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Celiac.com 04/16/2019 - A team of researchers from the Celiac Center at Beth Israel Deaconess Medical Center highlighted the potential of an enteric-release, oral budesonide as a treatment for acute reactions to gluten exposure in patients with celiac disease. The research team included Amelie Therrien, MD MSc, Jocelyn A. Silvester, MD PhD, Daniel A. Leffler, MD MSc, Ciaran P. Kelly, MD. They are variously affiliated with the Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston USA; the Celiac Research Program, Harvard Medical School, Boston USA; the Division of Gastroenterology, Hepatology and Nutrition, Boston Children Hospital, Boston USA; the Rady College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and with Takeda Pharmaceutical International Co, Cambridge, USA. Celiac Center physician, Ciaran Kelly, MD, and colleagues wrote that inadvertent exposure to gluten is still common even though patients specifically try to avoid it. Researchers report on a group of consecutive celiac patients with acute gluten exposure, who were treated with enteric-related budesonide. The group included 12 patients with biopsy-confirmed celiac disease, and one patient with potential celiac disease — defined as normal duodenal histology, elevated tissue transglutaminase antibodies, HLADQ2.5 or DG8 positivity and clinical response to a gluten-free diet. Researchers measured patient-reported clinical response to budesonide, defined in terms of symptom severity and duration as “substantial,” “partial,” or, simply “response." The patients started budesonide therapy as soon as possible after gluten exposure and symptom onset. All patients reported a clinical response to the drug, with eight patients reporting "substantial" improvement of GI symptoms. The team makes clear that they do not "advocate steroid use for uncomplicated [celiac disease]." The team notes that they selected patients for the budesonide trial based on severe, debilitating gluten reactions, due to intermittent accidental gluten exposure" despite following a [gluten-free diet],” the team wrote. Though the study lacks objective endpoints and includes varying treatments, budesonide can help to relieve serious symptoms of gluten exposures in celiac patients, justifying both this, and future, clinical trials, according to Dr. Alex Young. As a disclosure, Dr. Kelley notes that he served as a scientific advisory to Cour Pharmaceuticals, Glutenostics, Innovate, ImmunogenX, and Takeda. He also acts as a principal investigator on research grants on celiac disease supported by Aptalis and Takeda. Please see the full study for all other authors’ relevant financial disclosures. Clin Gastroenterol Hepatol 2019. doi:10.1016/j.cgh.2019.03.029.
So about a month and a half ago I got this awful rash that itched like crazy after some research and lots of reading web pages, blogs, forums I suspected that I have DH. I have had digestive problems for almost 4 years and could never figure out what it was that was making me run to the bathroom 20-30 min after eating!! So I went to the doctor on March 24th and she sent me for blood work (which came back negative for celiac) and then she gave me a steroid shot (as the creams did nothing for the itch) and with in about a week and a half the itch was gone and the rash was slowly fading. I went gluten free on April 1st and saw an immediate relief in my digestion problems (I can eat things now without the gluten bread and I have NO problems). How ever it has been a month since my shot and I was wondering if anyone knew how long the steroids would be in my system or how long until I have a backlash from the steroid? I did have a gluten meal the other day (ordered a gluten-free meal from Bob Evans and they totally screwed up...I didn't notice until I was home) and within 20 mins of eating it I was in the bathroom!!! So I am convinced I will be staying gluten-free for the rest of my life but anytime I have the slightest itch or red spot I freak out thinking that the rash is coming back!!! I hate waking up each morning wondering if today is the day the rash comes back!!!! Any help would be greatly appreciated!!!