Evidence map›Paper›PMID 27766109›Full record

ArticleAllergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology2016

Adrenal suppression in children treated with swallowed fluticasone and oral viscous budesonide for eosinophilic esophagitis.

Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Eosinophilic esophagitis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2024
    Review
  4. Review
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  6. Review
  7. Article
  8. Article
  9. Review
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  12. Paediatrics & child health · 2021
    Review
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  14. Article
  15. Review
  16. Correction to: Eosinophilic esophagitis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2019
    Article
  17. Review
  18. Review
  19. Diagnosis and Management of Eosinophilic Esophagitis.Immunology and allergy clinics of North America · 2018
    Review
  20. Eosinophilic esophagitis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2018
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Alexandra AhmetDivision of Endocrinology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada ; Department of Pediatrics, University of Ottawa, Ottawa, ON Canada.
Eric I BenchimolDivision of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada ; Department of Pediatrics, University of Ottawa, Ottawa, ON Canada ; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON Canada.
Ellen B GoldbloomDivision of Endocrinology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada ; Department of Pediatrics, University of Ottawa, Ottawa, ON Canada.
Janice L BarkeyDivision of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada ; Department of Pediatrics, University of Ottawa, Ottawa, ON Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAdrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS.

methodsIn this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month. First morning cortisol and low dose adrenocorticotropic hormone stimulation test (LDST) were performed 2 weeks following GC discontinuation. AS was defined as an abnormal LDST result (cortisol peak <500 nmol/L). We determined the prevalence and duration of AS related to swallowed topical GC therapy in EoE by LDST, as well as the diagnostic accuracy of first morning cortisol compared to LDST.

resultsOf 29 participants enrolled, 26 (89.7 %) received oral viscous budesonide and 3 (10.3 %) received swallowed fluticasone. Nineteen (65.5 %) participants had AS. Median duration of AS was 43 weeks. Five (17.2 %) participants had persistent AS at 12 months. There were no identifiable risk factors for the development of AS. First morning cortisol was highly specific but had poor sensitivity for detection of AS.

conclusionsThe majority of children with EoE had AS after discontinuation of swallowed topical GC therapy. Stress steroids should be considered in children treated with swallowed topical GC therapy for EoE, even after GC discontinuation, to prevent possible adrenal crisis.

Indexed as

Adrenal suppressionChildrenCohort studiesCortisolDiagnostic testsEosinophilic esophagitisGlucocorticoidTreatment

Identifiers

PMID27766109
PMCPMC5057375

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.