We treat some of the most challenging immune-mediated conditions. These pages are here to help you understand your diagnosis, know what to expect, and find support.
Conditions We Treat
Select your condition to learn more
Each page covers what the condition is, common symptoms, how we treat it at Veros, and trusted resources.
Immunology
Common Variable Immunodeficiency (CVID)
Your immune system doesn't produce enough antibodies to fight infections. IVIG therapy replaces what's missing.
Frequent infectionsFatigueIVIG/SCIG
Immune Dysregulation
Post-COVID Syndrome (Long COVID)
Persistent symptoms months after COVID infection, driven by immune dysregulation, autoimmunity, and inflammation.
Brain fogFatiguePOTS
Mast Cell
Mast Cell Activation Syndrome (MCAS)
Overly reactive mast cells release chemical mediators causing multi-system symptoms triggered by everyday stimuli.
FlushingAnaphylaxisGI symptoms
Connective Tissue
Hypermobile Ehlers-Danlos Syndrome (hEDS)
A collagen disorder causing joint hypermobility, chronic pain, and systemic effects. Frequently overlaps with MCAS and POTS.
Joint painHypermobilityFatigue
Rare Disease
Hereditary Angioedema (HAE)
A rare genetic condition causing sudden, severe swelling episodes. Life-threatening without proper on-demand therapy.
Swelling attacksAbdominal painThroat swelling
Gut Immune
Small Intestinal Bacterial Overgrowth (SIBO)
Bacterial overgrowth in the small intestine driving inflammation, MCAS flares, and systemic symptoms. Frequently misdiagnosed as IBS.
BloatingBrain fogIBS overlap
Allergy
Environmental & Seasonal Allergies
IgE-mediated reactions to pollen, dust mites, pet dander, and mold causing rhinitis, sinus symptoms, and allergic asthma.
SneezingCongestionAsthma
Pulmonary / Immune
Asthma
Immune-driven airway inflammation causing wheezing, coughing, and shortness of breath. Often overlaps with allergies and MCAS.
WheezingShortness of breathBiologics
Treatments & Therapies
Learn about your treatment
Whether you're starting IVIG, considering allergy shots, or exploring LDN — these pages explain what to expect, how to prepare, and how long it takes to work.
Infusion Therapy
Intravenous Immunoglobulin (IVIG)
Replaces missing antibodies or modulates an overactive immune response. Infused in our center every 3–4 weeks.
CVIDLong COVIDAutoimmune
Subcutaneous Therapy
Subcutaneous Immunoglobulin (SCIG)
Flexible at-home immunoglobulin therapy. Smaller doses given weekly under the skin — many patients self-administer.
At-homeCVIDFlexible
Immunotherapy
Allergy Immunotherapy
The only treatment that changes how your immune system responds to allergens — not just masking symptoms. Allergy shots and sublingual options.
AllergiesAsthmaMCAS
Immune-Modulating
Low-Dose Naltrexone (LDN)
A well-tolerated immune-modulating therapy for chronic pain, MCAS, Long COVID, ME/CFS, hEDS, and inflammatory conditions.
Chronic painMCASNeuroinflammation
Cellular Health
NAD+ Therapy
Oral or IV support for cellular energy production, healthy aging, and recovery — alongside your immune care plan.
EnergyBrain fogHealthy aging
Environmental & Seasonal Allergies
Allergic rhinitis, allergic asthma, and environmental triggers
The Immune Connection: Allergic rhinitis and allergic asthma are IgE-mediated immune reactions — your immune system misidentifies harmless environmental proteins as threats. At Veros, we test to find your exact triggers and offer immunotherapy, the only treatment that retrains the immune response rather than just masking symptoms.
What are environmental allergies?
Allergic rhinitis (hay fever) and allergic asthma occur when the immune system produces IgE antibodies against airborne allergens — tree, grass, and weed pollen, dust mites, pet dander, mold, and cockroach allergen. On re-exposure, IgE triggers mast cells in the nose, sinuses, and airways to release histamine and other mediators, causing inflammation.
Symptoms may be seasonal (pollen-driven) or perennial (dust mite, pet, or mold-driven) — many patients have both.
Common Symptoms
Sneezing, runny or stuffy nose
Itchy, watery, or red eyes
Itchy throat, ears, or roof of mouth
Postnasal drip and chronic cough
Wheezing or shortness of breath (asthma overlap)
Sinus pressure, congestion, or headaches
Poor sleep due to nasal congestion
Fatigue from chronic low-grade inflammation
How We Treat It at Veros Health
Allergy Testing
Skin prick testing (fastest, most sensitive) or specific IgE blood testing (ImmunoCAP) to identify your exact environmental triggers.
Intranasal steroids, antihistamines (Zyrtec, Allegra, Xyzal, Claritin), and leukotriene inhibitors (montelukast) for symptom control.
Allergy Immunotherapy
Allergy shots (SCIT) or sublingual drops (SLIT) — the only treatment that changes how your immune system responds to allergens. See our full immunotherapy page.
Biologics for Allergic Asthma
Omalizumab (Xolair) and Dupilumab (Dupixent) for moderate-to-severe allergic asthma or chronic hives. Your allergist will review eligibility and coverage.
MCAS Overlap Evaluation
When symptoms don't fit a clean allergic pattern, we evaluate for mast cell activation syndrome alongside standard allergy testing.
⚠ When to seek urgent care: Frequent rescue inhaler use, shortness of breath at rest, or a peak flow well below your personal baseline can signal a serious asthma flare — contact your Veros provider or seek urgent care.
Immune-driven airway inflammation — understood and managed at Veros Health
The Immune Connection: Asthma is driven by immune system overreaction: allergens, irritants, and infections trigger IgE antibodies, mast cells, and eosinophils to inflame and tighten the airways. At Veros, we treat the underlying immune dysfunction — not just the symptoms — to bring lasting control.
What is asthma?
Asthma is a chronic condition that causes the airways in the lungs to become inflamed, swollen, and narrow. This makes it harder for air to move in and out, leading to wheezing, coughing, and shortness of breath. Symptoms come and go, often set off by a trigger, and can range from mild to life-threatening.
Asthma cannot be cured, but with the right treatment plan it can be very well controlled.
Common Symptoms
Wheezing (a whistling sound when breathing)
Coughing, especially at night or early morning
Shortness of breath or rapid breathing
Chest tightness or a feeling of pressure
Trouble sleeping due to coughing or breathlessness
Symptoms that worsen with exercise, cold air, or allergens
A cold that "settles in the chest" or lingers for weeks
How We Treat It at Veros Health
Allergy & Trigger Testing
Skin or blood testing pinpoints the specific allergens driving your asthma so treatment can target the cause.
Personalized Asthma Action Plan
A written plan detailing daily controller medication, quick-relief use, and clear steps for worsening symptoms.
Daily Controller Therapy
Inhaled corticosteroids and other controllers reduce airway inflammation and prevent flares over time.
Allergen Immunotherapy
Allergy shots or tablets can gradually reduce sensitivity to specific triggers, easing asthma over time. See our full immunotherapy page.
For moderate-to-severe or hard-to-control asthma, biologics target the specific immune pathways driving inflammation. Eligibility depends on severity, biomarker testing, and response to standard therapy.
Co-Management of Related Conditions
Allergic rhinitis, chronic sinusitis, GERD, sleep apnea, vocal cord dysfunction, and anxiety are all routinely screened for and co-managed.
⚠ Seek emergency care if: severe shortness of breath or trouble speaking in full sentences, lips or fingernails turning blue or gray, quick-relief inhaler isn't helping or is needed every few hours, or ribs/neck are visibly pulling in with each breath.
Common Triggers
Allergens — pollen, dust mites, pet dander, mold, cockroaches
Irritants — smoke, strong odors, air pollution, occupational fumes
Other — GERD, stress, aspirin/NSAIDs, beta-blockers
Overlapping Allergic Conditions — The Atopic March
Asthma is one stop on what allergists call the "atopic march" — a progression of conditions driven by the same overactive Type 2/IgE immune pathway. Many patients with asthma also have, or go on to develop, eczema (often the earliest sign in childhood), food allergies, allergic rhinitis and eye allergies, chronic hives or angioedema, and eosinophilic esophagitis (EoE). Because these conditions share the same root cause, treating one can improve the others — this is why Veros evaluates the whole allergic picture, not asthma alone.
Understanding your diagnosis and treatment at Veros Health
What is CVID?
CVID is one of the most common primary immunodeficiency disorders. Your B cells — the immune cells responsible for making antibodies — do not produce enough immunoglobulins (IgG, IgA, IgM) to protect you from infections.
Without adequate antibodies, your body has difficulty fighting off bacteria and viruses, leading to frequent or severe infections. CVID is a lifelong condition, but with the right treatment most patients live full, active lives.
Common Symptoms
Frequent sinus, ear, or lung infections
Recurring pneumonia
Unusual reactions to common illness
Chronic diarrhea or digestive problems
Fatigue and prolonged recovery
Joint pain or autoimmune features
How We Treat It at Veros Health
The primary treatment is immunoglobulin replacement therapy (IgG), which replaces the antibodies your body cannot make on its own.
Intravenous Immunoglobulin (IVIG)
Infused in our state-of-the-art infusion center by specialized nurses. Typically every 3–4 weeks. Most covered by insurance with prior authorization.
Subcutaneous Immunoglobulin (SCIG)
Smaller doses given under the skin, often weekly or bi-weekly. Some patients self-administer at home after training from our nursing team.
Home Infusion Program
For eligible patients, our home infusion program brings treatment to you. Fully coordinated by the Veros team — you don't have to manage it alone.
Ongoing Monitoring
Regular IgG trough levels, infection tracking, and lung function monitoring ensure your dose stays optimized over time.
What to expect: IVIG infusions typically take 2–4 hours. Most patients feel noticeably better within a few months of starting therapy. Side effects are usually mild and manageable — tell your infusion nurse about any reactions.
Understanding your diagnosis, treatment, and resources at Veros Health
The Immune Connection: Long COVID is not a mystery — it is immune dysregulation. COVID-19 depletes B cells, triggers autoantibodies, activates mast cells via spike protein binding, and drives chronic inflammation. At Veros, we identify and treat these immune root causes — not just manage the symptoms.
⚠ Important — Post-Exertional Malaise (PEM): Do NOT push through fatigue. In Long COVID, overexertion causes crashes and worsening — a phenomenon called post-exertional malaise. Pacing — staying within your energy envelope — is the single most critical management strategy. Tell your Veros provider about any crashes after activity.
What is Long COVID?
Long COVID refers to symptoms persisting 4+ weeks after COVID-19 infection — even a mild one. It affects multiple organ systems because the root cause is immune dysregulation, not organ damage alone.
COVID-19 can deplete antibody-producing B cells, trigger autoantibodies, activate mast cells, cause fibrin microclots that impair circulation, and leave the immune system in a chronic inflammatory state. This is why immune-targeted treatment gets results where general supportive care does not.
Common Symptoms
Extreme fatigue and post-exertional crashes (PEM)
Brain fog, memory loss, concentration problems
Shortness of breath or chest tightness
Racing heart, palpitations, POTS symptoms
Widespread joint and muscle pain
Sleep disturbances and unrefreshing sleep
New food intolerances, flushing, histamine reactions
Headaches, sensory sensitivities, mood changes
Common Co-Occurring Conditions at Veros
Immunodeficiency (CVID-like)
COVID depletes B cells and suppresses antibody production long-term. New-onset low IgG/IgA/IgM is well-documented post-COVID. IVIG therapy is effective and backed by an active Phase 2 clinical trial (NCT06159283).
MCAS
Spike protein directly activates mast cells via ACE2 and IgE receptors. Post-COVID food intolerances, flushing, and histamine reactions are classic signs. Many Long COVID patients meet full MCAS diagnostic criteria.
POTS / Dysautonomia
One of the most common Long COVID sequelae. Autoantibodies against adrenergic receptors drive racing heart, lightheadedness, and presyncope on standing. Overlaps heavily with MCAS.
ME/CFS Overlap
Post-exertional malaise (PEM) affects ~50% of Long COVID patients. Pacing, energy management, and avoiding aggressive exercise are critical. Graded Exercise Therapy (GET) can worsen this subset.
Autoimmunity
New-onset autoantibodies against thyroid, neural tissue, and phospholipids are documented post-COVID. New-onset lupus, Sjogren's, and antiphospholipid syndrome have been reported. Immune panel at Veros can identify these.
Reactivated Viruses
EBV, HHV-6, and other latent herpesviruses can reactivate post-COVID, driving ongoing immune activation, fatigue, and neurological symptoms. Testing available at Veros.
How We Treat It at Veros Health
Comprehensive Immune Evaluation
Autoantibody panels, IgG/IgA/IgM levels, B & T cell counts, inflammatory markers (CRP, ferritin, cytokines), and viral reactivation testing to identify your specific mechanism.
IVIG Therapy
For patients with post-COVID hypogammaglobulinemia or autoimmune features — IVIG can be transformative. Validated by active Phase 2 trial (NCT06159283) specifically for Long COVID with B-cell impairment.
Biologic & Anti-Inflammatory Therapy
Baricitinib (JAK inhibitor) is in active Phase 3 trial REVERSE-LC (NCT06631287) for Long COVID neurological and cardiopulmonary symptoms. We follow emerging evidence closely.
MCAS Co-Treatment
If mast cell activation is identified — antihistamine regimen, mast cell stabilizers, and biologics (Xolair, Dupixent). Many Long COVID patients see significant improvement when MCAS is treated.
POTS & Dysautonomia Protocol
Hydration, sodium loading, compression, pyridostigmine (active trial at Brigham & Women's NCT06366724), and Low-Dose Naltrexone for autonomic and neuroinflammatory features.
Multi-Specialty Coordination
Neurology, rheumatology, cardiology — all immune-focused and all coordinated through your Veros team. You do not have to manage fragmented specialty care alone.
You do not have to "just live with it." Long COVID has measurable immune and inflammatory drivers. Immune-targeted treatment gets results. Please tell your Veros provider every symptom you are experiencing — the full picture matters.
Supplements with Evidence in Long COVID
Nattokinase / Lumbrokinase
Fibrinolytic enzymes targeting the fibrin microclots documented in Long COVID. Lumbrokinase in active Phase 1/2 trial at Mt. Sinai (NCT06511050). Discuss with your Veros provider before starting.
Low-Dose Naltrexone (LDN)
Anti-neuroinflammatory and immune-modulating. Active in LIFT trial at Brigham & Women's (NCT06366724). Widely used in ME/CFS and MCAS overlap. Well-tolerated at low doses.
CoQ10 + PQQ
Mitochondrial support addressing the mitochondrial dysfunction documented in Long COVID fatigue. Often combined for synergistic effect.
Vitamin D3 + K2
Deficiency strongly associated with Long COVID severity. Immune-regulatory. Optimize to 50–80 ng/mL — ask your Veros provider to check your level.
Quercetin + NAC
Quercetin: mast cell stabilizer and zinc ionophore — especially valuable in MCAS overlap. NAC: glutathione precursor, antioxidant, supports immune regulation.
Omega-3 / Magnesium / B12
Omega-3: anti-inflammatory. Magnesium glycinate: supports sleep and nervous system (commonly depleted post-COVID). Methylated B12: nerve repair and energy metabolism.
Diet & Lifestyle Modifications
Anti-Inflammatory Diet
Mediterranean-style: olive oil, fatty fish, colorful vegetables, legumes, nuts. Avoid ultra-processed foods, refined sugar, and trans fats. Reduces CRP, IL-6, and other inflammatory markers.
Low-Histamine Diet (if MCAS overlap)
For patients with post-COVID food intolerances or flushing — avoid aged, fermented, and cured foods. See whatthebleepcanieat.com — our top recommended resource.
Pacing & Energy Management
Track activity and energy in a pacing diary. Use heart rate monitoring to stay below your anaerobic threshold. Structured rest is treatment — not laziness.
Hydration & Electrolytes
Critical for POTS overlap: 2–3L fluid/day, 3–5g sodium/day. Electrolyte formulas (LMNT, Liquid IV) helpful. Compression garments and head-of-bed elevation for POTS symptoms.
Sleep Optimization
Consistent sleep schedule, limit screens before bed, cool room. Melatonin, magnesium glycinate, and LDN can support sleep quality. Treat sleep apnea if present.
Nervous System Support
Vagus nerve stimulation, breathwork (box breathing, 4-7-8), mindfulness. Dysautonomia and nervous system dysregulation respond to autonomic retraining programs (Gupta Program, DNRS).
Landmark paper defining Long COVID phenotypes and multi-organ involvement across 1.2M patients
Online Communities & Support Groups
Online communities offer peer support, practical tips, and connection with others who understand. Always verify medical information with your Veros provider.
Understanding your diagnosis, treatment, and resources at Veros Health
The Immune Connection: Mast cells are immune cells — MCAS is not just an allergy disorder, it is an immune system dysregulation. At Veros, we treat the full immune picture, including the common triad of MCAS, hEDS, and POTS/dysautonomia.
What is MCAS?
MCAS is an immunologic condition in which mast cells become too numerous or too easily activated. Mast cells reside throughout the body and when triggered release histamine, leukotrienes, prostaglandins, tryptase, and other inflammatory mediators — causing multi-system symptoms that often lack a clear trigger.
MCAS is frequently underdiagnosed because symptoms overlap with many other conditions. It commonly co-occurs with hEDS and POTS/dysautonomia — a triad seen frequently at Veros Health.
Common Symptoms
Flushing, hives, rashes, or itching
Severe allergic or anaphylactic reactions
Nausea, cramping, vomiting, or diarrhea
Brain fog, cognitive difficulties, fatigue
Racing heart or lightheadedness (POTS overlap)
Reactions to foods, scents, medications, heat, or stress
Sinus inflammation, cough, breathing difficulties
Joint pain and widespread muscle pain
How We Treat It at Veros Health
Trigger Identification
Detailed history and dietary/environmental review to identify and minimize your personal triggers. Common triggers include foods, fragrances, medications, stress, and temperature changes.
Antihistamine Regimen
H1 blockers (Allegra, Zyrtec, Xyzal, Claritin) and H2 blockers (Pepcid) used strategically twice daily. Timing and combination matter as much as dose.
Mast Cell Stabilizers
Cromolyn sodium and ketotifen prevent mast cell degranulation. Leukotriene inhibitors (Singulair) and Low-Dose Naltrexone may also be used.
Biologics — Xolair & Dupixent
Omalizumab (Xolair) — every 2–4 weeks, inhibits IgE-mediated mast cell activation. Dupilumab (Dupixent) — newly FDA-approved for MCAS, targets IL-4/IL-13 pathways. Ask your Veros provider if you are eligible.
Supplements
Quercetin (mast cell stabilizer), Hist-DAO (Diamine Oxidase — degrades histamine), Vitamin C (degrades histamine), and Luteolin may reduce mediator burden.
MCAS Triad Co-Management
At Veros, we evaluate and treat hEDS and POTS alongside MCAS — because in most patients, these conditions are deeply interconnected and must be managed together.
Every MCAS patient leaves Veros with: A personalized written emergency action plan, epinephrine auto-injector prescription, and clear guidance on when to treat at home versus go to the ER. You will not navigate this alone.
Open-access journal with freely readable MCAS and mast cell research articles
Online Communities & Support Groups
Online communities can be a valuable source of peer support, practical tips, and community. Always verify medical information with your Veros provider — community advice varies in accuracy.
Understanding your diagnosis, treatment framework, and resources at Veros Health
The Immune Connection: Most hEDS patients have immune co-conditions — MCAS, autoimmunity, or dysautonomia. Treating hEDS without addressing the immune system leaves most of the disease untouched. At Veros, we treat the full picture: joints, immune system, nervous system, and gut together.
What is hEDS?
hEDS is a heritable connective tissue disorder caused by defects in collagen — the protein that gives structure to joints, skin, blood vessels, and organs. Connective tissue is too lax, leading to joint hypermobility and wide-ranging systemic effects.
hEDS is the most common EDS subtype and is diagnosed clinically using the 2017 International Criteria. A major update to diagnostic criteria is expected through the Road to 2026 initiative — see ehlers-danlos.com/road-to-2026 for the latest.
The hEDS Triad
These three conditions are deeply interconnected and frequently co-occur:
POTS / Dysautonomia — autonomic dysfunction causing racing heart, lightheadedness, fatigue on standing
Treating all three together — as we do at Veros — produces far better outcomes than treating each in isolation.
Common Symptoms
Joint & Musculoskeletal
Joints that dislocate or sublux easily · Chronic widespread joint and muscle pain · Joint clicking, popping, or instability · Early onset osteoarthritis
Fatigue & Energy
Profound fatigue and post-exertional malaise · Unrefreshing sleep · Exercise intolerance · Muscle weakness · Brain fog and cognitive difficulties
Lightheadedness or fainting on standing (POTS) · Racing heart · Temperature dysregulation · Bladder dysfunction · Pelvic floor issues
Gastrointestinal
Gastroparesis · SIBO · IBS-like symptoms · Acid reflux · Nausea · Constipation or diarrhea — all driven by gut dysmotility from collagen defects
Neurological & Sensory
Sensory sensitivities (light, sound, smell) · Neuropathic pain · Headaches · Anxiety and nervous system dysregulation · Sleep disturbance
Treatment Framework: MENS PMMS
Dr. Linda Bluestein's comprehensive MENS PMMS framework addresses all dimensions of hEDS management. The first M — Movement — is the most important. At Veros, we integrate this framework with immune-focused care.
M — Movement
Gentle, targeted exercises to improve joint stability, strength, and proprioception. PT specializing in hypermobility, pelvic floor PT, Feldenkrais, or Pilates. Movement must be individualized — standard exercise programs can cause harm.
E — Education
Patient knowledge about your condition, symptom tracking, and self-management strategies. Understanding hEDS enables effective advocacy with your care team and helps you recognize new symptoms early.
N — Nutrition
Anti-inflammatory diet — minimize sugar and preservatives, increase hydration. Consider low-histamine modifications if MCAS overlap is present. Some patients benefit from eliminating gluten or dairy. Collagen-supporting nutrients (Vitamin C, glycine) are commonly used.
S — Sleep
Restorative sleep is treatment — not optional. Quality sleep is essential for pain management and recovery. Screen for obstructive sleep apnea (higher prevalence in hEDS). Magnesium glycinate and LDN can improve sleep quality significantly.
P — Psychosocial
The psychological impact of chronic pain and complex illness requires dedicated support. CBT, DBT, mindfulness, EMDR, DNRS, and the Gupta Program all help improve resilience, coping, and nervous system regulation. Pain amplification is a real neurological process — not "in your head."
M — Modalities
Physical therapy techniques, bracing, compression garments, vagus nerve stimulation, virtual reality for chronic pain, myofascial release, acupuncture, and acupressure. Supportive interventions that stabilize joints and reduce symptom burden without pharmacological side effects.
M — Medications
Individualized to your symptom profile. Low-dose naltrexone (LDN) for chronic pain and neuroinflammation · Ketotifen (antihistamine with anti-inflammatory properties) · Cromolyn (mast cell stabilizer) · POTS medications as needed.
S — Supplements
Targeted supplementation to address deficiencies and support tissue health. See the Supplement Recommendations section below for the full list used at Veros.
How We Treat It at Veros Health
Immune & Inflammatory Evaluation
MCAS panel, autoantibody screen, inflammatory markers, and complement studies. Identifying treatable immune drivers produces some of the most dramatic symptom improvements in hEDS patients.
MCAS Co-Management
Antihistamine regimen (H1 + H2), mast cell stabilizers (cromolyn, ketotifen), and biologics (Xolair, Dupixent for eligible patients). Treating MCAS frequently reduces pain, fatigue, and GI symptoms significantly.
POTS & Dysautonomia Protocol
Fluids, sodium loading, compression garments, beta-blockers, or pyridostigmine. Heart rate monitoring to guide activity pacing. Autonomic nervous system rehabilitation.
Biologic & Anti-Inflammatory Therapy
For patients with identified autoimmune or inflammatory immune drivers — targeted biologic therapy can meaningfully reduce pain and systemic inflammation beyond what standard treatments achieve.
Referral Coordination
PT specializing in hypermobility, genetics consultation, GI (gastroparesis/SIBO), urology (pelvic floor), and neurology — all coordinated through your Veros team so you don't have to navigate fragmented care alone.
LDN for Chronic Pain
Low-dose naltrexone has shown meaningful pain reduction in chronic pain and central sensitization — the neurological process that amplifies pain in hEDS. Well-tolerated, non-opioid, and addresses the neuroinflammatory component of hEDS pain. See our full LDN Research page.
Supplement Recommendations
Always discuss supplements with your Veros provider before starting — they can interact with medications. The following have clinical rationale for hEDS symptom management.
Creatine + NMN + Magnesium
This combination supports cellular energy production through the Krebs cycle and mitochondrial reserve capacity. Particularly valuable for muscle weakness, exercise intolerance, and fatigue related to mitochondrial dysfunction.
Magnesium Glycinate
Highly absorbable form specifically beneficial for sleep support. The glycine component has calming properties that promote relaxation and improve sleep quality. Gentle on the digestive system — important for GI-sensitive hEDS patients.
PEA (Palmitoylethanolamide)
Naturally occurring fatty acid compound that modulates mast cell activity and supports anti-inflammatory and pain-relieving pathways. Particularly helpful for neuropathic pain and heightened nervous system reactivity in hEDS.
Berberine
Plant-derived compound with antimicrobial, anti-inflammatory, and gut-protective properties. Supports intestinal barrier function — particularly beneficial for hEDS patients with SIBO, dysbiosis, or leaky gut.
Glutathione + NRF2 Activators
Glutathione is the body's master antioxidant, supporting detoxification. NRF2 activators enhance natural antioxidant defense systems. Together, these address fatigue and brain fog by reducing oxidative stress.
Oxaloacetate
Supports mitochondrial function and energy metabolism. May improve cognitive function and energy levels in patients with chronic fatigue. Used alongside other mitochondrial support supplements.
Associated Conditions to Monitor
hEDS patients are at increased risk for several less common but important conditions. If you experience symptoms suggestive of any of these, discuss with your Veros provider for appropriate evaluation.
May-Thurner Syndrome
Left iliac vein compressed by the right iliac artery — causing leg swelling, chronic left leg heaviness, varicose veins, or recurrent clotting. Increased DVT risk.
Nutcracker Syndrome
Left renal vein compressed between the aorta and superior mesenteric artery — causing flank pain, blood in urine (hematuria), pelvic congestion, and left-sided abdominal pain.
Eagle's Syndrome
Elongated styloid process causing throat pain, difficulty swallowing, foreign body sensation, and facial pain. Symptoms worsen with head turning or swallowing.
Median Arcuate Ligament Syndrome (MALS)
Celiac artery compression causing chronic abdominal pain especially after eating, nausea, weight loss, and a characteristic abdominal bruit. Positional and meal-related pain patterns.
Craniocervical Instability (CCI)
Excessive movement between skull and upper cervical spine — causing headaches, neck pain, dizziness, difficulty swallowing, and neurological symptoms. Worsens upright, improves lying down.
CSF Leak & CSF-Venous Fistula
Tears in the dura mater allow cerebrospinal fluid to escape — causing severe positional headaches (worse upright, better lying flat), neck stiffness, nausea, visual changes. CSF-venous fistula may not respond to typical CSF leak treatments.
Tarlov Cysts
Fluid-filled sacs at sacral nerve root sleeves — causing lower back pain, sciatica, bladder and bowel dysfunction, and sexual dysfunction. Many patients are asymptomatic.
SIBO & Gut Dysmotility
Collagen defects cause slow intestinal transit — creating bacterial stasis that drives SIBO. See our full SIBO page for screening and treatment information.
Diagnostic Criteria & Road to 2026
The current 2017 hEDS diagnostic criteria are under revision. The Ehlers-Danlos Society's Road to 2026 initiative aims to update these criteria with improved specificity and inclusion of systemic features. If you were diagnosed under the 2017 criteria — or have been told you don't "qualify" for hEDS — the updated criteria may change that. Follow the progress at ehlers-danlos.com/road-to-2026.
Community specifically for patients navigating the hEDS + MCAS + POTS triad together.
From Your Provider: Anecdotal Daily Suggestions
Disclosure — Heather King, PA-C: I have Hypermobility Spectrum Disorder/hEDS and POTS. These are anecdotal personal suggestions based on clinical research and my own experience — not medical advice, not a clinical recommendation, and no brand affiliations. Always discuss changes with your own provider.
Eliminate all high-impact jumping, running, or joint-snapping lockouts. Use High-Intensity Low-Impact Training (HiLIT) — at least one foot on the ground at all times, driving heart rate via resistance and incline, not impact.
Strength training is foundational for hEDS. Hypermobile joints cannot rely on ligament stability — muscle co-contraction from all directions becomes your primary joint protection. Aim for 2–4 resistance sessions per week.
Recommended activities:
Biking, rowing, incline walking, power walking
Free weights, resistance bands, strength/mobility training
Bosu ball for proprioception and stabilizer activation
Pilates for core stability — not flexibility
Critical form cues:
→
The 2-Degree Rule: Never fully lock out knees or elbows — maintain a constant micro-bend so muscles do 100% of the work.
→
Active Mobility Over Stretching: Your joints are already loose — do NOT stretch further. Stop 15% short of max and squeeze surrounding muscles to stabilize.
Nutrition & Daily Supplements
4–5 small, protein-first meals spaced throughout the day. Large meals redirect blood volume to the stomach, spiking heart rate and triggering POTS symptoms and nausea. Prioritize protein in every serving to slow gastric emptying and prevent blood pooling. Eat sitting or slightly reclined — never immediately after prolonged standing.
Collagen + Vitamin C together:
Collagen peptides cannot cross-link into joint tissue without Vitamin C. Take 500–1000 mg of buffered Vitamin C (calcium ascorbate or Ester-C) at the same time. Buffered form is stomach-gentle.
Hydration + electrolytes:
Water alone is not enough with POTS. Use bulk electrolyte powder (sodium-forward) throughout the day, scaled to your symptom level.
Creatine:
Take daily for muscle energy and recovery support. Mix into water or a protein shake.
Lifestyle & Compression
Working long healthcare shifts requires aggressive mechanical defense against gravity:
Daily compression strategy:
Compression socks (20–30 mmHg) daily — prescription strength not necessary for most
On high POTS days: add abdominal compression (shapewear) — compresses the abdomen and pelvis, forcing blood back to the heart far more effectively than knee-high socks alone
Hydration strategy:
Insulated gallon jug with bulk electrolytes mixed at shift start — clear visual baseline for sodium and fluid goals
Buffered salt tablets (potassium-buffered) for acute flares, hot weather, or illness — no stomach burning
Travel & flying:
Compression socks on travel days — consider adding an abdominal binder for longer trips or flights
Pre-flight buffered salt loading — start 1–2 hours before boarding
Keep buffered salt tablets in carry-on at all times
Daily Clinical Checklist
✓
Compression socks (20–30 mmHg) or abdominal shapewear
✓
Gallon jug with electrolytes — titrated to daily symptoms
✓
4–5 small, protein-first meals — no large meals
✓
Daily supplements: collagen + buffered Vitamin C + creatine
✓
HiLIT + strength training — no jumping, running, or full joint lockout. Micro-bend always.
Understanding your diagnosis and treatment at Veros Health
What is HAE?
HAE is a rare genetic disorder causing sudden, severe episodes of swelling beneath the skin or in the lining of internal organs. It is driven by overproduction of bradykinin due to low or dysfunctional C1-inhibitor protein.
Important: HAE is not caused by histamine — antihistamines and epinephrine do NOT stop HAE attacks. Proper on-demand therapy is essential.
Common Symptoms
Sudden swelling of hands, feet, or face
Severe abdominal cramping and vomiting
Throat tightness or difficulty swallowing
Skin tingling before an attack (prodrome)
No hives or itching during attacks
Triggers: stress, injury, hormonal changes
⚠ Throat swelling is life-threatening. If you feel throat tightness during an attack, use your on-demand medication immediately and go to the emergency room. Do not wait to see if it resolves on its own.
How We Treat It at Veros Health
On-Demand Therapy
Icatibant (Firazyr), C1-INH concentrate (Berinert, Ruconest), or ecallantide to stop active attacks quickly. We will train you to self-administer.
Short-Term Prophylaxis
C1-INH concentrate before high-risk procedures or surgeries to prevent peri-operative attacks.
Long-Term Prophylaxis
Lanadelumab (Takhzyro) or berotralstat (Orladeyo) for patients with frequent attacks — can dramatically reduce attack frequency and severity.
Emergency Action Plan
Every HAE patient leaves Veros with a personalized written attack protocol, emergency medications, and full self-injection training from our nursing team.
Step-by-step instructions for the injectable medications used to prevent and treat HAE attacks. Your nursing team will train you hands-on before you start at home.
A printable log to track attack frequency, severity, and triggers — bring it to your next appointment to help your Veros team fine-tune your prevention plan.
What to know before, during, and after your infusion
What is IVIG? Immunoglobulin (IgG) is infused directly into your bloodstream through an IV. It replaces the antibodies your immune system cannot make enough of on its own, and can also modulate an overactive immune response. It is used for conditions including CVID, Long COVID, MCAS, autoimmune neurological disorders, and many others.
How it works
IVIG contains pooled immunoglobulin G (IgG) antibodies derived from thousands of healthy donors. Depending on your condition, it works in two main ways:
Replacement therapy — for immunodeficiency (CVID), it simply replaces the antibodies your B cells don't make enough of.
Immunomodulation — for autoimmune or inflammatory conditions, high-dose IVIG regulates and dampens an overactive immune response.
Your Veros provider determines your dose, frequency, and product based on your diagnosis and lab levels.
What to expect at your first infusion
Plan for 2–5 hours for your first infusion — it runs slowly to check for reactions.
An IV is placed, usually in your arm. Nurses monitor you throughout.
You can read, use your phone, watch TV, or nap during the infusion.
Pre-medications (Tylenol, Benadryl) may be given to reduce side effect risk.
Future infusions typically run faster as your body adjusts.
Most patients go home the same day and resume normal activities.
Preparing for your infusion
1
Hydrate well the day before and the morning of your infusion — good hydration makes IV placement easier and reduces headache risk.
2
Eat a normal meal before coming. Do not arrive fasting.
3
Wear comfortable clothing with easy access to your arm or hand for IV placement.
4
Bring entertainment — a book, tablet, headphones, or anything to keep you comfortable during the infusion.
5
Arrange a ride for your first infusion. Most patients drive themselves for subsequent infusions once they know how they respond.
6
Tell your nurse about any current illness, fever, or new medications on the day of your infusion.
Side effects & what is normal
Common & manageable
Headache (most common), fatigue the day after, mild flushing or chills during infusion, muscle aches. These often improve after the first few infusions as your body adjusts.
Less common
Nausea, low-grade fever, mild rash. Slowing the infusion rate almost always resolves these symptoms.
Call us if you experience
Severe headache, stiff neck, chest tightness, difficulty breathing, significant rash, or symptoms that don't resolve within 24 hours after your infusion.
Reducing side effects
Stay well hydrated before and after. Take Tylenol or ibuprofen if your provider approves. Avoid strenuous activity the day of your infusion.
How long until it works?
First infusion
Antibody levels begin to rise
IgG levels in your blood start increasing immediately after your first infusion.
2–4 weeks
First noticeable changes
Some patients notice improved energy and fewer infections beginning around the time of their second infusion.
3–6 months
Meaningful clinical improvement
Most patients experience significant reduction in infection frequency, fatigue improvement, and stabilization of symptoms within 3–6 months of consistent therapy.
Ongoing
Dose optimization
Your provider will check IgG trough levels (drawn just before your infusion) and adjust your dose to keep you in the therapeutic range.
Frequently asked questions
Most patients receive IVIG every 3–4 weeks for replacement therapy. Some autoimmune protocols use monthly or more frequent dosing. Your provider will determine the right schedule based on your diagnosis and IgG levels.
IVIG is covered by most major insurance plans when medically necessary. Our team handles prior authorization. Coverage and out-of-pocket costs vary by plan — contact our office and we'll help you understand your benefits before your first infusion.
In most cases yes. Tell your Veros provider about all medications and supplements before starting. Live vaccines should be avoided for several weeks around IVIG infusions — your provider will advise you.
Yes — IVIG has an excellent long-term safety profile and has been used for decades. Regular monitoring of kidney function and IgG levels ensures the therapy continues to be appropriate for you.
IVIG is given intravenously (into a vein) every 3–4 weeks, usually in an infusion center. SCIG is given subcutaneously (under the skin) in smaller doses weekly or bi-weekly, and can be self-administered at home. Ask your Veros provider which option suits your lifestyle.
Subcutaneous Immunoglobulin (SCIG)
A flexible at-home alternative to IVIG infusion
What is SCIG? Subcutaneous immunoglobulin (SCIG) delivers the same IgG antibodies as IVIG, but through a small needle placed just under the skin rather than into a vein. It is given in smaller, more frequent doses — typically weekly or bi-weekly — and many patients self-administer at home after training from our nursing team.
How it works
SCIG delivers IgG antibodies into the subcutaneous tissue (the layer just beneath the skin), where they are slowly absorbed into the bloodstream. Because doses are smaller and given more frequently, IgG levels stay very stable — with fewer peaks and troughs than monthly IVIG.
Typical sites: abdomen, thighs, upper arms, or upper back
Infused over 1–2 hours using a small pump or push method
Can be done at home, at work, or while traveling
No IV placement needed — just a tiny subcutaneous needle
What to expect at training
Our nursing team provides 1–2 in-office training sessions before you go home.
You'll learn site selection, needle insertion, pump setup, and how to recognize problems.
Most patients feel confident to self-administer within 1–2 training visits.
Your first home doses are done with nursing support available by phone.
Supplies are delivered directly to your home through our specialty pharmacy partners.
Preparing for each dose
1
Remove from refrigerator 30–60 min before — room-temperature immunoglobulin is more comfortable to infuse than cold product.
2
Gather your supplies — product vials, tubing, needles, alcohol swabs, gauze, and your pump if applicable.
3
Choose and clean your site — rotate sites each week to prevent tissue buildup. Clean with an alcohol swab and let dry.
4
Insert the needle at a shallow angle — your nurse will teach you the correct technique. The needle should go just under the skin, not into muscle.
5
Infuse at your prescribed rate — never rush the infusion. If you notice unusual swelling, burning, or pain, stop and call our office.
Side effects & what is normal
Local reactions (common)
Mild swelling, redness, or firmness at the injection site. This is normal and usually resolves within a few hours. Rotating sites helps minimize this.
Systemic reactions (less common)
Because SCIG absorbs slowly, systemic reactions (headache, fatigue, fever) are much less common than with IVIG. Most patients tolerate SCIG very well.
Call us if you notice
Significant swelling or hardness that doesn't resolve, signs of infection at the site (increasing redness, warmth, discharge), or any difficulty breathing or chest tightness.
SCIG vs IVIG side effects
SCIG generally has fewer systemic side effects than IVIG. Many patients switch to SCIG specifically to reduce the headaches and fatigue associated with IV infusions.
How long until it works?
Week 1–2
IgG levels begin to stabilize
SCIG builds steady-state IgG levels more gradually than a large IV dose. Your levels will rise over the first several weeks.
4–8 weeks
Consistent steady-state levels
After 4–8 weeks of weekly dosing, IgG levels reach a stable therapeutic range with minimal fluctuation.
2–4 months
Clinical improvement
Reduction in infections, improved energy, and symptom stabilization are typically noticeable within 2–4 months.
Ongoing
Regular IgG monitoring
Your provider will check IgG trough levels periodically to ensure your dose is keeping you in the right range.
Frequently asked questions
SCIG is a great option for patients who prefer flexible scheduling, want to avoid repeated IV access, have difficult veins, or prefer the convenience of home therapy. Your Veros provider will discuss whether IVIG or SCIG is better suited to your lifestyle and diagnosis.
The needle is very small. Most patients describe a mild sting during insertion and mild pressure during the infusion. Warming the product to room temperature and infusing slowly both help reduce discomfort significantly.
Yes — SCIG is designed for flexible, portable use. Product must be kept refrigerated. A travel letter from Veros and an insulated travel bag make it straightforward to manage on trips. Our team can help coordinate supplies for travel.
Yes, SCIG is covered by most major insurance plans with the same criteria as IVIG. Our team handles prior authorization and works with specialty pharmacies to coordinate delivery of your product.
Allergy Immunotherapy
Allergy shots & sublingual immunotherapy — treating allergies at the root
What is allergy immunotherapy? Allergy immunotherapy is the only treatment that changes how your immune system responds to allergens — rather than just masking symptoms. By gradually exposing your immune system to increasing amounts of what triggers you, it learns to tolerate those triggers instead of overreacting to them. It is highly effective for environmental allergies, allergic asthma, and is also used to reduce mast cell reactivity in MCAS.
How it works
Immunotherapy works by retraining your immune system. Starting with a tiny, carefully measured dose of your specific allergens, doses are gradually increased over time. Your immune system shifts from an allergic response (IgE-mediated) to a tolerant response.
Allergy shots (SCIT) — injected under the skin in our office. Most effective, fastest desensitization.
Sublingual drops (SLIT) — placed under the tongue at home daily. More convenient, slightly slower response.
Both options use allergen extracts customized specifically to your allergy test results.
What to expect at appointments
Build-up phase: shots given 1–2x per week, increasing dose each visit. Lasts approximately 6–12 months.
Maintenance phase: once your target dose is reached, shots every 2–4 weeks.
You wait in our office for 20–30 minutes after each shot to monitor for reactions.
Appointments are quick — typically 10–15 minutes including wait time.
Total treatment course is typically 3–5 years for lasting benefit.
Preparing for each allergy shot
1
Don't exercise vigorously for 2 hours before or after your shot — exercise increases circulation and can increase reaction risk.
2
Tell us if you're feeling unwell — shots may be held during illness, fever, or significant asthma flares.
3
Take your antihistamine if your provider has recommended pre-medicating before shots.
4
Stay for your full wait time — the 20–30 minute wait after each shot is required and non-negotiable. Most reactions occur in this window.
5
Bring your epinephrine auto-injector to every appointment if you have one prescribed.
Side effects & what is normal
Local reactions (common)
Redness, swelling, or itching at the injection site within 30 minutes. Normal and expected. A cold pack and antihistamine resolve most local reactions quickly.
Systemic reactions (uncommon)
Sneezing, nasal congestion, hives, or mild asthma symptoms. These are manageable in the office with antihistamines and observation. Always resolved before you leave.
Anaphylaxis (rare)
Severe systemic reactions are rare but can occur — this is why we require the 30-minute wait. Our office is fully equipped to treat anaphylaxis immediately.
MCAS patients
Patients with MCAS may have a lower reaction threshold. Your provider will start at a lower dose and advance more slowly. Pre-medication is often used.
How long until it works?
3–6 months
Early symptom relief
Many patients notice reduced allergy symptoms and medication needs within the first 3–6 months of the build-up phase.
6–12 months
Maintenance dose reached
Your target maintenance dose is reached. Most patients experience significant symptom reduction by this point.
1–2 years
Substantial immune retraining
The immune shift from IgE-mediated reactivity to tolerance is well-established. Medication needs are often dramatically reduced.
3–5 years
Long-lasting tolerance
Completing the full course provides durable, often permanent desensitization — unlike medications that only work while you take them.
Frequently asked questions
No — you can continue antihistamines during immunotherapy. In fact, taking your antihistamine before shots can reduce local reaction size. Your Veros provider will advise you on timing.
Yes, with careful management. At Veros we have extensive experience managing immunotherapy in MCAS patients. We start at lower doses, advance more slowly, and use pre-medication protocols to minimize mast cell reactions. Many MCAS patients benefit greatly from immunotherapy.
Missing shots delays progress and may require dose adjustments. If you miss more than a few weeks, your dose may need to be reduced for safety. Consistency is important — try to keep your scheduled appointments or contact us to reschedule promptly.
Most insurance plans cover allergy immunotherapy when ordered by a board-certified allergist. Our office verifies benefits and handles the authorization process before you start.
A well-tolerated immune-modulating therapy used for chronic inflammatory conditions
What is LDN? Naltrexone is an FDA-approved medication used at full doses for opioid and alcohol dependence. At very low doses (1.5–4.5mg, compared to the standard 50mg), it has distinct immune-modulating and anti-inflammatory effects that are beneficial for a wide range of chronic inflammatory and autoimmune conditions. LDN is compounded by a specialty pharmacy and taken once daily, typically at bedtime.
How it works
At low doses, naltrexone works through two main mechanisms distinct from its full-dose effects:
Glial modulation — LDN inhibits microglial activation in the brain and nervous system, reducing neuroinflammation that drives pain, fatigue, and brain fog.
Endorphin upregulation — brief opioid receptor blockade triggers a rebound increase in endorphin production, supporting immune regulation and pain modulation.
Conditions it is commonly used for at Veros: MCAS, hEDS, Long COVID, fibromyalgia, autoimmune conditions, and chronic fatigue.
What to expect when starting
LDN is taken orally once daily, typically at bedtime.
Most providers start at a low dose (1–1.5mg) and increase gradually over weeks to the therapeutic range of 3–4.5mg.
It is compounded by a specialty pharmacy — your Veros provider will send the prescription directly.
LDN is very affordable — typically $30–$60/month from a compounding pharmacy.
It is generally not covered by insurance as a compounded medication, but cost is low.
Important things to know before starting
1
Opioid medications must be stopped before starting LDN. LDN blocks opioid receptors — taking opioids and LDN together causes immediate opioid withdrawal. Discuss all current medications with your provider.
2
Timing matters — LDN is taken at bedtime because its receptor blockade occurs during sleep, minimizing any effect on daytime opioid receptors if applicable.
3
Use a compounding pharmacy — commercial naltrexone comes only in 50mg tablets, which cannot simply be cut. A compounding pharmacy prepares the exact low dose prescribed.
4
Fillers matter for MCAS patients — ask your compounding pharmacy to use simple, low-reactivity fillers (microcrystalline cellulose or distilled water). Avoid flavored or dye-containing formulations.
Side effects & what is normal
Vivid dreams (common at start)
The most reported side effect when starting LDN. Usually resolves within 1–3 weeks as your body adjusts. Taking it earlier in the evening (rather than right at bedtime) can help.
Initial fatigue or mood changes
Some patients feel slightly more tired or notice mood shifts in the first 2–4 weeks. This typically resolves — many patients eventually report improved energy and mood.
GI symptoms (uncommon)
Mild nausea or stomach discomfort in the first week or two. Taking with a small snack can help. Usually resolves on its own.
Generally very well tolerated
LDN has a favorable safety profile and is well-tolerated by most patients, including those with MCAS and chemical sensitivities. Starting low and going slow minimizes early side effects.
How long until it works?
Weeks 1–4
Dose titration
Starting at 1–1.5mg and increasing gradually. Some patients notice early changes in sleep or energy during this phase.
1–3 months
Early immune modulation effects
Many patients notice reduced pain, improved energy, or less reactivity (for MCAS) within 1–3 months at therapeutic dose.
3–6 months
Meaningful clinical improvement
Neuroinflammation reduction takes time. Most patients see their best response at 3–6 months of consistent use at therapeutic dose.
Ongoing
Continued benefit
LDN is typically a long-term therapy for chronic conditions. Benefits are generally maintained with continued use. Your provider reviews periodically.
Frequently asked questions
Naltrexone is FDA-approved at full doses for opioid and alcohol dependence. Its use at low doses for inflammatory and autoimmune conditions is off-label — meaning it is not yet FDA-approved for these indications, though it has a growing evidence base and is widely used by specialists. Your provider will discuss the evidence and rationale with you.
LDN is compatible with most medications. The key exception is opioid medications — these cannot be taken with LDN. Also discuss with your provider if you are on immunosuppressants, as LDN's immune-stimulating effect may interact. Always give your full medication list to your Veros provider.
LDN must be filled at a compounding pharmacy — it is not available as a commercial generic at this dose. Your Veros provider will recommend a trusted compounding pharmacy. Cost is typically $30–60/month. Some pharmacies can ship directly to your home.
LDN can take 3–6 months to show full benefit. If you haven't noticed improvement after 3 months at your therapeutic dose, contact your Veros provider — your dose may need adjustment, or LDN may not be the right fit for your specific condition.
Cellular energy support for healthy aging, fatigue, and recovery
The Cellular & Immune Connection: Every immune cell in your body runs on energy made inside its mitochondria — and NAD+ is the fuel switch that keeps that energy production running. At Veros, we look at NAD+ support as part of the whole-patient picture, alongside immune and multi-specialty care.
What is NAD+?
NAD+ (nicotinamide adenine dinucleotide) is a natural molecule found in every cell in your body. Think of it as rechargeable battery fluid for your cells — without enough of it, your cells cannot convert food into usable energy. NAD+ levels naturally decline with age, and can drop further with chronic stress, poor sleep, inflammation, and illness.
How NAD+ Works in the Body
Cellular energy (ATP) — powers the mitochondria, the "power plants" inside every cell
DNA repair — helps activate enzymes that fix everyday cell damage
Brain & nerve support — fuels cognitive function, memory, and focus
Healthy aging — activates sirtuins, proteins that help regulate inflammation and metabolism
How We Administer NAD+ at Veros
Oral NAD+ Support
NMN and NR are precursor supplements that your body converts into NAD+. Taken by mouth, usually once daily. Typical starting ranges are 250-500mg/day for NMN and 300-600mg/day for NR.
IV NAD+ Therapy
Delivered directly into the bloodstream under medical supervision, given slowly to improve comfort and absorption — often chosen for faster, more noticeable support.
Potential Benefits
Increased energy & stamina, improved mental clarity, better exercise recovery, stress resilience, and cellular repair support. Individual responses vary and benefits may take several weeks to appear.
Who May Benefit
Patients with chronic fatigue, low energy, brain fog, high stress or burnout, recovery from illness, or age-related energy decline — as part of an overall wellness plan.
During IV NAD+ infusion: Mild nausea, flushing, headache, or chest tightness can occur and usually improve when the infusion rate is slowed. Tell your care team right away if you notice any of these symptoms so they can adjust your infusion.
Safety Considerations
Tell your Veros provider before starting NAD+ therapy if:
You are pregnant or breastfeeding
You have active cancer or are in cancer treatment
You have significant liver or kidney disease
You have gout or elevated uric acid
You take chemotherapy or immune-suppressing medication
NAD+ therapy is intended to support overall wellness and is not intended to diagnose, treat, cure, or prevent any disease.
Mechanism, evidence, and clinical applications across immune-related conditions
The Veros perspective on LDN: LDN sits at the intersection of immunology, neurology, and chronic disease — exactly where Veros Health specializes. For patients with MCAS, hEDS, Long COVID, ME/CFS, and other complex immune-mediated conditions, LDN is one of the most well-tolerated and versatile tools we have. This page covers the science, the evidence, and the community behind it.
What is LDN?
Naltrexone is an FDA-approved opioid antagonist used at 50mg for addiction treatment. At doses of 1–5mg — roughly 1/10th the standard dose — it produces entirely different pharmacological effects through distinct mechanisms that have proven beneficial for inflammatory, autoimmune, and chronic pain conditions.
LDN is not commercially available at these doses and must be compounded by a specialty pharmacy. It is inexpensive (typically $30–60/month), well-tolerated, and has no significant abuse potential.
It is used off-label — meaning FDA-approved for a different indication — but has a growing body of peer-reviewed evidence supporting its use across a wide range of conditions.
Dosing overview
Starting dose: 1–1.5mg at bedtime. Lower for sensitive patients (0.5mg).
Titration: Increase by 0.5–1mg every 2–4 weeks as tolerated.
Typical therapeutic dose: 3–4.5mg daily. Some patients do better at 1.5–3mg.
Timing: Bedtime is standard. If vivid dreams persist, try 5–6pm instead.
Form: Immediate-release capsule, liquid (for precise low dosing), or dissolve-in-water tablet. Liquid form allows ultra-low starting doses for highly sensitive patients (MCAS).
Fillers: Request microcrystalline cellulose or distilled water — avoid dyes and flavors, especially in MCAS patients.
Mechanism of action
Glial modulation & neuroinflammation
LDN's primary mechanism at low doses is inhibition of microglial and astrocyte activation. Microglia are the brain's immune cells — when chronically activated (as in Long COVID, ME/CFS, fibromyalgia, and chronic pain), they release pro-inflammatory cytokines (TNF-α, IL-6, IL-12) that drive pain sensitization, brain fog, and fatigue. LDN suppresses this glial activation via Toll-like receptor 4 (TLR4) antagonism.
Opioid receptor rebound & endorphin upregulation
LDN briefly blocks opioid receptors (4–6 hours, while you sleep). In response, the body upregulates its own endorphin and enkephalin production — a rebound effect. Elevated endogenous opioids have anti-inflammatory and immune-regulatory effects that persist throughout the day, long after LDN has cleared the system.
Mast cell stabilization
Naltrexone directly inhibits mast cell degranulation via opioid receptor modulation. This makes LDN particularly relevant for MCAS patients — it reduces the frequency and severity of mast cell reactions by raising the threshold for degranulation. This mechanism is synergistic with antihistamines and other mast cell stabilizers.
Immune modulation & cytokine regulation
LDN shifts the immune response from pro-inflammatory (Th1/Th17) toward regulatory (Treg) patterns. This makes it useful in autoimmune conditions where immune over-activation is the problem. It reduces IL-6, TNF-α, and other inflammatory cytokines while supporting IL-10 (an anti-inflammatory cytokine).
Gut immune axis
The gut has dense opioid receptor expression. LDN modulates gut immune function, reduces intestinal permeability ("leaky gut"), and has shown benefit in inflammatory bowel conditions (Crohn's disease, ulcerative colitis). Gut immune dysregulation is common in MCAS, hEDS, and Long COVID — making this mechanism highly relevant for Veros patients.
Mitochondrial support
Emerging evidence suggests LDN improves mitochondrial function through reduced oxidative stress and inflammatory burden. Mitochondrial dysfunction is a key driver of fatigue in ME/CFS and Long COVID — this may partly explain the energy improvements many patients report.
Conditions treated with LDN at Veros
MCAS — Mast Cell Activation Syndrome
LDN directly stabilizes mast cells and reduces mediator release. Many MCAS patients report reduced reaction frequency, improved histamine tolerance, and decreased baseline reactivity. It is often used as an add-on to antihistamines and mast cell stabilizers. Start ultra-low (0.5mg) in reactive MCAS patients.
Long COVID & Post-Viral Syndrome
LDN addresses multiple Long COVID drivers simultaneously: neuroinflammation (brain fog, headaches), glial activation, immune dysregulation, and fatigue. Active clinical trial: LIFT trial at Brigham & Women's (NCT06366724) combining LDN with pyridostigmine for Long COVID. One of the most prescribed off-label therapies for Long COVID by specialists.
Neuroinflammation and immune dysregulation are core ME/CFS mechanisms — both targeted by LDN. Clinical evidence includes a Stanford open-label trial showing significant fatigue and pain reduction. LDN does not cure ME/CFS but is among the best-tolerated symptomatic and mechanistic treatments available.
hEDS — Hypermobile Ehlers-Danlos Syndrome
Pain, neuroinflammation, and MCAS overlap are the primary targets in hEDS. LDN's central sensitization modulation makes it effective for the widespread chronic pain common in hEDS. Particularly useful for patients who cannot tolerate or don't respond to conventional pain medications.
Fibromyalgia
A Stanford RCT (Younger et al., 2013) showed LDN 4.5mg reduced fibromyalgia pain scores by 30% vs placebo, with good tolerability. Central sensitization driven by glial activation is the target. LDN is increasingly considered a first-line option in fibromyalgia management by pain specialists.
Chronic Pain & Central Sensitization
LDN reduces central sensitization — the process by which the nervous system amplifies pain signals. Effective for chronic widespread pain, neuropathic pain, and conditions where standard analgesics are poorly tolerated or insufficient. Often reduces need for other pain medications.
Autoimmune Conditions
LDN has the most published evidence in Crohn's disease (multiple trials showing mucosal healing) and multiple sclerosis (quality of life improvement). Also used for lupus, Sjogren's, rheumatoid arthritis, and psoriasis — conditions frequently seen in the immune-dysregulated patient population at Veros.
POTS & Dysautonomia
Neuroinflammation and immune dysregulation contribute to autonomic dysfunction in POTS — especially post-COVID POTS. LDN's anti-neuroinflammatory effects may reduce autonomic instability and improve quality of life alongside standard POTS management (fluids, salt, compression, beta-blockers).
Key literature & clinical evidence
Fibromyalgia RCT — Younger et al. (2013)
Pain Medicine. Double-blind crossover RCT: LDN 4.5mg vs placebo in fibromyalgia. 30% greater pain reduction with LDN. Reduced inflammatory markers. Landmark trial establishing LDN's efficacy in central sensitization.
American Journal of Gastroenterology. Pediatric RCT showing LDN produced mucosal healing and remission in Crohn's disease — the strongest GI evidence for LDN and the basis for its use in gut immune dysregulation broadly.
Frontiers in Pain Research (2023). Open-label study of LDN in ME/CFS showing significant reduction in fatigue, pain, and cognitive symptoms. Growing evidence base for LDN as the only well-tolerated mechanistic therapy for ME/CFS.
ClinicalTrials.gov NCT06366724. Phase 2 trial at Brigham & Women's combining LDN + pyridostigmine for Long COVID neurological and autonomic features. One of the most closely watched active LDN trials.
Annals of Neurology. Pilot RCT in MS: LDN improved mental health quality of life vs placebo with excellent tolerability. Multiple subsequent trials have confirmed quality of life benefits in progressive MS.
Brain, Behavior & Immunity. Foundational mechanistic research establishing LDN's action via TLR4 antagonism on microglia and astrocytes — the scientific basis for its anti-neuroinflammatory effects across conditions.
LDN Research Trust — the leading global LDN research and advocacy organization. Extensive patient resources, provider directory, and research database.
LDN Science — comprehensive database of LDN clinical trials, mechanisms, and condition-specific evidence summaries. Excellent for patients wanting the research.
Edited by Linda Elsegood. Comprehensive patient and clinician guides to LDN covering over 20 conditions. Available on Amazon and through LDN Research Trust.
Patient-run resource with condition-specific forums, dosing guides, and compounding pharmacy information. One of the oldest LDN patient communities online.
Expert interviews and patient stories on LDN use across conditions. Hosted by Linda Elsegood — one of the most recognized LDN patient advocates globally.
LDN Research Trust provider directory — if you are outside Colorado or need a specialist referral, this database lists LDN-prescribing physicians worldwide.
A note on off-label use: LDN is prescribed off-label for the conditions on this page. This means it is not yet FDA-approved for these indications, though the evidence base is growing rapidly. At Veros Health, we review the current evidence with each patient and make individualized treatment decisions. LDN is not appropriate for everyone — particularly patients on opioid medications. Always discuss with your Veros provider before starting.
Understanding your diagnosis, treatment, and resources at Veros Health
The Immune Connection: The gut is the largest immune organ in the body. SIBO is not just a digestive problem — it is an immune system failure that allows bacterial overgrowth to drive systemic inflammation, trigger MCAS, worsen hEDS, and fuel post-COVID symptoms. At Veros, we treat the immune root cause, not just the bacteria.
Frequently misdiagnosed as IBS: Up to 78% of patients diagnosed with IBS have underlying SIBO (Ghoshal et al., 2017). If you have been told you have IBS, ask your Veros provider about SIBO testing before accepting a functional diagnosis. These are not the same condition and they require different treatment.
What is SIBO?
SIBO occurs when bacteria that normally live in the large intestine migrate and overgrow in the small intestine. The small intestine should be nearly sterile. When it isn't, these bacteria ferment food before it can be properly absorbed — producing gas, toxins, and inflammatory mediators that cause both local and systemic symptoms.
SIBO is not simply a "bad bacteria" problem. It is a failure of the immune mechanisms that normally keep the small intestine clear — including secretory IgA, gut motility, and stomach acid. Treating the immune root cause is what prevents recurrence.
Common Symptoms
Bloating — especially after meals or carbohydrates
Abdominal pain, cramping, or pressure
Excessive gas, belching, or flatulence
Diarrhea, constipation, or alternating both
Nausea, early fullness, or acid reflux
Brain fog and fatigue (bacterial toxins cross gut lining)
Secretory IgA is the gut's primary immune defense against bacterial overgrowth. CVID patients have profoundly impaired mucosal immunity — 40% of CVID patients have SIBO (Baniadam et al., 2021, doi). SIBO screening is standard at Veros for all CVID patients.
MCAS
Bacterial toxins and lipopolysaccharide (LPS) directly activate mast cells. SIBO and MCAS create a vicious cycle — SIBO triggers mast cell reactions, and MCAS-driven gut inflammation worsens bacterial overgrowth. Treating SIBO often significantly reduces MCAS reactivity.
hEDS
Collagen defects in hEDS cause gut dysmotility — slow intestinal transit creates bacterial stasis that allows SIBO to develop and recur. Prokinetic support and motility optimization are essential alongside antibiotic treatment in hEDS patients.
Long COVID
COVID-19 devastates the gut microbiome and gut immune function. Post-COVID gut dysbiosis and small intestinal bacterial changes are increasingly documented. Many Long COVID GI symptoms may have an underlying SIBO component that is treatable.
POTS / Dysautonomia
Gut dysmotility in autonomic dysfunction slows intestinal transit, predisposing to SIBO. The gut-brain-autonomic connection means SIBO can worsen POTS symptoms, and treating SIBO may improve autonomic stability.
IBS Misdiagnosis
Between 4–78% of IBS patients have underlying SIBO depending on the study population and testing method (Ghoshal et al., 2017, doi). IBS is a symptom description — SIBO is a diagnosable and treatable cause of those symptoms.
Testing
Lactulose Breath Test
The standard non-invasive SIBO test. You ingest a lactulose solution, then breathe into tubes every 20 minutes for 2–3 hours. Bacteria ferment the lactulose and produce hydrogen and methane gases measured in your breath. Tests the entire small intestine. Available through Veros.
Test vs. Treat Empirically
Testing is ideal because it confirms diagnosis and guides antibiotic choice (hydrogen-dominant vs methane-dominant respond differently). However, many providers — including at Veros — may treat empirically when the clinical picture is clear and testing access or cost is a barrier.
How We Treat It at Veros
Rifaximin (Xifaxan)
Non-absorbable antibiotic — works locally in the gut without significant systemic absorption. 550mg three times daily for 14 days is the standard protocol for hydrogen-dominant SIBO. 15 controlled studies confirm efficacy (Rao & Bhagatwala, 2019, doi).
Rifaximin + Neomycin
For methane-dominant SIBO (intestinal methanogen overgrowth / IMO) — neomycin targets the methanogens that rifaximin alone does not adequately address. Combination therapy is the current standard for methane-dominant presentations.
Herbal Antimicrobials
Allicin (garlic extract), berberine, oregano oil, and neem have shown comparable efficacy to rifaximin in some studies. Used when antibiotics are not tolerated or preferred, or as an adjunct. Based on Siebecker and Pimentel protocols.
Gut Mucosal Immune Support
At Veros, we support recovery with serum-derived bovine immunoglobulin (SBI) — concentrated oral IgG/IgA/IgM that binds bacterial toxins locally. Clinical trials confirm significant IBS-D improvement (Wilson et al., 2013; Petschow et al., 2014; Camilleri/Mayo Clinic, 2017). Especially valuable in CVID and low-IgA patients.
Spore-Based Probiotics
Safe to use during and after SIBO treatment — unlike lactobacillus-based probiotics, which can worsen symptoms during active SIBO. Bacillus-based spore probiotics survive stomach acid, support microbiome restoration, and reduce recurrence risk.
Diet Support
Low FODMAP diet reduces fermentable carbohydrates that feed bacteria, reducing symptom burden during treatment. The Bi-Phasic Diet (Dr. Siebecker) is more targeted. Diet alone does not eradicate SIBO but reduces severity and supports healing.
Preventing recurrence is as important as treating the acute episode. SIBO recurs in many patients because the underlying immune or motility dysfunction is not addressed. At Veros, we treat the root cause — restoring gut immune defense and motility to prevent bacteria from re-establishing in the small intestine.
Dr. Allison Siebecker's SIBO resource center — the most comprehensive patient and clinician SIBO reference available. Protocols, diet guides, and research summaries.
European Annals of Allergy & Clinical Immunology. 40% SIBO prevalence in CVID patients — validates Veros approach of routine SIBO screening in immunodeficiency. doi:10.23822/EurAnnACI.1764-1489.137
