EPD - the practical details of what to do for each dose

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Instructions to follow for every dose of EPD

When I first started using EPD in 1988, there were strict instructions for patients to follow a propos diet and environment. These applied because there is a theoretical risk that patients could make themselves more allergic. However, I now believe these risks are purely theoretical - in practice this does not seem to happen.

Diet: For the 24 hours before EPD and three days after I recommend eating those foods to which you are not presently reacting badly, i.e. your normal "safe" diet. However, I recommend avoiding alcohol for that period.

Environment: Try to avoid unnecessary exposure to strong chemicals and fumes for the 24 hours before and three days after.

Vitamins and minerals: Continue to take your normal supplements. However, there are some supplements which are under suspicion as upsetting EPD. I am not convinced of this because many of my patients take these and the treatment works perfectly well. However, for your information, cod liver oil and megadoses of vitamin C (more than 2 grams daily) are those doubted.

Vaccinations: should be avoided one week before treatment and two weeks after.

Pregnancy: There is no theoretical reason why EPD should be avoided in pregnancy and indeed I have treated many ladies with EPD throughout pregnancy. The only problem is that should anything go wrong, the EPD may be unfairly blamed.

Cold/flu: If a cold/flu is caught immediately after EPD, the treatment may be spoilt, in which case I invite you back for a top up for which there is a small charge.

Avoid putting any creams or ointment on the forearm at the site of treatment.

THE COMMONEST CAUSE OF FAILURE OF EPD IS PARACETAMOL - many cough and cold remedies contain paracetamol, so beware and do not take around EPD time!

Another possible spoiling factor is yeast infection. So patients with gut fermentation syndrome (so-called candida) should take an antifungal for four days before EPD. I usually use Sporanox 100mgs - again, I can supply directly if your GP won't prescribe. Sporanox should not be used if there is any chance of pregnancy.

EPD can be blocked by:

  • Acute viral infections: immediately during or after treatment. If there is any suggestion that the treatment has not taken because of a viral infection then I invite patients to come back in a month for a top-up, for which there is a small charge.
  • Stress: try to make the EPD day an easy one!
  • Nutritional agents: mega doses of vitamin C may upset EPD (ie more than 2 grams a day), cod liver oil - stop these for 1 week before treatment and for 2 weeks after.
  • Drugs: paracetamol, aspirin, NSAIs, Ketotifen, slimming pills, ventolin, bricanyl in large doses (6 puffs a day is fine), trimethoprim, Septrin and antimalarials, Cimetidine or Ranitidine, Migraleve, "cold cures".

Asthmatics who rely heavily on their inhalers are a special problem - up to six puffs a day of their bronchodilator is safe. For this group it is often best to use a short course of steroids (such as prednisolone 15mgs one day before and 3 days after) to reduce the need for inhalers. Aminophylline helps EPD and is also useful.

How soon will I get better with EPD?

This is the question everybody asks! I give an EPD every two months for the first three doses, then every three months for 2-3 doses, and then play it by ear. By then most people will have had some sort of response and be able to judge when they next need a dose of EPD. I am disappointed if people have not started to improve by 3-4 treatments, but some people take 8-10 before they really pick up. I like to see clinical improvement before the diet is relaxed too much, but if EPD is working as it should, one should end up feeling well and eating a normal diet. However, in practice often people are left with one or two foods that they have to continue to be careful with. For example, the antigen in fresh milk and wholemeal bread is unstable and sometimes the desensitisation does not work for these foods.

Overall about a third of patients with simple allergy problems will have a course of 8 injections and remain well. About a third need a top up every 6-12 months. However, my complex allergy/CFS patients often need a regular treatment to remain well. This is a bore, but if the price of good health is an EPD every 4 months, then it is worth it. I have many patients now who I see regularly simply for such a top up treatment.

Responses to EPD can sometimes be fickle and the experienced EPD patient will recognise a good and a bad treatment. If a treatment has failed completely then I recommend coming back for a top up (not before at least 4 weeks have elapsed from the original treatment). There will be a charge for the vaccine but I will not charge for my time.

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