What is an ideal gentle initial chelation treatment to minimize Flare reactions. I think the gentlest yet effective approach (I think in comparison EDTA is gentle but relatively ineffective) is to start with just Zn-DTPA, and the gentlest administration is 5 ml ampule injected into a 1 liter bag of normal saline and the liter administered over 2 hours. It may well be, although not shown scientifically that EDTA may result in a lesser Flare reaction to the standard Ca-DTPA/Zn-DTPA protocol. My suspicion is that this is because much less Gd is mobilized with EDTA out of the body through the blood stream, but unfortunately what this means with EDTA is that Gd may be picked up in the tissues but then shortly redeposited elsewhere. Compared to Ca-DTPA, Zn-DTPA picks up less Gd, but unlike with EDTA, when it picks up the Gd it hangs onto it better (300,000 times better) so what gets picked up the vast majority excreted in urine.
Probably in the situation of GDD from macrocyclic agent or GDD treated between 3-6 months (maybe 3 months- 1 year) this gentle Zn-DTPA strategy is what I would start with. Why Flares are so strong between 3 - 6 month is that the immune system has only recently been stimulated by the original GBCA injection, and is on high alert and will be readily re-ignited when the Gd in tissues is rechelated and transported in the blood stream. A lesser bolus of Gd being transported through rechelation will result in a lesser host response. This Zn-DTPA protocol could be done every 2 weeks or every month, for 5 sessions (actually also the number of ampules of Zn-DTPA in a package). Probably the supplements that most practitioners use should be fine. The one critical thing is not to supplement Zn. It probably takes 5 days to get all the excess Zn that the chelator provided to you out of your system. Hence why I don't think chelations should be spaced too closely.
To restate: Ca-DTPA pulls out more Gd, but I think this massive transit of Gd in the body creates the circumstance of greater Flare reaction.
Another important modification is that although specific auto-immune disease drugs may be effective to mitigate the host immune response, most of them are very expensive. A much more affordable strategy, which may be worth trying initially is low dose Naltrexone.