What are Swallowed Inhaled (Topical) Steroids? Fluticasone & Budesonide
No medication is currently FDA approved for treatment of eosinophilic esophagitis. All medications prescribed for EoE prescribed should be considered as off-label and experimental. Therefore any decision to start treatment and continued monitoring should be discussed carefully with your medical provider.
A common option for the treatment of Eosinophilic Esophagitis (EoE) is topical steroids, also known as swallowed inhaled steroid therapy. This treatment typically involves swallowing a steroid medication that was meant for inhalation to treat asthma. These medicines which are intended for treatment of inflammation within the lungs are now used to treat the inflammation seen in the esophagus.
Steroids have long been used as therapy to reduce inflammation seen in allergic diseases. First line therapy in persistent asthma is an inhaled steroid. Topical steroid ointments or creams are frequently used for treatment of eczema, another allergic condition. And for treatment of allergic rhinitis (nasal allergies) steroid sprays, such as Flonase, Nasonex, Rhinocort, etc are very often needed to control symptoms. Steroids have a wide range of effects to decrease number of allergy cells that are involved in the allergic inflammation.
Steroid therapy has been now for a number of years used for treatment of allergic eosinophilic esophagitis. Swallowed inhaled steroids may be used as sole therapy or in conjunction with some type of dietary restrictions. The two most commonly used and well studied steroid medications for EoE treatment are fluticasone (Flovent) and budesonide (Pulmicort).
Flovent (fluticasone) comes as a metered dose inhaler (MDI) which is the puffers that are manually pumped to dispense an aerosolized form of steroids. Usually swallowed fluticasone (Flovent) is taken by puffing directly into the mouth then dry swallowing.
Pulmicort (budesonide) can come in solution which for asthma is then inhaled by using a nebulizer machine to aerosolize the medication. Swallowed Pulmicort (budesonide) is combined with other components such as Splenda or Nutra to create a slurry which is then swallowed. This Swallowed budesonide (Pulmicort) Slurry may be used for those who may have more difficulty with dry swallowing fluticasone from an MDI. Another option is oral viscous mometasone which has been evaluated in this retrospective EoE study.
For those who are on swallowed steroids it is recommended not to eat or drink anything for 30 minutes after taking this medication so that it can provide optimal coating of the esophagus. Furthermore, anyone on these medications should swish and spit or brush their teeth after each use to remove any residual steroids in the mouth where it may have unwanted side effects.
These medications need to be prescribed by your physician. The doses for each of these medications depend on a person’s size and age among other factors.