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Steroids (For Allergies) And Endoscopy?

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Posted 10 May 2013 - 07:51 AM

I'm new here, but I've been reading this forum for a while. I'm seeing my doctor in two weeks to discuss celiac testing. I'm 37 years old and have had many, many symptoms for my whole life and was given a lot of misinformation whenever I asked previous doctors about celiac or food allergy testing. (One doctor told me that I'd have died as a child if I had undiagnosed celiac, and that it was a ridiculous idea and she'd never order the tests. Another doctor said that the incredibly itchy rash covering my entire torso, which I had for years on end, did not require further investigation and would go away as soon as I "stopped worrying about it so much".) I finally have a doctor who seems willing to take my concerns seriously, and I want to make sure my test results are as accurate as possible.


I've gotten mixed results with food allergy tests. I had clear positive skin pricks for wheat and several other foods, but negative blood allergy tests for those same foods. On my skin pricks, I had very large red flares around half the fruit and vegetable prick sites but no wheals; this was considered negative, but it was unusual and didn't just indicate general skin irritability because the saline control spot and half the others had no flare. Anyhow, the allergist concluded that I did not have a wheat allergy because of the negative IgE test, and she said the positive skin pricks were just from cross-reaction to environmental allergens (which I know I have). I'm not entirely confident about that assessment, but I've had so many weird and inconclusive test results for various things over the years that I'm used to it.


I stopped eating wheat after the allergy tests anyway, and within days many of my long-standing problems were definitely improving. After several weeks I started eating a little wheat again while taking antihistimines, and the symptoms returned. My stomach bloated up even more than before, and it looked like I was six months pregnant just from one meal of wheat. Having this reaction while on antihistimines seemed like pretty clear evidence that a wheat allergy alone (if indeed I have one) couldn't be the whole problem. At that point I switched to a new primary care doctor and started eating small amounts of wheat again every day because I want the celiac tests to be accurate. 


My immediate question is about the effect that small amounts of topical cortisone cream or a one-time pill dose of prednisone might have on celiac blood tests or an endoscopy.


I've been using a tiny dab of cortisone cream on a rash spot on my face every day. It doesn't make the rash go away, but it makes it less red. I can do without it, but it's a tiny amount and the rash is embarrassing because it's so visible on my face. Should I stop using it completely? For how long?


Also, I get monthly allergy shots for environmental allergens, and after an full year on the maintenance dose my whole arm still swells up hugely after the shot unless I take two antihistimines and one prednisone pill first. I started to have breathing difficulty after the shot without the prednisone once, and it was scary so my allergist said to just routinely take the predinose on shot days from now on. I can take up to four doses on prednisone if needed, but I've never needed more than two and I'm willing to stick to just one even though it means dealing with the swelling longer. However, I'm very nervous about doing the allergy shot without that one dose. I do have an epi-pen and could treat myself for anaphylaxis until I got to a hospital, but that's the last thing I need right now! If I go more than 42 days between shots, the whole five-year process becomes invalid and I'd have to start all over again. My environmental allergies are pretty severe, so I really don't want to abandon the process. I can try to schedule the celiac tests so they're as close as possible to the 42-day cut-off since I've last had prednisone, but will one dose of prednisone five weeks earlier make the test results invalid? And do steroids affect blood test results too, or just the endoscopy? 


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Posted 10 May 2013 - 10:08 AM

I have heard that steroids can affect celiac endoscopic testing but I have no idea where or if it is even correct... Perhaps others can point you in the right direction on that.


It sounds like you have a reasonable plan for the celiac testing. Perhaps you can contact your doctor about the effect the steroids will have on testing? Perhaps contact the doctors performing the endoscopy too.


Good luck with testing. Try not to minimize your gluten intake too much before testing so your results are as accurate as possible.

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Posted 10 May 2013 - 03:29 PM

Yes, steroids can give a false negative for celiac testing. I have a citation somewhere - I think it's in the new guidelines for dxing children without scoping. There's a flow chart and at the end is "steroid use?" under a negative tests when all evidence points to positive.

I'm not in a position to search for the doc now, but you may find it by searching.

I don't know how much steroid is enough to interfere with testing. I've wondered, too. I was given mega doses, so it wouldn't have mattered. I also used topical cream and while the concentration was low, the results when the cream was withdrawn was dramatic. So, I don't know how much was circulating but it had a massive effect on my dh.

Perhaps you could time testing right at one month after your shot? Perhaps try going without the cream and see how it goes?
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Apparently there is nothing that cannot happen today. ~ Mark Twain

Probable Endometriosis, in remission from childbirth since 2002.
Hashimoto's DX 2005.
Gluten-Free since 6/2011.
DH (and therefore Celiac) dx from ND
Responsive to iodine withdrawal for DH (see quote, above).

Genetic tests reveal half DQ2, half DQ8 - I'm a weird bird!



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Posted 11 May 2013 - 08:07 AM

Thank you both!

I've stopped using the cortisone cream for now and will try to make the best of it until I'm tested. I'm sure my allergist will say to definitely take the prednisone pill, even if my other doctor says it's better not to. If necessary, I'll just try to space the testing out as far as possible after my last allergy shot, though I have limited control over how things are scheduled.
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Daughter: Positive tTG-IgA, DGP-IgA, and DGP-IgG. Celiac confirmed by biopsy in June 2013, at age four. Clear gastrointestinal, behavioral, and neurological/sensory symptoms since very early infancy, even when exclusively breastfeeding.

Me: Diagnosed by GI with "presumed celiac" based on health history, celiac in family, and resolution of fat malabsorption and many other symptoms on gluten-free diet. Long history of eczema, chronic diarrhea, steatorrhea, ataxia, peripheral neuropathy, infertility, chronic insomnia, low cholesterol, vitamin deficiencies, and joint pain. Negative celiac tests after 15 years gluten-light and then a brief but awful gluten challenge. 

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