Frequency of the dose in antihomotoxic medications Arturo O'Byrne De V., Hospital de agudos Carlos G. Durand; CIMEB 26 October 2010 Dear Editor, The article published by Singer, et al. (1) leads us to consider the pivotal role of the proper frequency election when administering an antihomotoxic medication. As it has been postulated (2), homeopathic substances may act as immune response modulators eliciting a Treg differentiation and leading to an augmentation of cytokines with inflammation modulatory properties (TGF-B and in lesser extent IL-4 and IL-10) and diminishing the production of proinflammatory cytokines (like IL-1b and TNF-a)(3, 4). The scheme chosen for the selected study (2 tablets 5 times per day on the first 3 days and then 3 times per day) and the route (oral) might be used for moderate inflammatory states, but certainly is not the one to be prescribed when a much higher state of inflammation is present. Any surgical procedure (and orthopaedic surgeries are good examples) will exert such an inflammatory response that much more frequent doses should be administered. According to the proposed mechanism of action, giving it every 15 minutes for the first 2 hours, then every half hour for the next 2 hours, then every hour for the next 6 to 12 hours and then every 2 hours for the next 24 to 48 hours would be at least theoretically more acceptable for the standards of an adequate use of these type of medications. Additionally in such cases it is also advisable to combine several routes for the antihomotoxic medications, for example oral + injectable. In the postsurgical patient any physician with experience in antihomotoxic prescription would probably recommend 1 ampoule IV daily for the first 3 to 5 days. The direct injection on the site of the operation as performed during the author's pilot trial (5) is also a very good possibility. In order to conduct an objective evaluation of any therapeutic measure, it should be applied as it has been proven it works (either theoretically or empirically). According to that, the proposed adjustments to the frequency of the administration of an antihomotoxic inflammation modulator should be taken into account when considering any further clinical studies on this area. Yours sincerely, Dr. med. Arturo O'Byrne De V. Avenida Díaz Vélez 5044, Capital federal. Buenos Aires, Argentina 1st year resident - Internal medicine / Immunology Hospital de agudos Carlos G. Durand References: 1. Singer RS, Amit-Kohn M, Weiss S, et al. Traumeel S® for pain relief following hallux valgus surgery: a randomized controlled trial. BMC Clinical Pharmacology 2010, 10:9 doi:10.1186/1472-6904-10-9. 2. Heine H, Schmolz M. Immunoregulation via “Bystander Suppression” Needs Minute Amounts of Substances – a Basis for Homeopathic Therapy? Medical Hypotheses 2000; 54(3): 392-393. 2. Porozov, S., Cahalon, L., Weiser, M., Branski, D., Lider, O., Oberbaum, M. Inhibition of IL-1b and TNF-a Secretion from Resting and Activated Human Immunocytes by the Homeopathic Medication Traumeel S; Clinical & Developmental Immunology 2004; 11(2): 143-149. 3. Docrat A. The effect of an anti-inflammatory homeopathic product on cytokine status in venous blood following 90 minutes of downhill running. Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2008. Document last accesed on 13.X.2010 at the web page: http://researchspace.ukzn.ac.za/xmlui/handle/10413/1129 Competing interests The author has worked as homotoxicology and antihomotoxic medicine lecturer for Heel laboratories in several countries (Colombia, United States and Argentina) but does not hold any long term contract with this company.