Study suggests asthma LABA medications do not increase severity of food allergy reactions during oral food challenges

New research from National Jewish Health suggests that long-acting beta-agonists (LABAs), commonly used in combination asthma inhalers, are not associated with more severe reactions during oral food challenges in children with asthma and food allergy. The study was recently published in the Annals of Allergy, Asthma & Immunology.

Oral food challenges (OFCs) have long been considered the gold standard for diagnosing food allergies. While generally safe when conducted in a medical setting, they can occasionally trigger allergic reactions. For years, guidelines have recommended withholding asthma medications that contain LABAs for at least eight hours before testing, based on concerns that the medication could delay respiratory symptoms and obscure early signs of a reaction.

However, in a retrospective review of 91 pediatric patients with asthma and food allergy who experienced an allergic reaction during an OFC between 2017 and 2023, researchers found no significant difference in reaction severity between children taking inhaled corticosteroids alone and those taking combination inhaled corticosteroid and LABA therapy.

“There has long been concern that LABA medications might mask respiratory symptoms during a food challenge,” said BJ Lanser, MD, senior author of the study and director of the Pediatric Food Allergy Program at National Jewish Health. “In our study, we did not see evidence that children taking combination inhalers experienced more severe reactions compared to those on inhaled steroids alone. These findings suggest that continuing asthma controller therapy may be appropriate in many cases.”

Among the 108 oral food challenges reviewed, most reactions were mild or moderate in severity. There were no statistically significant differences between the two groups in reaction grade, use of epinephrine, number of epinephrine doses required or presence of wheezing.

“Our findings highlight the importance of balancing theoretical risks with the real-world need for well-controlled asthma,” Dr. Lanser said. “Decisions about withholding or continuing LABA-containing medications before a food challenge should involve thoughtful discussion between clinicians and families.”

Researchers note that the study was retrospective and designed to evaluate association rather than causation. Larger prospective studies are needed to further evaluate the impact of LABA use on oral food challenge outcomes.

Reference:

Robillard, Kyle et al., Long-acting β-agonist (LABA) use in individuals with asthma is not associated with an increased severity of oral food challenge (OFC) reactions, Annals of Allergy Asthma & Immunology, DOI: 10.1016/j.anai.2026.01.006