Natural Sunflowers

Overcoming Lyme Disease Naturally

In regions across the United States, it no longer feels safe to work in the garden or walk in the woods. Many of these once benign outdoor places now host disease-ridden deer ticks, which are the main carriers of Lyme disease (LD), one of the fastest growing infectious diseases here and in Europe. For people who work and play outdoors, ticks have become our biggest enemy.

Unfortunately, many people who have been bitten by a LD-carrying tick have no clue they have ever been exposed. It is actually unusual for someone to know they have contracted Lyme disease early and get treatment right away. Due to tremendous confusion about the nature of this illness, the majority of cases go unreported. Hundreds of thousands of people have the typical symptoms without even knowing that they have LD—until long after it has spread throughout their bodies. Many more seek out medical help for chronic cases of LD only to find that medicine has little to offer. Often they are misdiagnosed or improperly treated. In many cases, their concerns are even dismissed. The illness can strike anyone, and has even afflicted people in the public eye, including Avril Lavigne, Ali Hilfiger, Richard Gere and George Bush.

That is why, if we value our health and spend time outdoors, we must familiarize ourselves with—and protect ourselves from—LD. With or without a visible bite, it’s urgent that people learn to identify LD’s characteristic symptoms so that they can begin treatment as soon as possible—and before the disease progresses.

According to the Centers for Disease Control (CDC), over 300,000 cases of LD are reported in the United States every year with many more remaining undiagnosed. Instant action is a necessity, because if left untreated, acute LD can morph into chronic LD. An acute case consists of symptoms that develop within days or weeks of a tick bite and may be more easily treated at the outset. A chronic case occurs when LD makes its way deep into our system and keeps recurring, possibly with periods of remission. However, both are misunderstood.

Customary approaches to LD often miss the mark. Conventional doctors view LD as an infection to stamp out with antibiotics, but, unless antibiotics are administered within 72 hours of a deer tick bite, they have a poor track record. Up to 20 percent of short-term antibiotic treatments for LD fail. There is a lack of recognition that LD triggers an autoimmune reaction in the body. What happens is that even if we’ve eradicated the infection, we are still left with a dysfunctional immune system continuing to cause symptoms.

Once LD progresses to the chronic stage, many conventional doctors administer heavy long-term doses of antibiotics. Yet these undermine our immune system. This mode of treatment may cause symptoms to abate, misleading people into thinking they are cured when they are not. Later, when they least expect it, the elusive or dormant LD spirochetes can all too easily reactivate themselves, producing a sudden relapse. By then, the immune system may be too weakened to fight off the next round of belligerent LD. Long-term antibiotics can actually suppress the immune system so that we are unable to defend ourselves against this persistent bug.

Although this one bug is one we really want to try to kill as quickly as possible, using antibiotics simultaneously harms our immune system, which is our best resource for defeating LD permanently.

Symptoms of Acute and Chronic Lyme

Signs and symptoms of early acute LD, which can occur three to 30 days after a tick bite, include fever; chills; pounding, throbbing headaches; persistent, noticeable fatigue; numbness and tingling; muscle and joint aches; swollen lymph nodes; and Erythema migrans (EM) rash or the “bull’s eye rash”.

According to the CDC, the EM rash occurs in approximately 70 to 80 percent of infected persons; it begins at the site of a tick bite and expands, reaching up to 12 inches or more across. Rarely itchy or painful, this rash sometimes clears as it enlarges, resulting in a target or “bull’s-eye.” However, other Lyme experts suggest that the EM rash occurs in less than 40 percent of people with LD; the lack of a rash does not eliminate the possibility of having LD.

Late-Stage, Chronic Lyme

If not treated early—or correctly—LD may become late-stage or chronic. Here, too, there is no definitive profile. Typically, patients with chronic LD report on average three of the symptoms listed below.

Signs and Symptoms of Chronic Lyme Disease

  • Severe headaches
  • Neck stiffness
  • Persistent fatigue and exhaustion
  • Additional “bull’s eye” rashes or other skin rashes around the body
  • Arthritis with severe joint pain and swelling, especially in the knees and other large joints
  • Facial or Bell’s palsy, including loss of muscle tone, or drooping on one or both sides of the face
  • Intermittent pain in tendons, muscles, joints and bones
  • “Wandering” pains from location to location
  • Irregular heartbeat (Lyme carditis) or heart palpitations
  • Dizziness or shortness of breath
  • Inflammation of the brain and spinal cord
  • Nerve pain
  • Shooting pains, numbness, tingling, or burning sensations in the hands or feet
  • Problems with short-term memory

Diagnostic Confusion LD can imitate, contribute to and often worsen many other serious illnesses. But because of inadequate medical understanding of both LD and these other conditions, the LD is often missed. And while treating LD may support recovery from these other conditions, the overlapping symptoms may lead to confusing LD with chronic fatigue, fibromyalgia, rheumatoid arthritis, multiple sclerosis, Parkinson’s disease and ALS.

To make matters worse, there is no good test for LD that can sort out the variety of symptoms and misdiagnoses to determine a definitive diagnosis. Current diagnostics miss up to 60 percent of true cases of LD. In fact, some physicians regard the current tests for LD as completely worthless as some of the antibodies it tests for are not LD-specific while some of the antibodies it does not test for are. LD researchers Drs. Raphael Stricker and Lorraine Johnson have referred to currently available tests for the Lyme spirochete as no more effective at making a determination than tossing a coin.

To find out if someone has been exposed to LD, it is advisable to work with a LD-literate doctor; that person must know how to properly evaluate symptoms and uses labs that specialize in LD testing. LD is actually diagnosed based on symptoms and not by a lab test alone. The lab test may help confirm exposure, but there is currently no test available that proves we have an active case. It is the combination of symptoms and tests that help us figure out if we have LD or another co-infection.

The good news is we don’t have to suffer and take months of antibiotics to get well. Our bodies have an amazing healing capacity; we just have to give it the right tools to do what nature intended. Think about LD as a complex medical illness that is the sum of multiple factors that undermine the immune system; to feel better, we need to address each of these factors that are the obstacles to cure.

Optimizing Immune System Function

Getting the immune system in better shape starts with a healthy diet and improving gut function. The gut accounts for 80 percent of immune function; if it doesn’t work well, then neither does the immune system. While there are many diets claiming to help various ailments, following an alkaline diet tends to give people with LD the best results. This means eating foods that help make our cells more alkaline. It has nothing to do with the acidity or alkalinity of the food itself, but rather what the food does to the body once eaten. For example, lemons are very acidic, but promote alkalinity in the body. So starting the day with a glass of lemon water is a great way to help move the body into a more alkaline state.

Gas, bloating, constipation, diarrhea, reflux or heartburn can be signs of an unhealthy gut. Working with a nutritionally oriented doctor can help heal the gut. Making changes to diet will help, but other herbs, nutrients and homeopathic remedies can help stop leaky gut and improve its function.

When LD is active, herbs can help control the load of microbe in the body. We don’t know for sure if we ever completely get rid of the LD bacteria, but we can certainly reduce the number of bugs that are causing symptoms. Although there are numerous herbal protocols, Dr. Zhang or a modified version of Dr. Cowden’s protocol seems to work the best for most people. The herbs help eradicate LD, while supporting the immune system and improving circulation to help bring nutrients and oxygen to the areas of the body that need it most.

Managing good lifestyle habits is important for getting well. Making sure to get enough quality sleep is essential for healing. It is also important to get as much exercise as can be tolerated because movement also helps with circulation. Gentle walking, yoga, tai chi or qigong are great forms of easy, slow movements that most people with LD can do on a regular basis without being wiped out. Lowering the body’s burden of chemicals, mold and other environmental factors can help. Use only non-toxic products in the home and on the body. Stop using toxic chemicals, herbicides and pesticides. Have the home checked for mold if there was ever water damage, or a leaky roof or basement. Mold toxicity looks and feels just like LD, so make sure the home environment is clean.

Sublingual immunotherapy and low dose immunotherapy have been effective at modulating the immune system and helping control allergies and autoimmune reactions.

LD can be challenging to overcome but it can be conquered. Finding a LD-literate doctor who can help support you in your process is important. Making some of these changes can be difficult, but the results will make it all worth it.

Dropper for Sublingual Immunotherapy

Sublingual Immunotherapy

Your immune system is a complex connection tasked with the responsibility of fighting infection and handling possible threats to the health and safety of the human body. It is a complex network that develops strengths, weaknesses, and specific reactions to chemical compounds and microorganisms.  An immune system can target and identify these substances or microorganisms and coordinate an effective response. This response is often a way to protect the body from the potential effects or side-effects from the substance or microorganism.

Sometimes, the immune system can get confused, as it works to identify different substances, and might actually create something called an allergy.

An allergy is the response of an immune system to a particular substance that the immune system considers dangerous and the resulting response can be something as simple as a little itchiness, to full on anaphylactic shock. However, some reactions are more subtle and mild, but can sometimes worsen over time. These immune system reactions are called allergic reactions and can be severe, even causing serious health issues or becoming life-threatening. The difficult part about allergens is that they could be common household substances that you are exposed to on a daily basis and aren't aware of. It could include pet hair, dust, molds, pollen, cleaners, foods and even plants.

Fortunately, most allergic reactions to substances are minor. Some more serious reactions can lead to death if not treated immediately. There are possible methods to reducing the severity of an allergic reaction. Immunotherapy is the concept that is built around this idea. Traditional immunotherapy uses injections to expose the body to a small amount of the allergen and the immune system can pick up on the tiny amount, but does not react strongly because the amount of the allergen is so small. Injections can be expensive, time consuming, and traumatic for someone who is fearful of them. So, there is an alternate type of immunotherapy that does not require sharp needles: sublingual immunotherapy.

Sublingual immunotherapy uses drops that contain a small amount of the allergen and works in the same exact way that allergy shots work. These liquid drops or pellets are placed under the tongue and are absorbed into the body. The absorption is immediate and bypasses digestion, making it very effective.

This kind of treatment has many benefits over traditional immunotherapy.

1.       It is less painful
Sublingual immunotherapy does not require the use of needles, reducing the sensation of pain from the injection. And for patients who have a fear of needles, it lessens the anxiety and fear that come from using them.

2.       It’s cost effective
Under the careful guidance of your practitioner, sublingual immunotherapy can cost less. Injections require a trained person to administer them, usually in a hospital or medical facility. This requires you to travel. Taking drops under your tongue does not require the same level of travel, nor does it require the presence of a trained professional. In some cases, your practitioner will suggest a personalized or tailored version of the drops. For instance, if you are allergic to your pet’s hair dander, the droplets might contain the hair from your pet instead of a generic version.

3.       Liquid and pellets are available
Sublingual administration of immunotherapy can also be through pellets. One such example of using tablets to treat allergies was published in the Journal of the American Medical Association on April, 2016. The study, titled Efficacy of a House Dust Mite Sublingual Allergen Immunotherapy Tablet in Adults With Allergic Asthma, focused on reducing the impacts of an allergic reaction to house dust mite through sublingual immunotherapy. The study authors found that the treatment improves the allergy to house dust mite, further research is needed for safety and efficacy.

The positive benefit to treating allergies is that there are proactive ways to improving our immune systems. Immunotherapy is one of them. The idea of small exposures to allergens can be a little alarming, but with cautious planning and careful monitoring, allergies will improve over time. We have ben using this therapy in our office for 17 years and find it to be a safe, effective way of managing allergies.

Field with flowers

Lyme Disease on the Rise

As the weather gets warmer, we enjoy more time outdoors. With warm weather comes more exposure to tick bites, which can lead to Lyme Disease. Lyme disease is a bacterial infection of Borrellia burgdorferi, a spirochete bacterium that can take many shapes once it infects humans.

The typical sign from a tick bite would be a " bulls eye" rash accompanied with fever and pain. However, this really isn’t the best indicator to prove that you have been bitten by a tick. In fact, most people may not have any visible symptoms at all. This is why Lyme disease can be so difficult to diagnose and treat.

Lyme disease is very complex. It can be categorized as an acute illness to some, but a long term, chronic, debilitating illness for many others. In addition to Lyme disease, these ticks can also transmit other co-infections. These organisms known as Anaplasma, Bartonella, Babesia, Mycoplasma, Rickettsia and Ehrlichia, are often worse than Lyme disease itself and can cause long-term autoimmune disorders if left untreated.
Symptoms of Lyme include:

Joint pain
Extreme chronic fatigue
Autoimmune disorders such as Multiple sclerosis
Neurological disorders such as Alzheimer's disease
Brain fog or cognitive impairment
Gastrointestinal issues
Food allergies/ sensitivities
Chemical sensitivities

One reason why Lyme is on the rise may be due to climate change. Unusually warm temperatures don't allow ticks to die off in cold winter months. Another reason may be because of an overpopulation of certain infected hosts that are rapidly spreading the bacteria that causes Lyme to other insects and animals. In the past 30 years or so, it is believed that Lyme carrying hosts have become much more aggressive and stronger. This just makes things so much more complicated.

Seeking treatment immediately is extremely important and crucial to the recovery process. Lyme disease can be treated and you can recover fully from it. It's also important to address immune disruptors, as well.
Lyme can be treated with many useful therapies such as:

Antibiotic therapy - short term
Herbal antimicrobials
Nutritional Supplements for immune boosting
IV therapy
Low dose immunotherapy
Diet and lifestyle

I want to stress the importance of diet and lifestyle. Following an alkaline diet is key. Microbes do not like to live in alkaline environments, therefore it's very beneficial to focus on eating foods that are alkalizing. This helps tremendously in recovering from Lyme and co-infections. I find my patients do very well with individualized food plans, based on their specific cases. I incorporate stress reduction programs into treatment plans, as well. Getting proper sleep is critical to recovery, as Lyme disease tends to disrupt the sleep cycle and interferes with the time our bodies need to heal.
After all, it is these lifestyle adjustments that will only encourage beneficial, long-term habits.

Woman blowing dandelion seeds

Why Your Allergies May Be Worse Than Ever

With allergy season in full swing it's important to stay healthy. You not only want to survive, but thrive throughout these challenging months.

Seasonal allergies affect millions of people. Symptoms can range from itchy watery eyes, runny nose, sneezing, skin rashes, itchy throat, wheezing, congestion and headaches.
Theses symptoms are your body's way of telling you something is wrong. They are a reaction to foreign substances, such as pollen, dust or mold. These reactions cause your body to produce antibodies known as immunoglobulin E or IgE.

You may remember a time when allergy season was not as severe as it is today. And that is actually true. Here are a few reasons why…

An increase in processed foods
The use of GMOs, preservatives, the hybridization of grains, additives, pesticides and antibiotics in foods we consume has affected our beneficial flora in our guts and immune systems. This weakens our immune systems thus creating a recipe for food allergies, dysbiosis, chemical sensitivities, and autoimmune disorders. To top it off,  it makes us much more susceptible to developing environmental allergies, as well.

Climate change
Rising temperatures and pollution make for a horrible allergy season. Because of this, the season starts earlier and ends later and is also a lot more intense. Increased pollen = increased allergies.

Antibiotics, antibacterials and poor diet destroy beneficial flora in your microbiome.
The amount of time it takes to restore bacteria becomes slower and slower, causing dysbiosis and a plethora of other immune issues.

What to do
You can lessen the severity or even eliminate allergies altogether with a few steps.

Address food allergies first and consider a cleanse or elimination diet. You may not realize but hidden food allergies and sensitivities make you much more responsive to other allergens. I have had many patients who have eliminated certain foods from their diets only to find out that they no longer have seasonal allergies because they no longer eat gluten, dairy, soy or whatever the offending food may have been.

Limit your exposure
If you exercise outdoors, try doing so in late afternoon or evening, as pollen is at its lowest at these times. Maybe even keep that workout indoors, if you really have to.

Remove shoes and clothes and shower immediately when coming into the house from playing outside or gardening. This prevents the spread of allergens from traveling around your entire home.

For indoor allergies, use air conditioning, especially on really bad days. This will help keep the mold count down in your indoor space.

Better indoor air quality means less allergy attacks. Keep your home or office clean by using a dehumidifier and/or a HEPA filter air purifier.

Avoid rugs as they trap allergens and all sorts of things in the fibers. If you can't avoid them, at the very least, vacuum and keep them very clean.

Supplementing with herbs and vitamins will help tremendously.
Vitamin C, Quercetin, Nettles, Butterbur, Bromelain, Homeopathic remedies, Probiotics, Omega 3 fatty acids, and Sublingual Immunotherapy are all extremely helpful in the fight against allergies.

These nutrients not only help to combat the symptoms but also aid in reducing inflammation and boosting the immune system. Unlike antihistamines, they do not cause drowsiness and fatigue.
Of course, as with any supplement or therapy, consult your healthcare practitioner before beginning any treatment.

Woman reading book

Dr. Ingels Chapter from "Cutting Edge Therapies for Autism 2011-2012"

Allergy Desensitization: An Effective Alternative Treatment for Autism

By Darin Ingels, ND

Allergies and asthma affect more than 50 million people living in the United States and comprise the sixth leading cause of physician office visits. Children with autism often have impaired immune function and may be predisposed to allergy symptoms.[i],[ii] Studies also show that children with autism have multiple defects in immune function and that the severity of immune dysfunction is proportional to the severity of autism.[iii] Unfortunately, allergies are often underdiagnosed and undertreated due to lack of verbal skills of the child or the lack of understanding by parents of what symptoms may be caused by allergy. The immune system produces five different antibodies (also known as immunoglobulins) in response to substances that are recognized as being foreign (e.g., bacteria, viruses, allergens, etc.). Immunologists refer to them as IgG, IgM, IgA, IgD and IgE. Each immunoglobulin serves a primary role in our normal immune function, and IgE is the one most associated with allergies. Common symptoms of allergy, including runny nose, itchy eyes, sneezing, and asthma, are often precipitated by IgE, which triggers the cascade of events leading to allergic symptoms. However, there is good evidence that many allergic reactions do not involve IgE at all and can be mediated by different immune mechanisms. Non-IgE reactions have been identified as causing neuropsychiatric symptoms such as irritability, hyperactivity, mood disorders, or cognitive deficits; gastrointestinal or motility problems; skin rashes; and sleep disturbances.[iv] Conventional allergy testing specifically looks mostly at IgE reactions (whether by blood test, intradermal, or scratch testing), so it is not uncommon for a child with autism to get allergy testing and be told they do not have any allergies. However, IgE testing excludes most non-IgE reactions and, therefore, has limited value in diagnosing these types of allergies.

Treatment of allergies usually consists of over-the-counter or prescription oral antihistamines (e.g., Benadryl®, Zyrtec®, or Claritin®), leukotriene inhibitors (Singulair®), or steroids. Nasal and inhaled steroids may also be prescribed to prevent inhaled allergy reactions. While medications may be used to suppress symptoms, they do not treat the underlying cause of allergies. Subcutaneous immunotherapy (SCIT), commonly referred to as “allergy shots” may be used to help desensitize the immune system to specific allergens, such as pollen, mold, or house dust mites. It is rarely used in the United States to treat food allergy due to its risk of triggering life-threatening (anaphylactic) reactions. However, children with autism who suffer from allergies and asthma now have a viable alternative to conventional injection immunotherapy in treating their symptoms. Although injection immunotherapy has been the gold standard for allergy desensitization for almost 100 years, over 300 published studies show that sublingual immunotherapy (SLIT) is equally or more effective than allergy shots in reducing allergy and asthma symptoms.[v],[vi],[vii],[viii] The allergy extracts used in SLIT are identical to those used in injection immunotherapy, but rather than receiving a shot on a weekly or monthly basis, oral drops are administered under the tongue, often on a daily basis.

Recent research shows that during SLIT, the allergen is absorbed into the oral mucosa. The underlying dendritic cells, which are part of the immune system, produce a series of chemicals that ultimately result in a decrease in IgE and other molecules that produce allergy symptoms as well as decreasing inflammation in target tissues.[ix],[x] This mechanism of action is similar to that observed in conventional immunotherapy.

Although SLIT seems relatively new in the United States, it has been used clinically for more than three decades. Its use has increased steadily in the past 15 years but mostly in other countries, especially those in Europe. There are many advantages to SLIT over injection immunotherapy. SLIT may be used in children who are not eligible to receive conventional allergy injections or who may have sensory issues that would prohibit using injections. There are no reports of SLIT causing anaphylaxis, making it a safer alternative to injections. SLIT is more convenient than injection immunotherapy, since the drops are administered at home by the parent, meaning fewer office visits and no needles. There are no significant medical disadvantages of SLIT treatment; however, many insurance companies in the United States do not reimburse for SLIT, which may be financially limiting for some individuals.

The practical application and successful use of SLIT is dependent on accurate assessment of a child’s allergies and sensitivities. Since conventional allergy tests only pick up on the serious types of allergic reactions, other assessment tools may be helpful in identifying more subtle allergic triggers. Environmental medicine physicians have specialized training in some of these alternative methods. Provocation/neutralization is a technique where a small amount of a food substance is injected just under the skin. If a child is allergic or sensitive to the food, then an area of redness will appear on the skin and the child may start to exhibit physical signs of reaction, including red ears, irritability, screaming, head banging, etc. When the neutralizing dose is subsequently injected, the area of redness goes away and the physical symptoms stop. It can be a very powerful tool for the parent to observe how specific foods affect their child. A similar technique is used to test for inhalant allergies, such as mold, pollen, or dust mites.

However, testing most children with autism with a needle technique is difficult and time consuming. Other noninvasive methods may be more suitable for these children. Electrodermal screening (EDS) is an effective method of determining a child’s sensitivities. Although there has been little research comparing EDS to conventional allergy testing, many practitioners have found it to be an invaluable tool in identifying hidden sensitivities. EDS is a noninvasive technology that allows the practitioner to measure energy patterns in the body. Dr. Alfred Gilman and Dr. Martin Rodbell won the Nobel Prize in Physiology and Medicine in 1994 by discovering that cells communicate electrically before they communicate chemically. This means we have a way of measuring how the energy of different allergens affects the energy of our own bodies.

EDS has the capacity to assess for sensitivities to foods, molds, pollen, animal dander, and even more subtle triggers, such as chemicals, hormones, and neurotransmitters. While conventional allergy testing looks specifically at IgE or IgG antibodies, EDS looks at the broader scope of immune reactions, particularly delayed reactions. It is not uncommon for a child with autism to go through allergy testing and be told that they do not have any allergies. Since the term “allergy” has a strict definition of IgE reaction, this may very well be true. However, this does not necessarily mean that the child does not react to various allergens. EDS is an effective means to measure delayed or subtle sensitivities that are often missed through conventional allergy testing.

The author of this article and other physicians has successfully treated thousands of children with autism with SLIT and has not observed any significant side effects or severe reactions to the treatment. Some children do get hyperactive or agitated during their initial course of treatment, but this usually resolves after a couple of weeks. Sometimes the dose has to be adjusted down for very sensitive children. Although injection immunotherapy can take a year or longer to begin controlling allergies or asthma, SLIT will often diminish symptoms within weeks. The combination of EDS and SLIT has enabled our practice to successfully treat children with autism for their various allergies and sensitivities. SLIT is a safe, effective treatment that should be considered as a first line therapy for the treatment of allergies and asthma in children with autism.

[i] Heuer L, Ashwood P, Schauer J, et al. Reduced levels of immunoglobulin in children with autism correlates with behavioral symptoms. Autism Res. 2008 Oct;1(5):275-83.

[ii] Careaga M, Van de Water J, Ashwood P. Immune dysfunction in autism: a pathway to treatment. Neurotherapeutics. 2010 Jul;7(3):283-92.

[iii] Trottier G, Srivastava L, Walker CD. Etiology of infantile autism: a review of recent advances in genetic and neurobiological research. J Psychiatry Neurosci. 1999;24(2):103-15.

[iv] Jyonouchi H. Autism spectrum disorders and allergy: observation from a pediatric allergy/immunology clinic. Expert Rev Clin Immunol. 2010 May;6(3):397-411.

[v] Incorvaia C, Masieri S, Berto P, et al. Specific immunotherapy by the sublingual route for respiratory allergy. Allergy Asthma Clin Immunol. 2010 Nov 9;6(1):29.

[vi] Frati F, Scurati S, Puccinelli P, et al. Development of a sublingual allergy vaccine for grass pollinosis. Drug Des Devel Ther. 2010 Jul 21;4:99-105.

[vii] Scala G, Di Rienzo Businco A, Ciccarelli A, Tripodi S. An evidence based overview of sublingual immunotherapy in children. Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4 Suppl):23-6.

[viii] Pham-Thi N, de Blic J, Scheinmann P. Sublingual immunotherapy in the treatment of children. Allergy. 2006;61 Suppl 81:7-10.

[ix] Akdis CA, Barlan IB, Bahceciler N, Akdis M. Immunological mechanisms of sublingual immunotherapy. Allergy. 2006;61 Suppl 81:11-4.

[x] O'Hehir RE, Sandrini A, Anderson GP, Rolland JM. Sublingual allergen immunotherapy: immunological mechanisms and prospects for refined vaccine preparation. Curr Med Chem. 2007;14(21):2235-44.