Food Allergies/Can entocort minimize pseudo-allergic response to food
QUESTION: I am a 60 year old woman who was diagnosed ~1 1/2 years ago with collagenous colitis (biopsy). I started Entocort (9 mg/day) almost 4 weeks ago. I will reduce the dosage to 6 mg/day next week. I have multiple food intolerances and could not eat fresh fruit, etc. Iíve these intolerances for many years. I addition, I am allergic (positive tests) to nuts, seeds, most foods that have proteins that cross-react with latex, etc. I am atopic and have minor asthma, as well as borderline extreme sleep apnea.However, I found that in the last week or so, I seem to be able to tolerate some fresh fruit without getting hives, or itching all over. However, these fresh fruits still triggered abdominal discomfort and diarrhea. I've been eating a substandard diet for so long. I would love to eat a more healthy balance of fruit and vegetables.I might be willing to tolerate some aggravated colitis symptoms if my pseudo-allergic response was minimized.
My question is: Can Entocort reduce food intolerances or even food allergies? If so, when I wean off Entocort in a few months will the intolerances return? Iím going this week to the dietician to try to make up a food plan with food that I can tolerate. But at this point, do I postpone the appointment and do a food elimination diet again? I did an elimination diet in Sept. and Oct and determined my C.C. as well as food intolerance triggers.What are your thoughts on my dilemma? I hadnít eaten the suspect foods in a long time. Do you think this holiday from hives is short-lived? I appreciate your considerate response to this issue.
ANSWER: You are actually asking very many questions. So much so, that this can only be addressed rather simply.
I have no idea what entocort is. I presume it is a corticosteroid. Tell me what it is in the standard international name and I could say more.. Unfortunately most drugs are sold in the US are not sold by their proper names, but rather by all numbers of different trade names.
Allergy to fresh fruits is part of a specific syndrome, called Fresh Fruit Syndrome in the UK and Oro-pharyngeal syndrome in the rest of Europe. US allergists seem little aware of it. Those that are, seem unaware of it's most significant features.(Those actually differ in different parts of Europe). It is characterized by the onset of mainly very rapid onset responses to fresh fruits (and occasionally celery). In one variant only is it associated with latex allergy. Sufferers nearly always have preceding seasonal rhinitis (grass pollen allergy in the UK and Southern Europe and birch pollen allergy in Scandinavia, Germany and possibly in Eastern Europe). I know of no such data from the US. Those reactions are usually restricted to the mouth and gullet, probably because the important allergens are broken down in the stomach acid. Ordinary skin tests with allergen extracts are always negative, but skin tests using a needle freshly stuck in a fruit will be positive. You cannot otherwise predict if any individual fruit will cause a reaction. There is no pattern of cross-reactivity between fruits. I think your colitis is almost probably not due to this.
Allergy to nuts is a quite separate issue, which is no more common in fruit allergy than in any one without. Standard skin prick tests are likely to be positive. Since peanuts are not actually nuts, they do not cross react with tree nuts. Some other so-called nuts are the same.
Personally, I think so-called elimination diets which involve eating virtually nothing, do more harm than good. They frequently lead to many foods being blamed and eliminated, when double blind challenge studies show that most "allergies" detected by this means are Psychogenic reactions induced by the therapists. Malnutrition often results.
Collagenous colitis is tricky. It is obviously very rare and I have never before heard of it, despite working alongside gastro-enterological specialists for many years. So, I looked it up just for you! From the described pathology it is extremely unlikely to be due to true allergy -that is an eosinophilic colitis, which would probably be easily distinguished on the biopsy (unless you were on steroids at the time however).
I have however seen an eosinophilic colitis induced by the use of the amino-salicylic acid commonly used to treat colitis. Such people do seem to improve along with their asthma on an aspirin/NSAID free diet and avoidance of structurally similar benzoate artificial food preservatives.
Steroids are a different issue. They will not affect any underlying allergy, but in high enough doses to cause significant systemic side effects, they will suppress immediate symptoms and alter the biopsy appearances. In particular, they will clear eosinophils from everywhere within minutes.
I hope this helps. You have a tricky problem. I would be pleased to help further if I can.
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QUESTION: Thank-you very much for your prompt and highly informative response. Here is some information on Entocort (Budesonide):
Budesonide is a corticosteroid structurally related to 16α-hydroxyprednisolone9. The drug has high topical antiinflammatory activity and low systemic activity as a result of its strong affinity for corticosteroid receptors and rapid hepatic conversion to metabolites with minimal biologic activity. Aerosolized budesonide is effective therapy for asthma and allergic rhinitis, and, when given as an enema, is as efficacious as other corticosteroids for distal ulcerative colitis. In these settings, few adverse events and little change in patients' adrenal function have been noted.
Budesonide has been formulated into a coated-capsule preparation (Entocort CIR, Astra Draco, Lund, Sweden) that facilitates delivery of the medication to the terminal ileum and proximal colon, the most common sites of Crohn's disease. This preparation minimizes proximal drug absorption and allows a high concentration of drug to come in contact with inflamed intestinal mucosa...
I normally exhibit symptoms of oral mouth allergy in response to consumption of fresh cherries, for example. I have had numerous positive skin tests using the needle in the fresh fruit method as youe have described: kiwi (4) , banana (3),eggplant (3),avocado (4),nectarine (3), etc as you have mentioned.I wasn't tested for a large number as a large range of fresh fruits were not available at the time in the supermarket.
I have not heard of any connection betwwen allergies and colitis.
I'm taking budesonide to help reduce the inflammation in the colon and rectum. Budesonide(oral) can also be given to treat allergies.(
). Therefore is it possible that the Budesonide is incidentally ( and temporarily) helping me tolerate more foods?
ANSWER: Your recent response got lost in cyberland. Sorry about the delay.
Thank you, budesonide is a medication I know well (I take it for asthma myself).
The overwhelming majority of colitis has nothing to do with allergy. Neither has Irritable Bowel Syndrone (IBS). But, I am probably the only person alive (apart from my research colleagues)that has proven, that just extremely rarely, it can be.
I doubt that intra-rectal budesonide is going to affect your respiratory allergies. But rectal budesonide has never been released in my part of the wotld, so I cannot exclude that it might. The manufacturers claim it is unlikely to cause systemic side effects. From only my personal experience, I simply do not believe that. In other words, while I doubt it likely, I cannot properly totally exclude it. Medicine is the art of deciding between the impossible, the improbable and (only very occassionally) the certain. I am rarely good enough to support the last.
Get back if you like.
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QUESTION: Thank-you. Iím taking oral Entocort capsules (Butesonide,) not rectal. Iíve been eating some foods lately that would normally have me reaching for the Hydoxyzine. However, Iím not experiencing the usual allergic symptoms. I can't understand. it . If I weren't going to the dietician this week to have a semblance of a normal diet plan made up, I wouldn't be spending my time playing around with food intolerance/allergies and bothering you with all these inane questions. I'm sick and tired of restricting foods. I would love to be able to eat out once in a while without staying up half the night itching to death.I have sleep apnea and sleep with a miserable full face mask.. Therefore the other half the night I usually have trouble sleeping. I also have excessive daytime sleepiness and must take Ritalin during the day to stay awake. Iím not allowed to drive without Ritalin in my system . Imagine it being illegal to drive without drugs in your system... In any case, sorry to go off topic.
p.s. I can't seem to see the complete page, including all questions and answers. There must be a glitch in your site.
You are not wasting my time. Your problems are causing you great distress, whatever their cause. To get upset by them does not make you insane or neurotic, just normal! Of course you want to get to the bottom of things, I would.
I think you seeing a dietician soon is a good idea. Not least because, although I have spent many years investigating food allergy, I do not think that elimination diets are always the best answer. It is relatively easy to avoid a single food, such as milk, or gluten. BUT, once people (rightly or wrongly) start eliminating multiple foods, malnutrition becomes an increasingly serious problem. I have published many examples of people on such restricted diets suffering a variety of illnesses due to dietary deficiency. Therefore, if nothing else, a professional dietician can help you assure a nutritionally adequate diet to prevent new problems in the future.
I am happy to accept that you do indeed have at least some food allergies, but! One thing about Fresh Fruit Syndrome is that whatever it is in fresh fruit that acts as an allergen, it is extremely labile (I.e. it's tertiary structure breaks down so rapidly and easily that it ceases to stop being "allergic". Does that mean you can never eat those foods? Not a bit of it. The overwelming majority of sufferers can have the same foods when they are no longer "Fresh". So, tinned or tinned fruit are just fine and still keep their vitamin C. Also, most carton fruit juice comes from concentrates and that process destroys the critical allergen #and most of the beneficial anti-oxidants by the way#. Carton and canned fruit juices probably do not have the health benefits of eating fresh fruit or drinking it's juice If your dietician disagrees (He /She probably will - just tell her to do some homework, or contact me). A fruit-free diet is therefore only very rarely necessary. Tree nuts may well be good for you because of their high selenium content, but hardly an essential part of the human diet.
The biggest part of the problem as I understand it,is your gut problem, which only just might be related to the fact you have allergies and may well have no relationship to what you eat (virtually all colon problems can be made worse by just eating anything). So, a very important question is whether or not you had taken any steroids before you had your biopsy done. If you had, then a repeat biopsy several weeks after you have had no steroids might contain inflammatory cells which could be useful in clarifying the situation. If there were still none and it again shows merely collagen deposition without inflammatory inflammation, then I would accept that those problems are not going to be related to your diet.
And, another resort - asking for a second opinion. No reasonable doctor would refuse such a request in such circumstances. Unless they have a big ego problem themselves of course. And if that is the case I would change my doctor anyway. I'm all for patient-empowerment!
You are welcome to get back any time.