Hypothalamic‐pituitary‐adrenal axis suppression and intranasal corticosteroid use: A systematic review and meta‐analysis

Sampieri, Gianluca; Namavarian, Amirpouyan; Lee, John J W; Hamour, Amr F.; Lee, John M.

doi:10.1002/alr.22863

Cited by 6 publications

(8 citation statements)

References 63 publications

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“…Oral mucosal diseases such as lichen planus, pemphigus, and pemphigoid are chronic diseases requiring long-term corticosteroid treatment [51]. Long-term use of high doses of topical corticosteroids can lead to adrenal and hypothalamic-pituitary-adrenal axis suppression [52,53].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional bioprinting of mucoadhesive scaffolds for the treatment of oral mucosal lesions; an in vitro study

2022

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Background Chronic oral lesions could be a part of some diseases, including mucocutaneous diseases, immunobullous diseases, gastrointestinal diseases, and graft versus host diseases. Systemic steroids are an effective treatment, but they cause unfavorable and even severe systemic side effects. Discontinuation of systemic corticosteroids or other immunosuppressive drugs leads to relapse, confirming the importance of long-term corticosteroid use. The present study aims to fabricate a mucoadhesive scaffold using three-dimensional (3D) bioprinting for sustained drug delivery in oral mucosal lesions to address the clinical need for alternative treatment, especially for those who do not respond to routine therapy. Methods 3D bioprinting method was used for the fabrication of the scaffolds. Scaffolds were fabricated in three layers; adhesive/drug-containing, backing, and middle layers. For evaluation of the release profile of the drug, artificial saliva was used as the release medium. Mucoadhesive scaffolds were analyzed using a scanning electron microscope (SEM) and SEM surface reconstruction. The pH of mucoadhesive scaffolds and swelling efficacy were measured using a pH meter and Enslin dipositive, respectively. A microprocessor force gauge was used for the measurement of tensile strength. For the evaluation of the cytotoxicity, oral keratinocyte cells' survival rate was evaluated by the MTT method. Folding endurance tests were performed using a stable microsystem texture analyzer and analytic probe mini tensile grips. Results All scaffolds had the same drug release trend; An initial rapid explosive release during the first 12 h, followed by a gradual release. The scaffolds showed sustained drug release and continued until the fourth day. The pH of the surface of the scaffolds was 5.3–6.3, and the rate of swelling after 5 h was 28 ± 3.2%. The tensile strength of the scaffolds containing the drug was 7.8 ± 0.12 MPa. The scaffolds were non-irritant to the mucosa, and the folding endurance of the scaffolds was over three hundred times. Conclusion The scaffold fabricated using the 3D bioprinting method could be suitable for treating oral mucosal lesions.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional bioprinting of mucoadhesive scaffolds for the treatment of oral mucosal lesions; an in vitro study

2022

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“…Studies have suggested that INCs do not significantly affect the hypothalamic–pituitary–adrenal axis in children (i.e. aged 3 or older) or adults 31–34 . However, several RCTs have studied the effects of INCs on the growth of children (i.e.…”

Section: Efficacy and Safety Of Intranasal Corticosteroidsmentioning

confidence: 99%

Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis

Rollema

Roon

Boven

et al. 2022

Clin Experimental Allergy

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This review presents an overview of the available literature regarding intranasal corticosteroids (INCs) for the treatment of allergic rhinitis (AR). Various treatment options exist for AR including INCs, antihistamines and leucotriene antagonists. INCs are considered to be the most effective therapy for moderate‐to‐severe AR, as they are effective against nasal and ocular symptoms and improve quality of life. Their safety has been widely observed. INCs are effective and safe for short‐term use. Local adverse events are observed but generally well‐tolerated. The occurrence of (serious) systemic adverse events is unlikely but cannot be ruled out. There is a lack of long‐term safety data. INC may cause serious eye complications. The risk of INCs on the hypothalamic–pituitary–adrenal axis, on bone mineral density reduction or osteoporosis and on growth in children, should be considered during treatment. Pharmacological characteristics of INCs (e.g. the mode of action and pharmacokinetics) are well known and described. We sought to gain insight into whether specific properties affect the efficacy and safety of INCs, including nasal particle deposition, which the administration technique affects. However, advances are lacking regarding the improved understanding of the effect of particle deposition on efficacy and safety and the effect of the administration technique. This review emphasizes the gaps in knowledge regarding this subject. Advances in research and health care are necessary to improve care for patients with AR.

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“…The relationship between upper and lower airway disease has long been debated, but there is compelling evidence that treatment of severe rhinosinusitis can improve asthma control, and treating the upper airway with nasal steroids and anti-histamines may be helpful before escalating asthma therapy ( 43 ). It should be noted that nasal steroids may, however, significantly contribute to adrenal suppression ( 44 ).…”

Section: Choosing the Right Medications For School Age Refractory Ast...mentioning

confidence: 99%

How to Choose the Correct Drug in Severe Pediatric Asthma

Bush

2022

Front. Pediatr.

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When a child with severe asthma (asthma defined clinically for the purposes of this review as wheeze, breathlessness, and chest tightness sometimes with cough) does not respond to treatment, it is important to be sure that an alternative or additional diagnosis is not being missed. In school age children, the next step is a detailed protocolized assessment to determine the nature of the problem, whether within the airway or related to co-morbidities or social/environmental factors, in order to personalize the treatment. For example, those with refractory difficult asthma due to persistent non-adherence may benefit from using budesonide and formoterol combined in a single inhaler [single maintenance and reliever treatment (SMART)] as both a reliever and preventer. For those with steroid-resistant Type 2 airway inflammation, the use of biologicals such as omalizumab and mepolizumab should be considered, but for mepolizumab at least, there is a paucity of pediatric data. Protocols are less well developed in preschool asthma, where steroid insensitive disease is much more common, but the use of two simple measurements, aeroallergen sensitization, and peripheral blood eosinophil count, allows the targeted use of inhaled corticosteroids (ICSs). There is also increasing evidence that chronic airway infection may be important in preschool wheeze, increasing the possibility that targeted antibiotics may be beneficial. Asthma in the first year of life is not driven by Type 2 inflammation, so beyond avoiding prescribing ICSs, no evidence based recommendations can be made. In the future, we urgently need to develop objective biomarkers, especially of risk, so that treatment can be targeted effectively; we need to address the scandal of the lack of data in children compared with adults, precluding making evidence-based therapeutic decisions and move from guiding treatment by phenotypes, which will change as the environment changes, to endotype based therapy.

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Hypothalamic‐pituitary‐adrenal axis suppression and intranasal corticosteroid use: A systematic review and meta‐analysis

Cited by 6 publications

References 63 publications

Three-dimensional bioprinting of mucoadhesive scaffolds for the treatment of oral mucosal lesions; an in vitro study

Three-dimensional bioprinting of mucoadhesive scaffolds for the treatment of oral mucosal lesions; an in vitro study

Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis

How to Choose the Correct Drug in Severe Pediatric Asthma

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