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Steroids and DTPA Chelation. Beware: Steroids are not a substitute for further chelation.

As everyone who reads my blogs and have read my peer-reviewed papers, I regularly (always) use steroids and antihistamines to manage the Flare reactions from DTPA chelation of GDD. I use them however in a tapered fashion, such that individuals start the regimen 2 - 0 days before chelation and continue for about 5-7 days post chelation. Some wiggle room to continue very low dose steroids ( 4 mg methylprednisolone) for a lengthier time period,, which includes continuous.

Now more recently I have instituted in individuals who experience relatively severe re-equilibration Flare, during the third week of a four week interval chelation regimen, they can start the pre-chelation steroids for the third week, and preferably at a dose of 4 mg- 8mg methylprednisolone to dampen the re-equilibration Flare prior to chelation.

The use of antihistamine / steroid regimen has been employed for acute hypersensitivity reaction (AHR) for GBCAs, iodine contrast in CT, and for many other drugs that have a high AHR association, such as a number of cancer drugs. Steroid tapers are used for many other indications: migraine, severe poison ivy, allergic dermatitis, severe bug bites and bee/wasp stings. This has been used for atleast 50 years, and perhaps 100 million to 1 billion times over that period

. A few individuals have told me they do not want to take steroids and from that I manage that in 3 ways: convince them steroids are safe, try alternatives, don't treat them. Many have also asked me if there is an alternative to steroids, and I generally tell them, a steroid taper is highly effective, been used in well over a million individuals, and very safe ... if there was a more specific, safe and equally effective immune dampening method I would use it, there isn't.

This chelation steroid regimen though uses steroids in a relatively low dose and tapered fashion. Some individuals have used steroids to manage re-equilibration Flare and sometimes in relatively high dose > 32 mg/ day and in a constant fashion. Usually it is because of severe re-equilibration Flare, and that they have stopped chelation for any of a number of reasons. money being the most common, Prior to the use of effective chelation for GDD, historically many patients did take high dose steroids to manage the pain of GDD. In both these cases a number of them developed the sequelae of using steroids: Cushing appearance, obesity, high blood pressure.. Excess steroids can lead to GI ulcers, avascular necrosis of bone, diabetes... in short a considerable number of bad things.

I never recommend long term steroids on their own, particularly at higher doses, to manage GDD.. Currently the most common reason individuals have done this is to manage re-equilibration Flare. The treatment for re-equilibration Flare is repeat DTPA chelation to capture and arrest ongoing and escalating Flare.

Occasional use of 4 mg or 8 mg of methylprednisolone for random Flare reactions is fine and appropriate. Long term high dose steroid to manage re-equilibration Flare can be dangerous, as it lends itself to the plethora of different forms of steroid toxicity.

Re-equilibration Flare is best treated with repeat chelation, which can also be done as low dose chelation if the individual is attempted to stop ongoing long term chelation.

Richard Semelka, MD

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