Steroids Everywhere

If you have suffered with allergies or asthma for any time, you have likely been prescribed a steroid medication of some kind, either as a steroid nasal spray, a steroid inhaler, a steroid eye drop, a steroid cream, or even a steroid tablet or injection.

Are all these steroids safe?   Don’t they have a lot of side effects, cause woman to grow beards, athletes to hit home runs or go berserk, and make you fat?

A Brief Biochemistry Review

Steroids are a class of chemicals produced naturally by plants and animals.  There are hundreds of different steroids but in humans they fall into three general categories:  sex hormones, corticosteroids, and anabolic steroids.

The sex hormones include testosterone and estrogen and orchestrate much of our lives, often without us knowing it.

The anabolic steroids are a class of synthetic (man made) chemicals with properties similar to testosterone – both the good and the bad.

The corticosteroids include chemicals related to cortisol, an important hormone produced naturally by our adrenal glands and the only steroid class used to treat allergies.

Dealing with a Bad Day

Cortisol is a stress hormone; it’s job is to help us deal with stressful events in life. This stress response begins in a part of the brain called the hypothalamus.  When it senses stress or believes that it needs to get you ready for something stressful, the hypothalamus produces corticotrophin releasing hormone or CRH.  CRH tells the pituitary gland (the master control gland) to wake the adrenal gland up and get to work making more cortisol.   This link between our brain and adrenal gland is called the HPA or hypothalamus-pituitary-adrenal axis.

The HPA plays a very important role in helping us deal with life, from the day-to-day stress of just getting up in the morning to facing the trauma of a major illness or injury.

Cortisol To The Rescue

In fact, one of the most important jobs for cortisol is to regulate our immune system’s response to a serious illness.  Inflammation is the body’s way of dealing with injury and infection.  When we are fighting an infection, the inflammatory response recruits a powerful army of weaponized cells that search out and destroy an invading pathogen with an arsenal of deadly chemicals.  In injury, inflammation increases blood flow to the injured area and allows healing and clotting factors in the blood to move to the injured part (this is why an sprained ankle gets red and swollen). We could not survive without the armed forces of our immune defense and yet these same weapons can injure us if not carefully kept in check.  This is the role of cortisol.

Cortisol keeps inflammation from getting out of hand.   Inflammation that is inappropriate and gets out of hand is a pretty good definition for allergy. Wouldn’t it be nice if we had a medicine that could control this inappropriate inflammation?    Once we realized that our bodies were already making the perfect treatment for the problem of allergy, it was not long before the world of steroid medications was born.

The good news is that because our immune system is designed to be regulated by cortisol, corticosteroids are some of the most powerful medications currently available for the treatment of allergies and asthma.

The bad news is that our bodies are not designed to experience high levels of corticosteroids for more than a few days.  Some of the effects of cortisol that are likely beneficial during brief periods of extreme stress, such as regulation of fat and sugar metabolism, can cause excessive weight gain and problems with diabetes if used in high dose on a daily bases to control a chronic disease.

Topical use of a corticosteroid such as in a nasal spray, asthma inhaler, or cream, can have the same beneficial anti-inflammatory effect with minimal systemic  side effects.  High doses of topical steroids can still be a concern in some individuals, particularly children, were even small amounts of absorbed corticosteroid can have an effect on growth.  In all cases, the minimal amount of steroid for the shortest amount of time required to control symptoms is the goal.