Origins-Availability
This method of treatment/prevention of allergies was invented by a brilliant immunologist Dr. Len McEwen, at St. Mary's Hospital, Paddington, a few yards from the point where penicillin was first discovered. EPD is manufactured in Berkshire, under absolutely sterile conditions; as it is an unlicensed product (i.e. not a drug), it is available on a "named patient" basis; EPD is not an "alternative" medicine. Since the early 1960's it has been used by a large number of doctors specialising in allergy in Europe (Austria, Germany, Italy, Greece) Canada, USA, Australia and New Zealand.

Description-Mode of Operation
The EPD comes in various "cocktails" of inhalants, moulds, foods or chemicals. Allergens are present in each cocktail in concentrations similar to a skin prick test or much less (1:1,000,000 - 1:10,000,000,000,000 of 1 ml). When mixed with a specific enzyme (beta-glucuronidase), the cocktail is activated and causes a gentle exposure of one's immune system to the allergens it contains, thereby initiating natural immunity. It is thought to stimulate the production of T-supressor cells (lymphocytes responsible to work against allergens). This explains the delayed therapeutic effect of EPD and the reason why repeated booster doses are necessary, until a good response is established.

Safety
Over 35 years of use and approximately 450,000 treatments, EPD has not caused one severe or life-threatening reaction. As there is a theoretical risk with any form of desensitisation, standard medications are on hand and ready to be used, at the time of treatment, for any allergies. Doctors using EPD are careful to follow protocols recommended by the manufacturers and will only administer the injections as frequently as necessary. The Medicines Control Agency has recognised that EPD does not have the same risks for severe reactions as the ordinary Incremental Desensitisation (discovered by Noon and Freeman in 1911).

Response
A pessimistic forecast is that EPD will fail in 20-25% of patients treated. The rest will experience variable degrees of improvement. Audits place the effectiveness of EPD very high (80-90%) providing that instructions are followed strictly. The majority of failures are linked with patients who give up treatment too early or do not follow instructions, i.e. overwhelming the treatment with exposure to perfumes, wrong diet or pets. Depending on the duration of their condition prior to EPD, some patients start feeling better after their third or fourth injection but most will respond sooner. A small percentage, take longer, to see results. For this reason, failure of EPD can only be accepted if the environmental, dietary and nutritional advice have been followed meticulously and treatment has been received over a two-year period. To ensure good response, instructions should be followed strictly. Occasionally, patients who did not benefit from their treatment during the first pollen season, will become immune to various seasonal allergens if given further booster doses during the second year.

Investigations
Treatment is usually recommended when there is satisfactory proof of allergy. This can be obtained with standard tests (IgE, skin prick test, RAST) in the case of classic allergies like asthma, atopic eczema, hay fever and so on. Food or chemical allergies may require different tests (e.g. elimination diet & challenge, cellular test of type B food reactivities or "non-atopic" allergy). It is often essential to assess one's nutritional needs by means of mineral and vitamin tests, before supplements can be recommended.

Indications/Aims of EPD
EPD is used for any type of allergy (IgE/Type I or other sensitivities), including allergies to inhalants, food or chemicals, where simple measures of avoidance are impossible or extremely difficult. Conditions, which respond to desensitisation range from common allergies (asthma, eczema, rhinitis, hay fever, urticaria) to "masked" allergies, when an allergic mechanism is suspected (chronic fatigue, arthritis, colitis or Crohn's disease, digestive problems, recurrent infections, irritable bowel, migraine, mood changes, paediatric and weight problems).
Other objectives include:
a. To improve diet and allow a limited or normal contact with common allergens.
b. To phase out or discontinue various medications, when free of symptoms.
c. The prevention of symptoms arising from newly acquired allergies.

Preparation
As EPD is highly diluted, it is important to avoid overwhelming it by getting in contact with foods or inhalants it contains, at the time of the treatment. It is therefore recommended to reduce or avoid exposure to any items in the environment which might jeopardise the strength of the treatment e.g. diet with low-risk foods around injection time; avoid perfumes and pets if you are being desensitised against inhalants. Some patients are advised to use specific combinations of anti-fungals and antibiotics prior to the time of treatment in order to reduce fungal and bacterial activity in the intestine.

Administration
An injection of 0.05ml is given intra-dermally (very superficially into the skin) in a way to form a small blister. This method might cause a small local irritation; this ensures a slow absorption through the skin, minimising the risk of side-effects. This is the most frequently used approach.

Contra-indications
EPD is rarely used with children under 5 and never under 2 years; during the first three months of pregnancy (its use in pregnancy has not been studied); it is contra-indicated in peanut or bee sting allergy. EPD can be wasted if it is given; (i) in a variety of circumstances, known to inactivate it (ii) at the same time with certain drugs or micro-nutrients.

Side Effects
During the early stages of treatment, symptoms such as muzzy head, headache, tiredness, feeling low are not uncommon but last no more than a few days. Occasionally, there is a temporary aggravation of the same symptoms EPD is used for (i.e. congestion in rhinitis or wheezing in asthma). Most of these problems gradually clear and the treatments can be spaced out, when the patient is symptom free.

Cost of Treatment
The cost depends on the type of problem to be treated. Desensitisation for hay fever requires two injections in the first year and one or two annually thereafter, depending on one's response. In inhalant allergies or food intolerance, it will normally cost £180.00 - £360.00 p.a. Most insurance companies reimburse the costs of various investigations but not the treatment. Please check with your insurance before the start of your treatment.

Duration of Treatment
This varies from person to person. Most allergic conditions are long-term and persist in spite of receiving various other (conventional or unconventional) treatments and stem from a disorder of the immune system; they are not incurable, as many doctors and patients believe. With this background, their treatment is often complex and time consuming. EPD is usually given as a course treatment, 2-4 times a year, over a three-year period. After that, an effective way to determine the time of the next booster dose is to let the patient return if/when the symptoms recur. This is needed regularly with some, infrequently with others.

EPD & the Medical Profession
Generally, the medical profession remains sceptical about less known treatments, not adopted by hospital medicine or not widely publicised in the medical press. EPD has been subjected to rigorous trials (see references). Its methods require considerable time to learn and practice. Today, its availability remains limited to a small number of private allergy clinics, a few NHS hospital departments, specialising in allergy and some G.P.'s. A growing number of doctors refer patients for this type of desensitisation. Clinical/scientific research papers on EPD trials have been published in various medical journals, some of which appear below.

Medical References
Double-blind placebo-controlled trials of EPD
1. Fell P. & Brostoff J. (1988) A single dose desensitisation for summer hay-fever. Results of a double blind study. Eur.J of Clin. Pharmacology (1990) 38:77-79. single dose of placebo or EPD. Unlimited doses of intranasal steroid aerosol and antihistamine were allowed to "comfort". No difference of symptom scores but significantly less drug consumption in EPD group. No side-effects reported.

2. Austarita C. Scala G. et al. Effects of Enzyme Potentiated Desensitisation in the treatment of pollinosis. A double blind placebo-controlled trial. J of Invest Allergology & Clin Immunol. (1996) 6(4):248-255. Single dose EPD or placebo. Escape drug intranasal disodium cromoglycate. Side-effect: transient headache after 24 hours reported in 20% of subjects. Highly significant difference in symptom scores. CD8+ T-lymphocytes significantly increased in actively treated group after six months. Expected rise in total IgE during pollen season was significant in placebo group but not in actively treated group.

3. Longo G. Poli F. et al. Efficacia clinica di un nuovo trattamento iposensibilzzante, (Enzyme Potentiated Desensitisation) nella terapia della pollinosi. Riforma Med. (1992) 107:171-176. Single dose of EPD or placebo. Escape drug oral terfenadrine (antihistamine). Highly significant difference in symptom scores, in favour of EPD. No side effects.

4. Businco L. et al. Enzyme Potentiated Desensitisation in children with asthma & mite allergy: a double blind study. J Invest Allrgoi & Clin Immunology (1996) 6(4):270-276. Two doses of EPD or placebo given between September and December 8 weeks interval. Assessment in 3 month follow-up. Significant large reduction of days with asthma and days with drug consumption. Conjunctivial provocation test; 10-fold increased threshold in actively treated group. No side-effects.

5. Egger J. Stolla A. & McEwen L.M. Controlled trial of hypo-sensitisation in children with food-induced hyperkinetic syndrome. Lancet (1992) 339:1150-1153. Behaviour previously shown to be affected by multiple foods. Three doses of EPD or placebo at 8-10 week intervals. End-point: ability to eat previously harmful foods regularly in normal quantities without deterioration of behaviour. Significant differences were observed in the actively treated group. No side-effects (p<0.001).

6. Egger J. McEwen L.M. & Stolla A. Hyposensibilisierung bei narhungsmittelinduzierter Migrane. Aktuelle Neuropadiatrie (1992) 287-291. Previously established reactions to multiple specific foods. Three doses of EPD or placebo at 8-10 week intervals. End point: ability to resume a normal diet and remain free from attacks of migraine. Significant improvement in the EPD group. No side-effects (p<0.001).

7. McEwen L.M. A double blind controlled trial of Enzyme Potentiated Desensitisation for the treatment of ulcerative colitis. Clin Ecology (1987) 5:47-51. No attempt at diagnosis of allergy. Normal diet continued. Stratified randomisation to ensure equal distribution of subjects admitted to the trial during an exacerbation and of subjects on sulphasalazine. 5 doses of EPD or placebo were given single blind in 10 months. No differences were observed during the 10 month period. During the 16 month follow-up there was a significant reduction of "severe events" (Sigmoidoscopy grade 3, ptovyovolrvyomy and 5-day steroid regime) in the actively treated group.

Other references
1. McEwen L.M., Ganderton M.A., Wilson C.W.M., Black J.H.D. Hyaluronidase in the treatment of allergy. Brit.Med.J(1967)2:507-508.

2. McEwen L.M., Mary Nicholson, Kitchen I., Sheila Whiter. Enzyme Potentiated Hyposensitisation III: Control by sugars and diols of the immunological effects of beta-glucuronidase in mice and patients with hay-fever. Annals of Allergy(1973)31:543-550.

3. McEwen L.M., Enzyme Potentiated Hyposensitisation V:Annals of Allergy (1975)35:98-103.

4. Scadding G.K., Brostoff J. Low dose sub-lingual therapy in patients with allergic rhinitis due to house dust mite. Clin.Allergy(1986)16:483-491.

5. Anderson N.H., Jeppesen F., Schioler T. et al. (1987) Treatment of hay fever with sodium cromoglycate, hyposensitisation or a combination. Allergy 42:343-346.

6. Challacombe S.J., Brostoff J. Hyposensitisation iin Food Allergy & Intolerance. London: Balliere Tindall (1987) 983-984.

Other publications
1. The Guide to Food Allergy & Intolerance. Dr. J. Brostoff & Linda Gamilin (1988).

2. Allergy & Intolerance: A Complete Guide to Environmental Medicine. Drs. G. Llewith, J. Kenyon & D.Dowson:Green Print (1992)112-113.

3. Effective Allergy Practice. A Document on Standards of Care and Management for the Allergy Patient. Brit.Soc. of Allergy, Environmental & Nutritional Medicine (1994)7. Available from BSAENM P.O. Box 7 Knighton LD7 1WT and this practice.

4. 12 Ways You Can Beat Your Allergies. Readers' Digest (May 1995)51-54.

For "Frequently Asked Questions", visit epdallergy.com, a website set up by American patients treated with this method.

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