Dr. Amy Nett: Absolutely, it will. Hydrocortisone, or cortisol, it suppresses the immune system, and specifically cortisol is going to suppress the B cell-mediated antibody production. The Cyrex tests rely on antibody production to help us determine whether or not someone has an intolerance to these foods, so if you’re suppressing their ability to generate antibodies, you’re going to end up with false-negative results. It’s going to look like the patient doesn’t have an intolerance, but that’s really just because you’re suppressing their ability to respond as they otherwise would to those antigens. I don’t think the Cyrex tests are reliable when a patient is taking oral steroids. When I have patients on topical steroids, I will run an immunoglobulin panel to see if their antibody production is adequate before I would run a Cyrex food sensitivity panel. You want to make sure they’re making adequate levels of immunoglobulins and see how much their immune system is suppressed. With taking oral steroids, you can run an immunoglobulin panel, but in general, I think Cyrex does not recommend doing the testing while someone is on an oral steroid.
The duration they need to be off, that’s going to vary on several factors, including how long they’ve been on the cortisol. That one could be worth doing a consult with Cyrex. You can call them and schedule a 15-minute clinical consult. You might want to gather the patient details and get their recommendations. Some patients can’t come off of their oral steroids, so it gets a little bit tricky, but another option is take them off for about a week or two weeks and then run an immunoglobulin panel to make sure that they have adequate levels. Just be aware that you’re going to get a higher false-negative rate.
Laura just said that she has talked to Cyrex, and they said steroids and CellCept will interfere with results, but not biological immune TNF suppressors like Humira. Yeah, that’s fair because, again, we’re looking at antibody production, so really you just want to make sure they have adequate levels of immunoglobulins. Thank you for letting us know.