Biological Treatments for Autism and PDD Online > Chapter 5: Part I | Part II
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Therapies
Gamma globulin therapy.
Dr. Gupta has used intravenous immunoglobulin (IVIG) successfully to treat a small number of autistic children (20). IVIG therapy is also called gamma globulin therapy. This product of human plasma has been used to treat immunodeficiency since 1952. Gamma globulin is purified from human blood components and then treated to remove harmful germs such as the HIV virus. Varying degrees of improvement after this therapy reported by Gupta included improved eye contact, calmer and improved social behavior, reduced echolalia, and improved speech in terms of better articulation and improved vocabulary. Speech improvement took the longest time to improve. Several patients regressed when the infusions stopped and then improved again when they were restarted. One child had a nearly complete reversal of the autism after about a year of therapy.
What is the mechanism of this improvement? No one knows for sure. I suspect that the immune system has a better ability to fight yeast and that the reduction of yeast byproducts allows the brain and the body to function better. It may have the effect of suppressing the production of antibodies against myelin, the covering of the nerve fibers in the brain. Elevated levels of this antibody have been reported in this illness. It may be that a specific component of the gamma globulin is responsible for the effects.
Intravenous IgG is usually given once a month due to the 28 day half-life of IgG. After administration of IgG, a child with low IgG values may have values in the normal range. An intravenous infusion takes about 2 hours. A sedative may be given the child to keep the child from being frightened during the procedure.
There are occasional mild and self-limiting reactions to IVIG including fever, muscle aches and pains, headache, nausea and vomiting, dizziness, and tachycardia that occur in less than 5% of all cases. The gamma globulin is derived from human blood so there is also a risk that unknown viruses might be present in the gamma globulin. The gamma globulin is checked for any known viruses such as HIV and hepatitis. Rarely, there are severe allergic reactions (less than 0.1%). This is a very expensive therapy that may cost as much as $1500-$2500 per month.
Insurance coverage for immune therapies.
Because immunological therapy for the treatment of autism is considered experimental, most insurance companies and HMO's will not cover these (substantial) medical expenses. Since virtually every company will cover expenses due to immune deficiencies, it is essential that the physician document the fact that the child has a significant immune deficiency. Because some insurance companies may not even cover the laboratory tests for the diagnosis of immunodeficiency, the wisest course is to contact a clinical immunologist.
Clinical immunologists are often physicians who are working part-time in the treatment of patients and part-time in research activities as well in a large medical center or medical school. These physicians may be of assistance in getting insurance coverage for therapies, which are based on an immune deficiency diagnosis-such therapies might not be covered with an autism or PDD diagnosis.
When medical plans and HMOs are reluctant to provide even testing, it may be necessary to begin a letter writing campaign, which includes scientific books (such as this one) and articles (referenced herein). If education does not help, it is sometimes necessary to bring in letters from an attorney, to show that you are very serious about pursuing testing and treatment. You may want to consider contacting the news media about your dilemma.
Cimetidine.
Cimetidine (Tagamet) is a drug that is primarily used to treat ulcers and is now available as an over the counter (nonprescription) drug. In a review article on candidiasis, Dupont (51) states that this drug is relatively safe and well-tolerated and recommends that this drug should be used more frequently to treat patients with Candidiasis who do not respond adequately to antifungal drugs. Cimetidine has been used at a dose of 30 mg/kg body weight/day to stimulate in the immune system in patients with chronic mucocutaneous Candidiasis (52,53). This drug stimulates the white blood cells to kill the Candida. Cimetidine may reduce the rate of metabolism of many other drugs such as the antifungal drugs that are absorbed into the bloodstream as well as antidepressant drugs and antiseizure drugs. Combining zinc supplementation with cimetidine has proven to be very successful in the treatment of recurrent infections in patients with immune deficiency (Int J Clin Lab Research 27:79-80,1997.) Check with your physician and pharmacist before using this drug about an appropriate pediatric dose and about any drug interactions that might be associated with the use of this drug.
Transfer factor therapy.
Transfer factors are molecules that may contain both protein and nucleic acids (54) produced by the white blood cells. These molecules can transfer immunity from a healthy donor to a recipient who has impaired immune function. Dr. Masi found that severe Candidiasis could be effectively treated by Candida-specific transfer factor (55). Recent studies show that transfer factor can be given orally; this was a surprising result, since many proteins are destroyed by digestive enzymes when taken orally (56). Dr. Hugh Fudenberg, a clinical immunologist from the Neuroimmuno-Therapeutics Foundation, found that 21 of 22 autistic children treated with transfer factor from parental cells responded favorably to transfer factor therapy. Ten improved enough to be mainstreamed into regular school classrooms. (26). Dr. Fudenberg believes that a live virus from one of the vaccines or an adverse reaction between the antibodies obtained from the mother and the vaccine are responsible for the impairment of the immune system in autism. (Dr. Fudenberg can be reached at the Neuroimmuno-Therapeutics Foundation, 1092 Boiling Springs Rd, Spartanburg, SC 29303.)
Pentoxifylline.
Pentoxifylline is a drug that is a purine derivative and is an inhibitor of an enzyme called phosphodiesterase. Purines are one of the components of DNA, the genetic material for most living creatures. Pentoxifylline was given to a child with autism in Japan to treat suspected brain damage from an accident (57,58). After this treatment, the boy showed marked improvement of his autistic symptoms. When 23 children with autism were treated with pentoxifylline (150-600 mg/day), the drug was reported to be remarkably effective in 10 of the children with some of the group no longer considered to be autistic. The drug was also very effective in treating seizures. Side effects included nausea, vomiting, low blood pressure, and headache. Since the primary use of this drug is to improve blood circulation, you may find it difficult for a physician to prescribe it to treat autism.
IL-2
Interleukin-2(IL-2) is a protein called a cytokine that stimulates the proliferation and activation of T cells, B cells, granular lymphocytes, and macrophages. When T-helper cells are stimulated by antigens from the Candida, white blood cells called T-helper cells produce IL-2 and activate other resting T-cells. IL-2 also stimulates natural killer cells to produce gamma interferon, granulocyte macrophage stimulating factor and other factors that help to fight Candida. Gupta's work shows that natural killer cells are deficient in children with autism. Although IL-2 is toxic at high doses, low doses of IL-2 are relatively safe. The use of low doses for several weeks would result in selective expansion of natural killer cells that will kill yeast(51). IL-2 is available as a pharmaceutical agent prepared using recombinant DNA. Most family doctors or pediatricians will probably be reluctant to use this product but a clinical immunologist might be willing to discuss the possible use of low dose IL-2 therapy.
Allergic phenomena, food sensitivity, and altered behavior
A number of reports and books have documented the fact that allergiesto foods, molds, and other allergens or direct toxic effects of certain foods can markedly alter behavior and that removal of such foods or desensitization can restore normal behavior (59-71). Doris Rapp M.D. has written several books including Is This Your Child (59) in which she documents behavioral disorders in children caused by allergic reactions. She also has several videotapes available that dramatically demonstrate bizarre behavior after the introduction of an extract of an allergenic substance. This book or Solving the Puzzle of Your Hard-To-Raise Child. by William Crook M.D. (72) give many details on how to identify and eliminate food allergies and sensitivities. Dr. Jaeckle, a physician trained as both a psychiatrist and allergist in Austin, Texas has recorded on videotape severe psychotic reactions following mold exposure (73) and indicates that many cases of schizophrenia may have a significant yeast involvement. The Feingold Association, started by the late allergist Ben Feingold M.D., can provide a list of foods that commonly cause hyperactivity, which is a common problem in autism and PDD.
Tests of allergies.
There are numerous allergy tests that are available including those that introduce the allergenic substance into the skin (prick test) as well as many other tests that are done on blood. Many laboratories perform the blood tests for IgE antibodies against specific allergens and IgG antibodies against specific allergens. These tests should not be confused with tests of total IgG and total IgE that were done to assess a possible immune deficiency; they are completely different tests and give completely different information. Thus, an individual could be deficient in total IgG and yet still have high levels of IgG against a specific food.
Another kind of test called the ELISA-ACT test assesses food allergies by measuring the toxic effects of both antigen-antibody reactions and cell-mediated toxic reactions. This latter test is somewhat more comprehensive and may also be able to assess sensitivity to heavy metals, environmental chemicals, and food additives, which may be important but are not involved directly with the immune system. The Serammune test can evaluate over 300 different foods and chemicals but the cost is over $1000. The allergy tests offered by The Great Plains laboratory are only a fraction of this amount.
To get the tests mentioned:
IgGfood allergy test.
Available from The Great Plains Laboratory,
Inc.
Email: GPL4U@aol.com
ELISA ACT TEST.
Serammune Physicians Lab
1890 Preston White Dr.ive, Second Floor
Preston, VA 22091
(703) 758-0610 or (800) 553-5472
IgEallergy test.
The Great Plains Laboratory also performs the IgE allergy test. I recommend IgE allergy testing for inhalants like dust, mold, mildew, and pollen, and the IgG allergy test for foods. I have noticed that many people with autism may have completely normal results for foods in the IgE allergy tests but very abnormal results for foods in the IgG allergy tests. These tests should not be confused with tests of total IgG and total IgE that were done to assess a possible immune deficiency; they are completely different tests and give completely different information. The Great Plains Laboratory can provide testing to anyone in the world.
Immunotherapy with enzyme-potentiated desensitization (EPD)
In autism and PDD, allergies to foods, molds, pollen and other materials may lead to behavioral disturbances in addition to the usual allergic phenomena such as sneezing, asthma, and skin rashes.
EPD is a method of immunotherapy developed by Dr. Leonard McEwen (74-78). The method involves desensitization with a combination of very low dose mixed allergens with the enzyme, beta-glucuronidase. The beta-glucuronidase increases the immunizing effects of the allergens and acts directly on T-suppressor cells, apparently inducing a longer lasting desensitization than does any type of previously known immunotherapy, and necessitates injections only be given every 2 to 3 months at first, and then decreasing over time. The frequency of injections varies with the condition being treated and patient response, but once maintenance is reached, average patients seem to require treatment 2 to 3 times yearly. Furthermore, it has been the experience of McEwen that at least 50% of patients can discontinue EPD after between 8 and 20 injections. Patients have remained in remission without immunotherapy for over 20 years. EPD also appears useful in the treatment of a large variety of conditions not previously considered responsive to immunotherapy of any kind (78).
Numerous parents of children with autism and other behavioral disorders (see chapter by Pamela Scott) have reported beneficial results with this therapy. They also report that their children often don't do as well when the effects of the EPD begin to wear off just before the next series of EPD injections. As with every therapy, some children respond much more dramatically than others.
Homeopathy.
Homeopathy is a technique employed by both physicians and non-physicians called homeopaths. The theoretical basis of this technique is unknown but those who use this technique prepare dilutions of substances to which a person is sensitive and the person takes these dilutions by mouth and becomes desensitized in a way that is not completely understood. It appears that the small amount of a harmful substance is able to mobilize the body's own defenses against the substance. Although not generally approved of by mainstream medicine in this country, many alternative medicine physicians may use this technique in their medical practices. This technique is also recognized as valid by the World Health Organization and is part of mainstream medicine in France. When trying any new therapy, the best approach is to talk to the physician and with other people who have employed a particular therapy and find out how helpful the particular medical practitioner was. One physician who employs homeopathy reported that homeopathic dilutions of arabinose, the sugar derived from Candida, favorably improved behavior of children with autism but that the response only lasted a few days. Homeopathic treatment also appears to be more effective than antibiotic therapy (79) for the treatment of earaches (otitis media).
References