Hope for When You’ve Accidentally Been ‘Glutened’

accidental gluten ingestionBudesonide possible treatment option for acute gluten exposure. 1

  • Therrien A, et al. in healio.com 2

A small case series conducted by 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.

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.

“Previous reports showed that budesonide may induce clinical and histologic response in refractory celiac disease,” they wrote. “Budesonide has been used also for the treatment of celiac crisis and as an adjuvant to the [gluten-free diet] at diagnosis.”

Researchers identified consecutive patients with celiac disease with an acute exposure treated with enteric-related budesonide. They included patients with biopsy-confirmed celiac disease (n = 12) or 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 (n = 1).

The primary outcome was patient-reported clinical response to budesonide, defined in terms of symptom severity and duration as “substantial,” “response” and “partial.”

Patients initiated budesonide therapy as soon as possible after gluten exposure and symptom onset. All patients reported a clinical response to the drug, including eight patients who reports substantial improvement to GI symptoms. Researchers wrote that most of the “partial” responses to budesonide were related to extraintestinal manifestations.

“We do not advocate steroid use for uncomplicated [celiac disease]; the patients included in this report were selected for a trial of budesonide because of severe, debilitating gluten reactions due to intermittent inadvertent exposures despite their best attempts to adhere to a [gluten-free diet],” Kelly and colleagues wrote. “Although this retrospective study lacks objective endpoints and various treatment regimens were used, we report that budesonide may be an attractive option to mitigate acute flares of symptoms related to gluten exposures in celiac disease, justifying future clinical trials.” – by Alex Young

Disclosures: Kelly reports 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.

1 What is Budesonide?
2 https://www.healio.com/gastroenterology/malabsorption/news/online/%7B3fab8571-4225-452f-8d77-5e78aafb6940%7D/budesonide-possible-treatment-option-for-acute-gluten-exposure

SOURCE ARTICLE: Therrien A, et al. Clin Gastroenterol Hepatol. 2019;doi:10.1016/j.cgh.2019.03.029.