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Abstract

We appreciate the feedback and clarification from Harel et al, who studied the prevalence of adrenal suppression among children treated with oral viscous budesonide for eosinophilic esophagitis.1Harel S. Hursh B.E. Chan E.S. Avinashi V. Panagiotopoulos C. Adrenal suppression in children treated with oral viscous budesonide for eosinophilic esophagitis.J Pediatr Gastroenterol Nutr. 2015; 61: 190-193Crossref PubMed Scopus (48) Google Scholar Using low-dose adrenocorticotropin stimulation testing, adrenal suppression was found in 6 children, 3 of whom were also treated with inhaled glucocorticoids. Two children showed improved cortisol levels following discontinuation of budesonide, further supporting the etiology of adrenal suppression. We acknowledge that the possibility of adrenal insufficiency should not be excluded in those treated with swallowed budesonide. Cumulative exposure to glucocorticoids, swallowed or inhaled, should be taken into account when determining risk for adrenal insufficiency. Our summary statement reflected the observations from our cohort. Taken together, these observations suggest a need for a multicenter prospective study on the effect of multiple steroid regimens on adrenal function in eosinophilic esophagitis. Adrenal insufficiency exists for both swallowed budesonide and fluticasone propionate in the treatment of eosinophilic esophagitisThe Journal of PediatricsVol. 174PreviewThe report by Golekoh et al1 examined the prevalence of adrenal insufficiency in children with eosinophilic esophagitis treated with swallowed fluticasone propionate (FP) or budesonide and found that all patients on budesonide had normal testing. This contrasts with our study,2 in which we documented an adrenal insufficiency prevalence of 43% with budesonide. They consequently explain these contrasting results by suggesting that our study population was treated concomitantly with inhaled corticosteroids for asthma. Full-Text PDF