals and [5] improve or resolve when incitants are removed) are still unrefuted in published literature.)  Along with a 6th criterion that we now propose adding (i.e., requiring that symptoms occur in multiple organ systems), these criteria are all commonly encompassed by research definitions of MCS.  Nonetheless, their standardized use in clinical settings is still lacking, long overdue, and greatly needed–especially in light of government studies in the United State, United Kingdom, and Canada that revealed 2-4 times as many cases of chemical sensitivity among Gulf War veterans than undeployed controls.  In addition, state health department surveys of civilians in New Mexico and California showed that 2-6%, respectively already had been diagnosed with MCS and that 16% of the civilians reported an “unusual sensitivity” to common everyday chemicals.  Given this high prevalence, as well as the 1994 consensus of the American Lung Association, American Medical Association, U.S. Environmental Protection Agency, and the U.S. Consumer Product Safety Commission that “complaints [of MCS] should not be dismissed as psychogenic, and a thorough https://murraymed.com/nexium-over-the-counter/ workup is essential,” we recommend that MCS be formally diagnosed–in addition to any other disorders that may be present–in all cases in which the 6 aforementioned consensus criteria are met and no single other organic disorder (e.g., mastocytosis) can account for all the signs and symptoms associated with chemical exposure.  The millions of civilians and tens of thousands of Gulf War veterans who suffer form chemical sensitivity should not be kept waiting any longer for a standardized diagnosis while medical research continues to investigate the etiology of their signs and symptoms.”


*”archives of Environmental Health”, May/June 1999 [Vol. 54 (No. 3)]

The Maximum Intradermally Tolerated Dose (MITD) Method of Food Allergy Testing and Immunotherapy: New Concepts


by Joseph B. Miller, M.D.

(“The Environmental Physician”, Fall 1994)


I have long noted that the symptom-relieving dose in intradermal relief-dose (“neutralizing”) testing was almost always 0.05 ml of the strongest concentration that produced a negative wheal. Any concentration stronger than this almost always produced a positive wheal, equivalent to a mild local reaction, sometimes accompanied by symptoms, equivalent to a mild systemic reaction. The strongest negative wheal concentration (SNWC) usually did neither; it was almost always totally tolerated, both locally and systemically.

In a 4-year analysis of 50,421 consecutive tests, I found that the strongest negative wheal concentration was the symptom-relieving concentration in 98.8% of tests in which symptoms were elicited. So in these tests, the strongest negative wheal concentration could be termed the “maximum intradermally tolerated concentration”. In the remaining 1.2% of symptom-associated tests, relief occurred on the second (or in one patient, the third) negative wheal concentration. In this 1.2%, the SNWC failed to relieve, i.e., the induced symptoms continued on. Therefore, the SNWC was not totally tolerated, although it produced a negative wheal. The second negative wheal concentration, which did provide relief in these tests was, therefore, the maximum intradermally tolerated concentration in these instances. Summing up, in essentially 100% of all tests in which symptoms were induced and relieved, the maximum intradermally tolerated dose was the effective immunotherapeutic dose. This was true of both inhalants and foods. I feel justified, therefore, in defining this allergy testing procedure as the Maximum Intradermally Tolerated Dose (MITD) Method. This contrasts it with the Maximum Subcutaneously Tolerated Dose Method of build-up treatment for inhalants long employed in allergy immunotherapy.

I then utilized the strongest negative wheal concentration to treat clinically food-sensitive and inhalant-sensitive patients who produced positive wheals but no symptoms on testing; by wheal-based testing alone, these patients almost invariably obtained the same remarkable immunotherapeutic relief on the strongest negative wheal concentration, despite displaying no symptoms on testing. Finally, I found that the subset of patients with clinically food-induced or inhalant-induced syndromes, who did not display test symptoms and who also did not produce positive wheals even on 0.05 ml of Concentration #2, almost invariably obtained the same remarkable relief on immunotherapy with Concentration #2.

This suggested that testing could be made more efficient by first finding the strongest negative wheal concentration in all tests, and secondly utilizing the second negative wheal concentration when needed in the 1.2% of symptom-associated tests in which symptoms might remain. The same principle turned out to be true with other extracts, e.g. Influenza Virus Vaccine, Candida extract, oak-ivy extract, and others. This has standardized and streamlined the procedure and made it more objective, more efficient, more error-free, and more free of test symptoms. It has also freed us from the concept that provocation and neutralization of symptoms were necessary for successful diagnosis and treatment.


In 1964, I was practicing by conventional allergy concepts–and suffering from severe daily migraine. At that time, I did not know that migraine was largely a food-allergy syndrome. I was unable to determine the cause or obtain relief from my own background, and received no help from multiple physicians of several pertinent specialties.

Then I heard a lecture by Dr. Carleton Lee on an intradermal food test procedure which he called provocation-neutralization. Migraine was at the top of his list of responding syndromes. I immediately tested myself, and reproduced (“provoked”) headache with specific concentrations of extracts of milk, wheat, corn, and chocolate–my favorite foods. Much to my astonishment, I found, with each of these extracts, that a concentration different from the provoking concentration relieved (“neutralized”) the headache within ten minutes.

I then used subcutaneous injections containing the relieving doses of these foods twice a week. After three weeks, my migraine headaches were virtually gone–and still are.

For the past 30 years, I have been studying this remarkable system of allergy immunotherapy in carefully selected patients, and have added to the long list of responding syndromes and useful extracts other than foods. In addition, I have been interested in systematizing and teaching methods of obtaining greater efficiency, precision, and objectivity, and have published some of my experiences.(1-10) This report contains descriptions of more recent observations and concepts.

The Unique Rapid Relief Response:

Intradermal testing utilizes 1:5 serial concentrations (dilutions) of food extracts (some now term this a sequential-incremental system). One such concentration, specific for each food extract in each patient, provides rapid relief of symptoms that may have been induced by just-prior intradermal injections of other concentrations of that extract. When later administered subcutaneously as a regularly-scheduled immunotherapeutic injection, 0.05 ml of this concentration usually will then provide a major degree of protection from the symptoms caused by ongoing exposures to this food.

The individualized treatment doses for all the foods are combined into a single immunotherapeutic solution. This solution can be injected subcutaneously in judiciously selected patients with remarkable effectiveness and safety, and with virtually complete freedom from significant local or systemic side effects.

No build up of doses is needed, and none is desirable. Nothing can be gained by build-up, and much can be lost by building from relieving doses to overdoses. The optimal, effective, safe maintenance doses of all the allergens in the solution have already been determined by intradermal testing. They cannot get any better. Therefore, the very first subcutaneous treatment injection contains the full maximally effective, maximally safe maintenance doses of all the foods.

Favorable response usually occurs very rapidly. Relief of chronic food (or inhalant, etc.) symptoms begins by the time testing is completed in 55% of my patients. Injection by injection, this percentage increases. Within 3 weeks, 93% of my patients have achieved marked relief.

It is characteristic for relief to occur shortly after each immunotherapeutic injection. If symptoms are present at the time of an injection, relief occurs within 30 minutes in 40% of the patients, within one hour in 60%, within two hours in 77%, and on the same day in 88%. Some who take their injections at bedtime note their improvement on arising.

The Maximum Intradermally Tolerated Concentration Has Provided Relief in Virtually 100% of Tests:

I recently analyzed 50,421 consecutive tests perfumed on 1,525 patients over four years in my office. In this series, 98.8% (6,748 tests) of relief-providing (neutralizing) doses in the 6,829 tests which had produced symptoms in 834 patients occurred on the strongest negative wheal concentration (SNWC). In the remaining 81 symptom-associated tests (1.2%), in which test symptoms did not clear on the SNWC, the symptoms cleared on the second (77 tests, or 1.12%), or the third (4 tests, or 0.06%) negative wheal concentration. No weaker concentrations than these were required in this series.

Seven patients accounted for two-thirds of the second negative wheal doses (55 of the 81 tests). After retesting, their doses reverted to the strongest negative wheal dose. One of these patients (E.L.), in 1989, accounted for 38 of the 77 second negative wheal doses and all four of the third negative wheal doses. After she improved as was later retested, all her doses reverted to the strongest negative wheal dose. I have had no tests in which the third negative wheal dose was required since then, and even the need for the second negative wheal dose has become progressively less frequent.

This reversion to the SNWC is the usual situation. Thus, for homeostasis, the human immune protective system displays an almost universal need for the strongest negative wheal concentration. This may be looked upon as the anti-inflammatory non-wheal-producing concentration on step weaker than the pro-inflammator wheal-producing concentration. Even in the 1.2% of tests in which the body is unable to tolerate the SNWC on initial testing, a brief course of immunotherapy usually quickly produces tolerance and need, then, for the strongest negative wheal concentration.

In the 1.2% of tests in which the strongest negative wheal concentration is not the symptom-relieving concentration, the strongest negative wheal concentration cannot be called a tolerated dose at that time because it is accompanied by a continuation of test symptoms. Therefore, in these few instances, the second (or third) negative wheal concentration is the maximum intradermally tolerated concentration. So in this four-year study, the term “maximum intradermally tolerated concentration” has defined 100% of tests in which symptoms were induced and relieved. Therefore, this method can be accurately described as the Maximum Intradermally Tolerated Dose Method. (It could also be termed the Relief Dose Method or the Optimal Dose Method, since both these terms describe it also.)

Even so, there is a rare instance in which a test is not completed, either because of an inability to find a relieving dose that day, or because of the discomfort or possible danger to continuing the test. Many such patients can be retested successfully later with milder or no symptomatology.

Selection of patients for initial testing must consider many factors. Some patients are not selected for testing at all, and some are discontinued from testing if they experience uncomfortable symptoms or poor neutralizing capacity.

The remarkable consistency of physiologic need of the body for the strongest negative wheal concentration has an additional beneficial aspect. When the history indicates allergenicity of a food, inhalant, or other incitant, but no symptoms can be induced during intradermal testing, 0.05 ml of the strongest negative wheal concentration will almost invariably provide relief in therapy–without ever having produced symptoms during testing. In other words, patients who do not display symptoms on testing, but do display positive wheals, can be tested successfully and relieved of life-long suffering by whealling alone. Therefore, we can provide the same striking benefits to non-symptom-reacting patients who are allergically sensitive and who display positive wheals but do not display symptoms on testing.

Thirdly, there is also a subset of patients who display neither symptoms nor positive wheals on testing. In these patients, 0.05 ml of Concentration #2 is negative for all or many active allergens. Innumerable clinical trials have revealed that in these instances, 0.05 ml of Concentration #2 is not only tolerated, producing neither symptoms nor positive wheals, but is also almost invariably protective in immunotherapy. It provides relief to patients who have failed to find help even in multiple major medical centers. It is a near-universal protective dose in such patients, providing rapid relief (usually in one-half to two hours) after each injection, as well as ongoing protection by means of regularly scheduled immunotherapeutic injections.

The Wheal is an Almost Infallible Guide to the Perfect Treatment Dose Whether or Not Symptoms are Induced:

This primarily wheal-based system provides an objective, precise, reliable, repeatable method of testing. Unlike primarily symptom-based test systems, dependent on provocation of symptoms by the intradermal, sublingual, or subcutaneous route, it puts this method onto firm objective footing and provides relief for patients who do not display symptoms by any route of test administration of antigens.

Wheals are measurable, visible, palpable, and photographable for objective evidence of accuracy in testing and for correlating symptom-initiation or subsidence with wheal positivity or negativity. This wheal-based test system also provides precision in determining the perfect treatment dose. The ultimate evidence of effectiveness of wheal-based testing is the ongoing relief of symptoms during regularly scheduled immunotherapy, the return of symptoms when the regularly scheduled injection is delayed, and the rapid relief (usually within 30 minutes to 2 hours) when the delayed injection is finally administered. The willingness, or rather eagerness, of the patients to continue these injections for years speaks further to effectiveness, as does the success of MITD therapy in infants as young as three months of age.

The near-infallibility of the wheal in indicating the optimal therapeutic dose has been consistently overlooked. Investigators have simply not adequately studied intradermal serial concentration (sequential-incremental) testing. Many conventional allergists do not employ intradermal testing, particularly for foods. Most of those who do, utilize only a single concentration (usually 1:1000) of an antigenic extract. This cannot provide the quantitative bioassay-type information obtained by testing with a series of concentrations of different strengths. Furthermore, they usually intradermally test several antigens simultaneously, so if symptoms arise, they do not usually know which antigen caused them. In addition, they consider all test symptoms as adverse systemic reactions, and miss the opportunity to seek the perfect treatment dose by determining the strongest negative wheal concentration of the causative antigen.

Test and Treatment Dose Volumes:

The treatment dose of each allergen is invariably 0.05 ml, but in testing, two volumes are used. These are the 0.01 ml volume, which usually produces about a 4 mm wheal, and the 0.05 ml volume which usually produces about a 7 mm wheal. The 0.01 ml volume is not readily measurable on the syringe so is defined as the volume that produces approximately a 4 mm wheal.

The 0.05 ml volume produces a greater symptom response than the 0.01 ml volume, and a highly reliable relief response in both testing and immunotherapy. In addition, it is virtually 100% reliable in producing wheal responses that correlate with symptom responses. The 0.01 ml volume usually produces fewer, milder, or no symptoms in testing, but is slightly less reliable in correlating wheals with symptom responses.

Therefore, in order to minimize test symptoms, I test all patients to all antigens with 0.01 ml volumes until I have determined the SNWC with the 0.01 ml volume. I then “verify” negativity by administering 0.05 ml of that concentration. In 89% of such tests, the 0.05 ml volume has produced a negative wheal as did the 0.01 ml volume, and this dose has been the effective treatment dose. However, in 11% of such instances, the 0.05 ml volume has produced a positive wheal when the 0.01 ml volume had produced a negative wheal. In these 11%, 0.05 ml of the next weaker concentration has been negative and has been the effective treatment dose.

For example, suppose 0.01 ml/#2 produces a positive wheal and no symptoms. The next dose will be 0.01 ml/#3. If this produces a negative wheal, the next dose will be 0.05 ml/#3. If this produces a negative wheal, it is the treatment dose, and the test has been completed. However, in 11% of tests, the 0.05 ml/#3 will produce a positive wheal, in which case 0.05 ml/#4 will produce a negative wheal, will relieve any symptoms that may have been induced, and will be the effective treatment dose.

Deletion of Concentration #1 From Testing:

Stable extracts are critical for accurate testing and retesting. Non-glycerinated extracts arrive at the office in various stages of decreasing potency, and the decrease continues after dilution, requiring much retesting. Glycerinated extracts are remarkably stable and are little subject to loss of potency even when later diluted and even at room temperature. Almost all of my patients have tolerated glycerinated extracts, and I use them almost exclusively. The chief disadvantage is that glycerin produces a non-specific positive wheal in 80% of tests with the #1 concentration, which contains 10% glycerin. This does not occur with #2 or weaker concentrations.

When a positive wheal has occurred on Concentration #1, I have been unable to distinguish whether it was a non-specific positivity due to glycerin or a specific positivity due to allergen, despite measuring schemes by which the non-specific and specific responses have been said to be distinguishable.

In my experience, the #1 concentration is rarely useful as a relief-dose concentration. When it has been utilized in immunotherapy, it has usually soon started producing symptoms, and the #2 concentration has been needed for relief. Furthermore, delayed overdose reactions are more likely to occur from the #1 concentration than from any other. On the other hand, 0.05 ml of #2 has been a near-universal beneficial immunotherapeutic and protective dose in patients who display a negative wheal and no symptoms on 0.05 ml of #2. Therefore, I now rarely use Concentration #1 in testing. This has markedly decreased the incidence of delayed overdose reactions, has made test procedures more accurate and less time consuming, and has greatly reduced the need for retesting.

Wrap-up Injections:

If testing is completed in one day, ten combined treatment doses are made up, and one is administered to the patient before leaving the office. If testing requires more than one day, a “wrap up” injection of all doses determined the first day is administered subcutaneously at the end of the day. All doses determined over a two-day period will be injected subcutaneously at the end of the second day; and so on each day. When testing is completed, the first complete immunotherapeutic injection is administered in the office. In all instances, the patient is observed for thirty minutes for both local and systemic reactions. Characteristically, there is no local or systemic reaction, and the patient often volunteers that he is already feeling better, often after the first or second wrap-up injection. In the event of a local reaction or the induction of symptoms from a wrap-up injection, the antigens tested that day must be omitted from the treatment injections until they can be retested. In this manner, the accuracy of doses and the safety and effectiveness of the injections are verified, and the possibility of adverse reactions from subsequent injections is minimized.

Some Fundamental Concepts in Testing:

Some physicians with minimal or no personal experience with the relief-dose or MITD method of testing seem to think that it is a “mathematical” symptom-based system in which symptoms are produced in every test by a concentration either stronger or weaker than the relieving concentration, and that no symptoms occur on relieving concentrations. This is far from the truth, and has led to major investigative errors. So let us correct these errors by taking a close look at overdose, relief-dose, and underdose wheals and their accompanying symptoms as they actually occur.

  1. Overdoses Produce Positive Wheals but may or may not Produce Symptoms:

Overdoses (concentrations stronger than the relieving concentration) do not always produce symptoms, but virtually always (98.8%) produce a characteristic positive wheal. This wheal is blanched, hard, raised, and disk-shaped i.e., with sharply demarcated cliff-like borders, like a disk). It is as though the underlying mediator-activated dermal capillaries with their attached mast cells have extruded fluid into the site of the intradermal injection, ballooning up the wheal to the point that the skin over the wheal has become stretched and blanched. Although there is a relatively large amount of allergenic material in the positive wheal, symptoms are not always expressed, or at least not in the ensuing 10 minutes. They may finally be expressed 10 to 30 minutes later, or even hours later after the patient has left the office.

  1. Relief Doses and Underdoses Produce Negative Wheals but may or may not Produce Symptoms:

When a positive (overdose) wheal is produced, consecutively weaker concentrations in the 1:5 series are then injected intradermally at 10-minute intervals. A concentration is soon reached which produces a negative wheal. This is the first (strongest) negative wheal concentration. All concentrations weaker than this (underdose concentrations) will also produce negative wheals.

The negative wheal is not blanched, hard, raised, or disk-like. Rather, it is relatively soft and flat, and may be either neutral-colored or erythematous, but not blanched. The borders are sloping and irregular in shape as though the injected material has been draining out of the wheel, absorbing into the underlying tissues, leaving the wheal somewhat shrunken and deflated, with frayed out, slightly wrinkled, uneven borders.

In addition, the positive overdose wheal will have usually (not always) grown 2 mm or more in average diameter in 20 minutes. By contrast, the negative wheal usually grows less than 2 mm in average diameter. The blanching, hardness, and discoid characteristics are the most reliable indicators of positivity, even more than the 2 mm growth of the wheal, and constitute the strongest indication of overdosage and the need to inject the next weaker concentration.

Common Errors in Symptom-Based Testing:

  1. The Erroneous Rejection of Relieving Doses if Accompanied by Symptoms:

As described, a positive overdose wheal does not always produce symptoms, and not always in the ensuing 10 minutes. When the strongest concentration which produces a negative wheal is then injected, the overdose symptoms often emerge within minutes after this negative-wheal injection. Therefore, the symptoms arise after the administration of the negative wheal relieving dose, and may not have cleared by the end of the ten minute observation period. Then the relieving dose may be rejected by the physician because of the emergence and persistence of symptoms, and a weaker dose (an underdose) prematurely chosen for that antigen. This leads to poor therapeutic response and a need for retesting, due to the erroneous conclusion by the physician and patient that the poor therapeutic response indicates a defect in the system.

  1. The Erroneous Acceptance of Underdoses as Treatment Doses:

The same error is made when symptoms arise after the injection of the strongest negative wheal dose, even when no positive wheal dose has been previously injected. The error consists in then injecting the next weaker concentration (an underdose), after which the symptoms often subside, possibly because of the increasing benefit of the previously injected strongest negative wheal dose. This results in erroneous acceptance of the underdose as the treatment dose, and also results in treatment with the underdose. This, too, leads to a poor response and a need for retesting.

One of the most common errors in this system of testing is the use of underdoses as treatment doses. This error can usually be avoided by simply repeating the strongest negative wheal dose one or more times to allow it to finally clear out the induced symptoms rather than prematurely going to weaker doses.

In 761 tests (1.5% of the 50,421 consecutive tests being reported on), test symptoms failed to clear on a single test injection of 0.05 ml of the strongest negative wheal concentration. A second injection of the identical concentration produced clearing in 576 (76% of the 761 tests). A third such identical injection was required in 138 (18%), a fourth in 40 (5%), and a fifth in 7 (1%). More than five identical doses were not required in this series.

If using repeated neutralizing doses does not clear the symptoms, or symptoms worsen while repeating the strongest negative wheal concentration, 0.01 ml of the second negative wheal concentration is then indicated. Usually symptoms will begin to improve on this test dose. If symptoms do begin to improve or at least do not worsen on 0.01 ml of the second negative wheal concentration, then 0.05 ml is utilized and will almost always provide final clearing of the symptoms. If symptoms worsen on the second negative wheal dose, a return to the first negative wheal dose will often provide relief, although it had not done so previously. NOTE: Regardless of how many repetitions of the symptom-relieving dose are required during testing, the immunotherapeutic dose need only be 0.05 ml.

  1. The Erroneous Acceptance of Overdoses as Treatment Doses:

Symptoms sometimes occur on a positive overdose wheal and then clear before the 10 minutes are up. A useful clinical concept is that the antigen or the wheal has become gradually more tightly “bound” so that no more antigen escapes from it, at least for the time, so the symptoms clear. Because of symptom clearance, overdoses may be used erroneously as relief doses when testing is based entirely on symptom-clearing.

Accepting overdoses as treatment doses often results in delayed absorption of the antigen from the un-neutralized bound wheal after the patient has finished that test or even after he has left the office (delayed overdose symptoms). Furthermore, overdoses do not stand up to the final test of accuracy in immunotherapy in that they fail to optimally protect the patient from exposures to that antigen, or even cause mild local reactions or symptoms after therapeutic injections. An adverse local or systemic reaction to a therapeutic injection virtually never occurs when the doses are correct, so their occurrence is almost always a signal that retesting is indicated.

This third error can be avoided, and the need for retesting reduced, by never accepting a positive wheal concentration as a relieving concentration, even if symptoms subside on that concentration.

So, during symptom-based testing, errors may arise because of three seemingly paradoxical responses:

(1) An overdose can be accompanied by no test symptoms or even by relief of test symptoms, yet will not be a suitable dose for immunotherapy;

(2) An under dose can be accompanied by relief of test symptoms, yet will not be a suitable dose for immunotherapy;

(3) A relieving dose can be accompanied for ten minutes or longer by newly-arisen test symptoms rather than by relief, yet will be the safe, effective dose for immunotherapy.

Under dose Symptoms Require Constant Vigilance but are Infrequent and are Usually not Reliably Repeatable:

An under dose concentration is defined as any concentration weaker than the relieving concentration. Surprisingly, an under dose concentration can at times cause “under dose symptoms” on intradermal administration, rarely if at all on subcutaneous administration. These under dose test symptoms sometimes occur more rapidly and more dramatically than the symptoms produced by overdose concentrations, and can be severe.

In under dose reactions, it is a useful clinical concept that the antigen has been absorbed into the circulation rapidly to impact target organs abruptly rather than being bound in the skin over a longer period of time and released slowly as in a positive overdose wheal. It is interesting that under dose symptoms occur predominantly on intradermal test injections rather than subcutaneous treatment injections. This suggests a role for intradermal Langerhans Cell activation, since these potent cells are present in the epidermis but not in subcutaneous tissues.

Overdose vs. Underdose Symptoms:

Opposing mechanisms of homeostatis (exemplified by sympathetic vs. parasympathetic actions, norepinephrine vs. acetylcholine, etc.) are suggested by some test reactions. Overdose symptoms are often different and opposite to under dose symptoms. Overdose symptoms are often slower in onset and may be accompanied by tenseness, irritability, flushing, warm skin, and “hot sweats”, resembling over-stimulation of neuromuscular as well as hemodynamic homeostatic mechanisms. On the other hand, under dose symptoms are often more rapid in onset and are more often accompanied by limpness, weakness, faintness, pallor, cool skin, and “cold sweats”, resembling inhibition or depression of these homeostatic mechanisms. The important clinical point is that, when under dose symptoms occur rapidly, the immediate intradermal injection of the strongest negative wheal dose usually relieves the under dose symptoms quickly.

Because of the rapid and dramatic onset of symptoms which have sometimes occurred from under doses, it is important for physicians to be constantly vigilant in awareness of this possibility. The purpose of this vigilance is to be ready to immediately administer stronger (rather than weaker) concentrations for quick relief whenever negative-wheal under dose symptoms should occur. Repeated reminders of this over the years were to counter the common error of always going weaker when symptoms occur. It is important to head for the positive wheal landmark, which guides us to the next weaker concentration, the strongest negative wheal concentration, which almost invariably provides relief.

To summarize, symptoms can arise of subside on overdoses, relief doses, and under doses. Symptom changes alone are simply not reliable guides to the selection of treatment doses, much less to double-blind studies.

Errors in Double-Blind Studies Using Symptom-Based Testing:

Somehow the message concerning constant underdose vigilance became interpreted erroneously by some non-users, and possibly even by some users of this system. Jewett(11) developed the notion, possibly from his own test experiences, that every underdose must produce such symptoms reliably and repeatedly. This is far from the truth.

It was this false assumption that led Jewett, a professor of orthopedics with no background in either allergy management or the relief-dose allergy system, to devise a flawed protocol and perform a predictably “negative” double-blind study. His simplistic theory was that the whole test system was based on the assumption that every under dose produces symptoms, and that the failure of under doses to always produce symptoms reliably and repeatedly was proof that the entire testing and treatment system was invalid.

The fact is that under dose symptoms are uncommon; they only occurred in 2.88% of all tests in which symptoms occurred in the 50,421 consecutive tests analyzed in my office. And when it does occur, retesting the same extract in the same patient usually results in failure of under dose symptoms to recur on the second test. It is not reliably repeatable, so it cannot be a valid basis for a double-blind study. The scientific world does not know this because it has no hands-on experience with the system, and hailed Jewett’s persuasively written paper of a fallacious study as definitive proof of the ineffectiveness of the entire system.


When the body’s dosage needs change during the course of therapy, retesting determines the new dosage needs and restores response immediately. This is particularly true if the initial relief doses are weak. The need for retesting may occur early if some of the doses were erroneous initially due to symptom-based testing. So retesting when indicated is an important part of maintaining optimum response. However, testing by current concepts described in this paper has markedly reduced the need for retesting.

Convincing the Patient During Testing vs. During Treatment:

Some physicians will undoubtedly still prefer to test by trying to produce and relieve test symptoms rather than utilizing the primarily wheal-based system described. When it occurs, the production and rapid relief of symptoms is very convincing to the patient and to the physician. However, dependence on symptom production for diagnosis of food (or inhalant) allergy misses the majority of real clinically important allergens, since many will produce symptoms on ingestion (or inhalation) but not on skin testing. I prefer to provide more appropriate coverage and to eliminate or minimize test symptoms, and let patients be impressed by the rapid, marked relief they obtain within days or weeks after starting immunotherapy.

Test Symptoms Must be Relieved:

It must be emphasized that whealing is not the only factor involved. When symptoms occur, they must be relieved, even if the relieving concentration is the second negative wheal concentration, or even the third.

If a symptom-relieving concentration cannot be found, symptoms can be relieved by one or more small doses of Sus-Phrine, e.g. 0.03 to 0.05 ml. Sus-Phrine is a preservative-free quick-acting long-lasting aqueous solution and suspension of epinephrine. This can be supplemented if needed by other medications such as a steroid, e.g. prednisone 30 mg. in the office and possibly again in the evening if indicated. (Neither epinephrine nor steroids interfere with testing or wheal responses.) They physician’s judgement and the nature of the symptoms must determine such procedures.


Relief dose testing can be made much more accurate and efficient, and the need for retesting much diminished, by first seeking the strongest negative wheal concentration (SNWC). By testing only with 0.01 ml volumes until the SNWC is determined, and then verifying with 0.05 ml, much test symptomatology can be eliminated. Use of 0.05 ml of the SNWC will relieve induced test symptoms in 98.8% of tests in which symptoms are induced. Essentially, all of the remaining symptom-associated tests (1.2%) will produce relief on the second negative wheal concentration. When a single dose of the SNWC fails to relieve, one or more repetitions of this dose (as long as symptoms are not worsening), will often provide relief and prevent the error of prematurely changing to underdose concentrations. This can markedly diminish the incidence of underdose symptoms. Overdose reactions also can be markedly reduced by avoiding the use of Concentration #1.

When relief occurs on the strongest negative wheal dose, any dose stronger than this will produce a positive wheal, a symptom, or both–so it is the strongest intradermally tolerated dose. When symptoms persist on this dose, it is not a tolerated dose; then the next weaker dose will almost invariably provide relief, thus becoming the maximum intradermally tolerated dose (the strongest dose that does not produce a positive wheal or a symptom). Summing up, in essentially 100% of tests, this procedure can thus be described and defined as the Maximum Intradermally Tolerated Dose Method.


  1. Miller JB: Food Allergy: Provocative Testing and Injection Therapy. Springfield: Charles C Thomas, Publisher, 1972.
  2. Miller JB: Relief At Last! Neutralization for Food Allergy and Other Illnesses. Springfield: Charles C Thomas, Publisher, 1987.
  3. Miller JB: Intradermal provocative-neutralizing food testing and subcutaneous food extract injection therapy, in Food Allergy and Intolerance, Brostoff J and Challacombe SJ (Ed.). London: Bailliere Tindal, 1987, pp 932-946.
  4. Miller JB: A double-blind study of food extract injection therapy: A preliminary report. Annals of Allergy, Vol. 38, No. 3, March 1977, pp 185-191.
  5. Miller JB: Hidden food ingredients, chemical food additives, and incomplete food labels. Annals of Allergy, Vol. 41, No. 2, August, 1978, pp 93-98.
  6. Miller JB, Lee C, Binkley EL, and Hardt S: Relief of Influenza symptoms by the provocative-neutralizing method–A preliminary report. Journal of the Medical Association of the State of Alabama, Vol. 41, No. 7, January, 1972, pp 493-502.
  7. Miller JB: Influenza: Rapid relief without drugs. Clinical Medicine, Vol. 81, No. 9, September, 1974, pp 16-19.
  8. Miller JB: Treatment of active herpes virus infections with influenza virus vaccine. Annals of Allergy, Vol. 42, No. 5, May, 1979, pp 295-305.
  9. Miller JB: Rapid relief of varicella and infectious mononucleosis through immunotherapy. Annals of Allergy, Vol. 47, No. 5, 1981, pp 135-136.
  10. Miller JB: Relief of premenstrual symptoms, dysmenorrhea, and contraceptive tablet intolerance. The Journal of the Medical Association of the State of Alabama, Vol. 44, No. 2, August, 1974, pp 57-60.
  11. Jewett DL, Fein G, Greenberg M: A double blind study of symptom provocation to determine food sensitivity. NEJM, Vol. 323, NO. 7, August 16, 1990, pp 429-33.

The Case for Neutralizing (Optimal Dose) Immunotherapy

by Joseph B. Miller, M.D.

(“The Environmental Physician“, Fall 1991)

The neutralizing (optimal dose) method of intradermal skin testing and subcutaneous immunotherapy represents a major technological advance. It constitutes the safest, most effective, and most rapidly beneficial method of allergy skin testing and immunotherapy available today.

Each subcutaneous immunotherapeutic injection usually provides rapid relief of allergy symptoms, often in 30 minutes. The unusual rapidity, effectiveness, and safety of this response is based on the fact that the absolute precise best dose of each individual allergen is included in the treatment solution.

The Rapid-Relief Response

Bookman(1) has described what experienced allergists have always known. He reported that an occasional patient on build-up inhalant injection therapy would note marked improvement within 30 minutes to two hours after an injection of a given submaximal dose of an inhalant allergy extract. Usually the relief would continue for nearly a week. This near-universal clinical observation has been recently confirmed by a carefully controlled study at Johns Hopkins which reported favorable response to ragweed extract long before the maximum tolerated dose was reached.(2)

Allergists have long been puzzled by this rapid-relief phenomenon. Relief was not supposed to occur after any one injection.

Until recently, we had no technique for deliberately reproducing this rapid-relief effect. Now, by optimal-dose testing and treatment, we can reproduce this rapid-relief effect for all of the allergens in the treatment solution with a high degree of reliability.

How is the Rapid-Relief Response Achieved?

Optimal-dose testing involves administering intradermal test injections, one at a time, of 0.01 ml of consecutively stronger or weaker concentrations of an allergy extract in a 1:5 dilution series every 7-10 minutes. The first goal of testing is to determine the strongest concentration which produces a negative wheel. The second goal is to determine the strongest negative-wheal concentration that relieves any symptoms induced by preceding test doses. The two concentrations are usually the same, i.e. the strongest negative wheal concentration is almost always the concentration that relieves test-symptoms, if such symptoms occur.

The optimal dose (treatment dose) is 0.05 ml of this concentration. This has provided protection and relief in 99.7% of tests in my patients. My books and other publications detail the technique and many of its applications.(3-24)

The Maximum Tolerated Intradermal Concentration is the Optimal or Rapid-Relief Concentration and is Both Effective and Safe

The optimal intradermal test dose produces a negative wheal (no local reaction) and relieves (not causes) any symptoms that may have been induced by preceding test doses (no systemic reactions). Therefore, it is properly termed the “maximum tolerated intradermal concentration”. This terminology is to distinguish it from the conventionally employed maximum tolerated subcutaneously administered dose, which can cause both local and systemic reactions.

The maximum tolerated intradermal concentration is truly the maximum tolerated. The next stronger concentration would invariably produce a positive wheal (local reaction) or symptoms (systemic reaction), or both. The absence of both local and systemic reactions, and the marked effectiveness in protecting from and relieving symptoms induced by subsequent natural exposure to the antigen, make this a uniquely safe and effective procedure.

This safety allows the patient to self-administer his injections for protection on a regular schedule. He can also self-administer additional (“booster”) injections for quick relief whenever he encounters a sufficient natural exposure to an allergen to breach the protection of his regularly scheduled injections. Furthermore, the same system of testing and treatment are equally applicable to foods as well as inhalants, and also to many other substances (hormones, viruses, contactants, chemicals, etc.).

The Imprecision of Orthodox Allergy Procedures

Orthodox allergy skin testing provides no information concerning the precise dosage needed for each individual allergen. Therefore, orthodox allergy treatment solutions usually contain equal amounts of all allergens, regardless of the fact that the patient may be much more sensitive to some allergens than to others.

Subcutaneous injections of this solution in increasing dosage usually are administered until a large local or significant systemic reaction occurs. This is usually followed by a reduction in dosage.

This reduction is usually temporary in order to keep the dosage maximally strong, and yet (hopefully) not cause major local or systemic side effects. In practice, however, major local and/or systemic side effects do occur at times, sometimes including urticaria, laryngeal edema, acute severe asthma attacks, or anaphylaxis.

These reactions to orthodox build-up therapy occur chiefly because patients are not usually equally allergic to all their allergens. Their adverse reaction is to the one or more allergens in the solution to which they are most sensitive.

Subcutaneous optimal-dose treatment injections simply do not cause these severe reactions because they contain the “just right” dose of each individual allergen. With optimal-dose immunotherapy, each allergen dose is analogous to Goldilocks’ bowl of porridge. It is not too strong and not too weak, but “just right”. Therefore, no build-up of dosage is required. The first dose is the maintenance dose.

The Rapidity of the Optimal-Dose Response

Some patients report relief while still undergoing testing. Thirty percent of patients report relief after the first post-testing treatment injection. Ninety-five percent have reported marked relief by the tenth injection (3 or 4 weeks). If “rush” immunotherapy is desired for rapid relief, several injections can be administered safely each day without the dangers of the urticaria, laryngeal edema, acute asthma, or anaphylaxis often encountered in orthodox rush immunotherapy.(25,26)

After this initial relief has been established, each optimal-dose injection will usually provide relief of symptoms induced by natural exposure to any or all of these allergens. This relief usually occurs within 30 minutes to two hours. Furthermore, in contrast to orthodox build-up injections, optimal-dose injections provide protection from and relief o the patient’s actual symptoms, not a hoped for but seldom achieved beneficial change in igG and igE levels which may have no relationship to patient benefit.

The Objectivity of the Optimal-Dose Test

Each relief dose is precisely determined by objective parameters, namely measurement to determine if the wheal has grown 2mm or more in 10 minutes, plusinspection and palpation of the wheal to determine the presence or absence of blanched, hard, raised, and discoid characteristics. (A discoid wheal is “ballooned up” and has a sharply demarcated border like a disc, rather than being frayed out around the edges, “deflated”, and absorbing into the surrounding skin.)

A positive wheal typically grows at least 2mm in 10 minutes and is blanched, hard, raised, and discoid. If test doses induce no symptoms, the optimal dose is 0.05 ml of the strongest concentration which does not produce a positive wheal. If test symptoms occur, the optimal dose is 0.05 ml of the strongest concentration which does not produce a positive wheal and which also relieves the induced symptoms.

In a recent study of 24,556 consecutive intradermal optimal-dose tests for inhalants and foods performed over a period of two years in my office, the first (strongest) negative wheal concentration was the treatment concentration in 99.7% of tests. In 0.27%, the second negative wheal concentration was the treatment concentration, and in 0.02%, the third. No tests in this series required any weaker concentrations than this.

The Dangers of Orthodox Immunotherapy

Optimal-dose immunotherapy conveys none of the three main dangers involved in conventional immunotherapy. These consist of starting injection therapy with a too-strong starting dose of one or more antigens in the treatment solution; building immunotherapy dosage to a gross overdose and causing a reaction along the way; or maintaining very strong doses in a brittle or asthmatic patient whose health and strength are not necessarily at the same level with every injection and who may suffer a severe reaction to a dosage which has been tolerated in the past.

The Slow Response to Orthodox Immunotherapy

Textbooks of orthodox immunotherapy suggest that the allergist warn the patient in advance that he may not notice improvement for a year or two. Furthermore, if he has not noted slight improvement after two or three years, a discussion of whether or not to continue therapy may be considered.

This contrasts with the marked and almost invariable improvement that occurs within one to three weeks with optimal-dose immunotherapy. Furthermore, this same testing technology and the same safety and benefits of treatment occur with foods and many other antigens as well as inhalants, thus greatly increasing the number of patients that can be helped by clinical allergy procedures.

Both Orthodox and Optimal-Dose Procedures
are Based on Clinical Experience

It is paradoxical that orthodox allergists attack optimal-dose procedures because they were derived from clinical experience rather than research. The fact is that orthodox procedures are also based on opinions derived from clinical experience, not research. Here are three quotations from the “bible” of conventional methodology.(27) The underlined and parenthetical material is mine.

  1. “…the scientific data now available simply do not provide information sufficient for physicians to make totally objective decisions. There are answers based on the approaches that have evolved through long and extensive clinical experience. In spite of the lack of directed clinical research, this experience provides background for decisions about many details. These questions and answers present one viewpoint, with the full recognition that these opinions are not derived from research in many cases but rather from experience.”
  2. Physicians “customarily include equal concentrations of each antigen (in the treatment solution) once a decision has been made to include that particular antigen in the treatment schedule.”
  3. “If immunotherapy that is being given (in addition to environmental control and medication compliance) does not seem to be effective after a period of two to three years, then serious consideration should be given to its continuation.”


The Body Requires a Specific Optimal Treatment Dose for Each Individual

Antigen, and Changes its Needs from Time to Time

The fact is that one allergen may require a relatively strong dose, another a relatively weak dose. Other allergens may require doses of various intermediate strengths.

The body’s dosage needs for individual allergens may vary over time. Whenever the body’s dosage needs change, the new dosage needs can be determined quickly and precisely by retesting. Retesting restores optimal response immediately.

Thus, each optimal-dose injection contains the just-right dose for each allergen in each patient’s treatment solution for the state of his immune mechanism at a given time. In summary, the optimal-dose system provides a safe, effective, rapidly beneficial, precise, objectively-determined, patient-specific, allergen-specific and time-specific treatment.

Optimal-Dose Immunotherapy Saves Time and Money

An additional benefit of optimal-dose immunotherapy is the tremendous saving of time and money. Each orthodox build-up injection requires a visit to a physician’s office for safety. It is recommended that these injections be given only in office with resuscitative equipment.

Furthermore, in Britain, the post-injection waiting period in the office has recently been required by decree of the Committee on Safety in Medicine (equivalent to our FDA) to be increased from the old standard of twenty minutes to a new standard of two hours. This has virtually eliminated the use of orthodoximmunotherapy in Britain.

However, the use of optimal-dose immunotherapy has not been affected by this ruling, as the injections are eminently safe and can be self-administered by the patient in his own home. This is much more practical and economical, since it does not require the time loss and inconvenience of having to go to an appropriate physician’s office or hospital for each injection.

In addition many patients are seeing one or more other specialists (e.g. neurologists for migraine, gastroenterologists for diarrhea, etc.), taking multiple medications, and undergoing repeated diagnostic workups or hospitalizations. These can be very expensive, and can usually be markedly decreased or eliminated by optimal-dose therapy.

Optimal-Dose Immunotherapy is the True Gold Standard

The gold standard of orthodox allergists for food testing is the prick test followed by double-blind placebo-controlled challenges with opaque capsules containing powdered food antigens. Actually, prick tests for foods are very unreliable, and an opaque capsule challenge usually provides too small a dose to be an adequate stimulus to evoke an allergic response. Furthermore, capsules cannot be swallowed by small children.

Symptom induction by oral challenge usually requires four days of avoidance followed by at least two or more large closely-spaced feedings. Sometimes several feedings each day for several days or even for 1-2 weeks are required to induce symptoms. But even if orthodox procedures were reliable for diagnosis, they would still offer no information as to the precise treatment dose for each antigen, as does optimal-dose testing.

A New Approach is Required

Continued re-examination of limited old concepts, such as prick tests, opaque capsule challenges and orthodox rush procedures is analogous to earlier attempts to breed stronger horses and build better buggies. Applying the principles of the internal combustion engine to transportation was not initiated by horse-breeders or buggy-builders. It took a different mindset, beginning with a determination to find a better solution to the problem, even if novel, rather than an attempt to improve a technology which is well-established but limited. Hopefully, we can all open our minds to new approaches and move into the 21st century a stronger and more effective medical specialty.

Why is Change so Urgently Needed?

The 40 million patients with inhalant sensitivities can be provided far greater, safer, and quicker relief by optimal-dose immunotherapy rather than by orthodox immunotherapy. In addition, optimal-dose immunotherapy for foods can provide relief for most of the 24 million patients with migraine, the 18 million patients with gastrointestinal allergies (abdominal pain, diarrhea, “irritable bowel syndrome”, chronic ulcerative colitis, and Crohn’s disease), the 15 million children (and uncounted adults) with attention deficit hyperactivity and hypoactivity disorder, the 15 million patients with atopic dermatitis, and the 15 million people with chronic urticaria (total: 127 million).

Also, optimal-dose immunotherapy with influenza virus vaccine can provide the same 30-minute relief response for untold millions of patients with acute influenza. It is highly effective for the millions of patients with infections caused by members of the herpes virus family (herpes simplex I and II, herpes zoster, infectious mononucleosis, varicella).

Optimal-dose treatment with progesterone for premenstrual syndrome, dysmenorrhea, and hyperemesis gravidarum can provide the same rapid relief response in the many millions of women with these conditions.

Optimal-dose immunotherapy with oak/ivy extract can provide the same rapid relief response for millions of people suffering from oak/ivy dermatitis. Optimal-dose immunotherapy with extracts of Candida albicans can provide much relief to the millions of women with resistant vaginal candidiasis.

Additional uses of this exciting procedure are being studied. Investigation into the applicability of other extracts, vaccines, hormones, contactants, etc. is sorely needed. This is an expanding field with many additional potential applications. Decades may pass before sufficient i’s are dotted and t’s are crossed to satisfy all the no-sayers.

As physicians, we cannot in good conscience continue to withhold this valuable treatment. Patients with known responsive syndromes should not be made to suffer needlessly on when relief is safe, effective, quick, and available.

This is Only the Beginning

The discovery and development of the optimal-dose system seems to me to be in the same echelon of importance as the discovery of anesthetic agents, antibiotics, corticosteroids, and ground-breaking surgical procedures such as open-heart, endoscopic, and laser surgery. It is not just a superb method of treating food allergy (which it is), but a comprehensive system for re-balancing faulty, ongoing imbalanced immunologic mechanisms for a great many specific allergens and other incitants.

This does not make it a panacea any more than did the landmark discovery of the agents and procedures just listed. Each of these discoveries has started simple, just as did food neutralization. Each then developed into a major system of managing many medical problems. An example is the growth of the antibiotic concept from the first antibiotic to the many now available. The same is true of anesthetic agents, uses of steroid hormones, expanding surgical procedures, etc.

Furthermore, optimal-dose therapy is specific to the incitant being treated, which is the opposite of a panacea. The great breadth of applications is based only on the great breadth of ills caused by specific immunologic dysfunctions.

For the first time, we have a system for safely controlling immune dysfunction. We have barely begun. It will be fascinating to see the many new applications not yet dreamed of that the future will bring. It would be a shame if this great potential were to be suppressed by individuals and agencies who simply are not knowledgeable about its usage and its vast implications for the relief of the human condition.



  1. Bookman R: Observations and reflections of a practicing allergist. Annals of Allergy 45:4, pp 264-266, 1980.
  2. Hedlin G, Silber G, Naclerio R, Proud D, Eggleston P, Adkinson NF Jr: Attenuation of allergen sensitivity early in the course of ragweed immunotherapy. J Allergy Clin Immunol, September 1989, pp 390-399.
  3. Miller JB: Intradermal provocative-neutralizing food testing and subcutaneous food extract injection therapy, in Food Allergy and Intolerance, Brostoff J and Challacombe SJ (Ed.). London: Bailliere Tindall, 1987, pp 932-946.
  4. Miller JB: Food Allergy: Provocative Testing and Injection Therapy, Charles C Thomas, 1972.
  5. Miller JB: Relief at Last! Neutralization for Food Allergy and Other Illnesses, Charles C Thomas, 1987.
  6. Miller JB, Lee C, Binkley EL, and Hardt SH: Relief of influenza symptoms by the provocative-neutralizing method–A preliminary report, Journal of the Medical Association of the State of Alabama, Vol. 41, No. 7, January, 1972, pp 493-502.
  7. Miller JB: Relief of premenstrual symptoms, dysmenorrhea, and contraceptive tablet intolerance, The Journal of the Medical Association of the State of Alabama, Vol. 44, No. 2, August, 1974, pp 57-60.
  8. Miller JB: Influenza: Rapid relief without drugs, Clinical Medicine, Vol. 81, No. 9, September, 1974, pp 16-19.
  9. Miller JB: Influenza neutralization, Transactions of the American Society of Ophthalmologic and Otolaryngologic Allergy, Vol. 14, No. 1, October, 1974, pp 159-168.
  10. Miller JB: Management of migraine headaches, in Current Therapy of Allergy, Frazier CA (Ed.) New York: Medical Examination Publishing Company, Inc., 1974, pp 224-225.
  11. Miller JB: Food allergy: Technique of intradermal testing and subcutaneous injection therapy, Transactions of the American Society of Ophthalmologic and Otolaryngologic Allergy, Vol. 16, No. 1, October, 1976, pp 154-168.
  12. Miller JB: Virus and hormone neutralization, in Clinical Ecology, Dickey LD, (Ed.), Springfield: Charles C Thomas, Publisher, 1976, pp 597-605.
  13. Miller JB: A double-blind study of food extract injection therapy: A preliminary report, Annals of Allergy, Vol. 38 No. 3, March, 1977, pp 185-191.
  14. Miller JB: Management of migraine headaches, in Current Therapy of Allergy, Frazier CA (Ed.), New York: Medical Examination Publishing Company, Inc., 1978, pp 307-320.
  15. Miller JB: Optimal dose method of food allergy management, The Journal of Continuing Education in O.R.L. and Allergy, Vol. 40, No. 5, May 1978, pp 37-50.
  16. Miller JB: Hidden food ingredients, chemical food additives, and incomplete food labels, Annals of Allergy, Vol. 41, No. 2, August, 1978, pp 93-98.
  17. Miller JB: Immunotherapy of virus infections, Transactions of the American Society of Ophthalmologic and Otolaryngologic Allergy, Vol. 18, N. 1, September, 1978, pp 144-148.
  18. Miller JB: Treatment of active herpes virus infections with influenza virus vaccine, Annals of Allergy, Vol. 42, No. 5, May, 1979, pp 295-305.
  19. Miller JB: Management of food allergy, in Food Allergy: New Perspectives, Gerrard JW (Ed.), Charles C Thomas, Inc., September, 1980.
  20. Miller JB: The optimal-dose method of food allergy management, in Otolaryngologic Allergy, King HC (Ed.), Symposia Specialists, Inc., 1981, pp 253-283.
  21. Miller JB: Rapid relief of varicella and infectious mononucleosis through immunotherapy, Annals of Allergy, Vol. 47, No. 5, 1981, pp 135-136.
  22. Miller JB: Neutralization therapy update, in Allergy–Immunologic and Management Considerations, Spencer JT (Ed.), MEDED Publishers, Inc., 1982.
  23. Miller JB: Herpes: Rapid relief with influenza virus vaccine, The Journal of the Alabama Dental Association, Vol. 68, No. 3, Summer, 1984.
  24. Miller JB: Mini-dose therapy may relieve progesterone intolerance, Clinical Ecology, Vol. 2, No. 4, Fall, 1984, pp 224-226.
  25. Armentia-Medina A, Blanco-Quiros A, Martin-Santos JM, Alvarex-cuesta E, Moneo-Goiri I, Carreira P, Losada-Cosmes E: Rush immunotherapy with a standardized Bermuda grass pollen extract. Annals of Allergy, Volume 63: August 1989, pp 127-135.
  26. Horst M, Hejjaoui A, Horst V, Michel FB, Bousquet J: Double-blind, placebo-controlled rush immunotherapy with a standardized Alternaria extract. J Allergy Clin Immunol, February 1990, pp 460-472.
  27. Patterson R, Lieberman P, Irons JS, Pruzansky JJ, Metzger WJ, Zeiss CF: Immunotherapy, Allergy Principles and Practice, Middleton E Jr, Reed CE, Ellis EF, Second Edition, CV Mosby Co., 1983, p. 1131.