scholarly journals Clarification of Eosinophilic Esophagitis Treatment in the DoD Retention Standards

2021 ◽  
Author(s):  
Austin Gable ◽  
Benjamin Fiore ◽  
Joseph Cheatham
Keyword(s):  
Side Effects ◽  
Eosinophilic Esophagitis ◽  
Chronic Inflammatory Disease ◽  
Oral Steroid ◽  
Topical Steroids ◽  
Medical Evaluation ◽  
Systemic Side Effects ◽  
Immunosuppressant Medications ◽  
Oral Steroid Therapy ◽  
Evaluation Board

ABSTRACT The DoD Instruction 6130.03, Volume 2, outlines the retention standards for the U.S. Military, providing guidance on medical conditions and treatments that are disqualifying for all branches of the military. This document states that patients with conditions requiring immunomodulating or immunosuppressant medications do not meet retention standards. Eosinophilic esophagitis is a common, chronic inflammatory disease of the esophagus that typically presents with dysphagia. Although proton pump inhibitors are effective at treating this disease in some cases, swallowed topical steroids are the most frequently used therapy within the DoD. These medications act locally in the esophagus and do not cause systemic side effects typical of oral steroid therapy, including immunosuppression. They are effective at inducing and maintaining disease remission and are generally well tolerated, with minimal side effects. We propose a brief amendment to this document to clarify the language used and avoid inappropriate Medical Evaluation Board referrals.

"Topical Steroid Holiday"

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 455-456
Author(s):  
David Hepburn ◽  
Joseph Morelli ◽  
William L. Weston
Keyword(s):  
Side Effects ◽  
Plasma Cortisol ◽  
Topical Steroid ◽  
Topical Steroids ◽  
Prescribing Pattern ◽  
Biphasic Pattern ◽  
Systemic Side Effects ◽  
Continued Use ◽  
Cortisol Levels ◽  
Pediatric Prescribing

Daily use of low-potency topical steroids is a frequently observed pediatric prescribing pattern.1 Many clinicians believe such a strategy is safe because low-potency topical steroids usually do not suppress levels of plasma cortisol or produce systemic side effects. However, daily use of low-potency steroids may result in suppression of plasma cortisol levels.1-4 Suppression of plasma cortisol levels after use of topical steroids has been observed in a biphasic pattern. There is suppression within 2 weeks of starting daily therapy, then recovery to normal despite continued use, then suppression again after 4 to 6 weeks of daily therapy.2,3

scholarly journals OUTCOME OF TOPICAL STEROID IN TREATMENT OF PHIMOSIS

1969 ◽  
Vol 4 (1) ◽  
pp. 426-429
Author(s):  
TARIQ AHMAD ◽  
MOHSIN ALI ◽  
RIAZ AHMAD KHAN
Keyword(s):  
Side Effects ◽  
Steroid Therapy ◽  
Topical Application ◽  
Kidney Diseases ◽  
Topical Steroid ◽  
Primary Treatment ◽  
Clobetasol Propionate ◽  
Topical Steroids ◽  
Successful Result ◽  
Systemic Side Effects

BACKGROUND:Topical steroid is effective alternative to circumcision in boys with phimosis. We evaluated theeffectiveness of topical steroid therapy as primary treatment in patients with phimosis.MATERIAL AND METHODSThe study was conducted from January 2010 to Jan 2013 in institute of kidney diseases Hayat abadmedical complex Peshawar. A total of 38 male children who had a Kikiros retractability grade of 4 or 5phimosis were included in the study. Topical steroids (0.05% clobetasol propionate cream) were appliedtwice a day. The outcome was defined as successful if the prepuce was retractable with completeexposure of the glans after 4 to 6 weeks of treatment and there was no recurrence at 6-month follow up.RESULTS: A total of 38 male children with mean age of 2.11±1.78 years (range, 3 months to 12 years)were allocated to treatment with topical steroid cream. Three patients were excluded for lost to followup. A successful result (i.e., full retraction of the foreskin), after 4 or 6 weeks treatment with topicalcream was achieved in a total of 29 (82.85%) patients. The remaining 6 patients (17.14%) showed noresponse. Three had circumcision. No significant local or systemic side effects were noted with theadministration of the topical steroidCONCLUSION: Treatment with topical application of 0.05% clobetasol propionate cream and skinstretching for 4-6 weeks is a safe, simple, and effective procedure with no significant side effects forsevere phimosis in boys.KEY WORDS: phimosis, topical steroids, circumcision

scholarly journals The dreaded osteonecrosis of femur following chronic steroid therapy: a case series from a dermatologist’s eye

2020 ◽  
Vol 6 (2) ◽  
pp. 264
Author(s):  
Abiram Ponnuswami ◽  
Cordelia Babitha S. ◽  
Krishnakanth Muralidhar ◽  
Murugan Sundaram
Keyword(s):  
Side Effects ◽  
Steroid Therapy ◽  
Lupus Erythematosus ◽  
Case Series ◽  
Oral Steroid ◽  
Oral Steroid Therapy ◽  
Autoimmune Dermatoses

<p>Corticosteroids, undoubtedly, is the saving grace of many patients ailing from a variety of inflammatory and autoimmune dermatoses. But it is not free of side effects, some being crippling enough to subject the patient to huge amounts of morbidity. Here we report a series of cases – Vesiculobullous diseases and Lupus Erythematosus - with prolonged oral steroid therapy that lead to osteopenia and osteonecrosis of the femur.</p>

scholarly journals Recent advances in understanding NRF2 as a druggable target: development of pro-electrophilic and non-covalent NRF2 activators to overcome systemic side effects of electrophilic drugs like dimethyl fumarate

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2138 ◽  
Author(s):  
Takumi Satoh ◽  
Stuart Lipton
Keyword(s):  
Side Effects ◽  
Specific Interaction ◽  
Dimethyl Fumarate ◽  
Carnosic Acid ◽  
European Medicines Agency ◽  
Related Factor ◽  
Inflammatory Phase ◽  
First Case ◽  
Systemic Side Effects ◽  
Transcriptional Pathway

Dimethyl fumarate (DMF) is an electrophilic compound previously called BG-12 and marketed under the name Tecfidera®. It was approved in 2013 by the US Food and Drug Administration and the European Medicines Agency for the treatment of relapsing multiple sclerosis. One mechanism of action of DMF is stimulation of the nuclear factor erythroid 2-related factor 2 (NRF2) transcriptional pathway that induces anti-oxidant and anti-inflammatory phase II enzymes to prevent chronic neurodegeneration. However, electrophiles such as DMF also produce severe systemic side effects, in part due to non-specific S-alkylation of cysteine thiols and resulting depletion of glutathione. This mini-review presents the present status and future strategy for NRF2 activators designed to avoid these side effects. Two modes of chemical reaction leading to NRF2 activation are considered here. The first mode is S-alkylation (covalent reaction) of thiols in Kelch-like ECH-associated protein 1 (KEAP1), which interacts with NRF2. The second mechanism involves non-covalent pharmacological inhibition of protein-protein interactions, in particular domain-specific interaction between NRF2 and KEAP1 or other repressor proteins involved in this transcriptional pathway. There have been significant advances in drug development using both of these mechanisms that can potentially avoid the systemic side effects of electrophilic compounds. In the first case concerning covalent reaction with KEAP1, monomethyl fumarate and monoethyl fumarate appear to represent safer derivatives of DMF. In a second approach, pro-electrophilic drugs, such as carnosic acid from the herb Rosmarinus officinalis, can be used as a safe pro-drug of an electrophilic compound. Concerning non-covalent activation of NRF2, drugs are being developed that interfere with the direct interaction of KEAP1-NRF2 or inhibit BTB domain and CNC homolog 1 (BACH1), which is a transcriptional repressor of the promoter where NRF2 binds.

scholarly journals A14 WIDE VARIATION IN CLINICAL MANAGEMENT OF PAEDIATRIC EOSINOPHILIC ESOPHAGITIS: A CANADIAN EXPERIENCE.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 16-18
Author(s):  
K A Bortolin ◽  
D Ashok ◽  
V Avinashi ◽  
J Barkey ◽  
D Burnett ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Eosinophilic Esophagitis ◽  
Online Survey ◽  
Treatment Algorithm ◽  
Elimination Diet ◽  
Practice Variation ◽  
Initial Diagnosis ◽  
Response To Therapy ◽  
Topical Steroids ◽  
Repeat Endoscopy

Abstract Background Eosinophilic esophagitis (EoE) is a chronic disorder treated by food elimination diet (FED), topical steroids and/or proton-pump inhibitors (PPI). Serial endoscopies and biopsies assess response to therapy. EoE management has evolved as guidelines are updated. Aims To identify practice variation among Canadian paediatric gastroenterologists (PG) who care for children with EoE. Methods An online survey using REDCap about decision-making in children with EoE was distributed to PG in Canada in November 2020. Results 62 PG completed the survey (response rate 69%, 62/94). The majority work in academic centres (92%). 3 centers indicated an accrual of &gt;50 new patients per year; 9/16 centres have &gt;100 patients in follow-up. An EoE Clinic is present in 5 centres. Diagnosis: Familiarity with the 2018 AGREE and 2020 AGA EoE guidelines was found to be 57% and 67% respectively. Criteria required to diagnose EoE according to current guidelines were correctly indicated by 42% of PG. (Figure 1). Endoscopy: The majority of PG (95%) adhere to guidelines in terms of required number and location of biopsies for the initial diagnosis. Ideal timing of repeat endoscopy after change in therapy in patients who are not in histological remission was 8–12 weeks by 67% of PG, timing in stable patients on maintenance therapy varied (33% only if patient is symptomatic). 25% used the EREFS Score in reporting endoscopic findings. Therapy: Improvement of symptoms was the highest ranked goal (64%), followed by remission of histologic findings (30%). A treatment algorithm was in place in 4 centers. The majority routinely assess adherence to therapy (73%) and consult a dietitian for FED (77%). Most (87%) do not consult an allergist for initial management. Preferred choices of 1st-line therapy varied among PG (Figure 2). When FED was selected, 32% of PG started with 1 food, 32% started with 2 foods, most frequently excluding dairy, followed by wheat. 14 (26%) start with ≥6 FED. Prescription of budesonide slurry was consistent among PG with doses of 1 and 2 mg/day in children &lt;10 and &gt;10 years, respectively. Conclusions The is the first Canadian study to assess the variation in management of children with EoE by PG. Overall, PG demonstrated good adherence to the guidelines in terms of initial diagnosis, but differences in maintenance therapy choice and timing of endoscopies. The results highlight a need for standardized management algorithms to deliver uniform care to this growing group. Grounding these guidelines in evidence will warrant a significant investment in further paediatric EoE research. Funding Agencies None

Focal vasculitic myositis as a primary manifestation of Behçet’s disease: a case series of 10 Korean patients in a locomotive medicine clinic

Rheumatology ◽  
2021 ◽  
Author(s):  
Du Hwan Kim ◽  
Sun Woong Kim ◽  
Seung Mi Yeo ◽  
Min-Soo Kang ◽  
Young Cheol Yoon ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Adult Patients ◽  
Oral Steroid ◽  
Imaging Findings ◽  
Behcet's Disease ◽  
Medicine Clinic ◽  
Oral Steroid Therapy

Abstract Objectives Muscle involvement in Behçet’s disease (BD) is rare, and several cases have been reported in the literature. Therefore, this study aimed to describe the clinical, laboratory and imaging findings in adult patients presenting with BD-associated myositis before the diagnosis of BD. Methods We retrospectively screened patients who visited a locomotive medicine clinic presenting with myalgia, local swelling, or tenderness of extremities without an established diagnosis of BD. We enrolled patients whose pain in the extremities was proven to be suggestive of focal vasculitic myositis and who were eventually diagnosed as having BD at the initial visit or during follow-up. We thoroughly reviewed the clinical, histological and imaging findings and treatment outcomes in patients who presented with focal vasculitic myositis as the primary manifestation of BD. Results Ten adult patients with focal vasculitic myositis as the primary manifestation of BD were enrolled. The lower and upper extremities were affected in eight and two patients, respectively. The affected lower extremities were the calf (n = 6) and thigh muscles (n = 2). The common findings of MRI included high signal intensity of the affected muscles and intermuscular fascia on fat-suppressed images, suggestive of myofascitis and oedematous changes in the subcutaneous layer. The results of skin or muscle biopsy were suggestive of vasculitis. All the patients were pain-free at the short-term follow-up (1–3 weeks) after oral steroid therapy. Conclusion Focal vasculitic myositis can be a primary manifestation of BD warranting medical attention. BD-associated myositis responds well to oral steroid therapy.

scholarly journals Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Caroline Michèle Andrist ◽  
Lukas Jörg ◽  
Thomas Greuter ◽  
Anna Gschwend ◽  
Alex Straumann ◽  
...  
Keyword(s):  
Hypersensitivity Reaction ◽  
Eosinophilic Esophagitis ◽  
Systemic Reaction ◽  
Chronic Inflammatory Disease ◽  
Delayed Hypersensitivity ◽  
Caucasian Woman ◽  
Case Presentation ◽  
Commercial Test ◽  
Delayed Hypersensitivity Reaction ◽  
Subsequent Intake

Abstract Background Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that has been known since the early 1990s. Swallowed topical corticosteroids (STC) belong to the therapeutic cornerstones. We describe a delayed hypersensitivity reaction to Jorveza®, a newly developed orodispersible budesonide tablet licensed for the treatment of eosinophilic esophagitis. Case presentation A 32-year-old Caucasian woman with EoE was newly treated with Jorveza®. Hours after the first intake, she felt a “strange pruritus” in the throat. This sensation worsened with each subsequent intake. On day 4 she developed oral mucosal symptoms (paresthesia of the tongue, sore and an itchy throat). Intraoral, throat and facial swellings, but no systemic reaction were observed. Patch testing using two commercial test series as well as the orodispersible budesonide tablet revealed a strong sensitization, proving a T cell mediated allergy to budesonide. Conclusions Orodispersible budesonide is increasingly prescribed for the treatment of eosinophilic esophagitis. The development of oropharyngeal symptoms after initiating should alert the treating physician to the possibility of a hypersensitivity reaction.

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