Turns out it's allergy season around here, especially with all the olive trees blooming. Seems everyone is complaining of itchy watery eyes & runny stuffy nose, so we prescribe a lot of oral & ophthalmic antihistamines as well as intranasal steroids. But there's always someone who wants a course of oral steroids or a corticosteroid shot. It's the only thing that works for me, doc! I try to dissuade these patients of their request and point out (nicely) the folly of their shortsightedness. When used w/o oversight, the benefit of oral/injectable steroids is outweighed by their potential side effects, including but not limited to cataracts, diabetes, immunosuppression, osteoporosis & striae (stretch marks), etc.
What amazes me is that some of these patients still insist on getting their steroids. Well, as
I mentioned yesterday, take the medication only if you need it and only if the hoped for benefits outweigh the potential risks. Personally, I'm not convinced that the short-term gains are worth the long-term risks but I guess I've never been beset by allergies like this patients, so I shouldn't force my views on them but rather just provide education.
Well, along those lines, a
population-based nested case-control study was published yesterday in JAMA Internal Medicine, in which the authors concluded that
oral glucocorticoid use is linked to an increased risk of acute pancreatitis. Of note, the participants were 40-84yo Swedes of whom 6,161 cases of initial acute pancreatitis were compared to 61,673 controls, each selected based upon similar age, gender, and calendar period. Greatest risk for this exquisitely painful condition occurred 4-14 days after starting glucocorticoid therapy. Recent use & former use did not increase risk, nor did stopping use.
So be careful what you wish for. That short course of corticosteroids might relieve your allergies but could also potentially bring about some rather painful consequences. Granted that's a big step to assume cause & effect, which this study was not designed to do, but the association was strong and the outcome poor. So why take that risk unless you feel it's absolutely necessary? Caveat emptor.
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