ICS/LABA Not Linked to Increased Oral Food Challenge Reaction Severity: Study
USA: Current recommendations advise withholding long-acting beta-agonists before conducting an oral food challenge (OFC). However, recent findings of a study show that the severity of OFC reactions in patients using a combination of inhaled corticosteroids and long-acting beta-agonists (ICS/LABA) did not significantly differ from those using inhaled corticosteroids (ICS) alone. The odds of experiencing more severe reactions were similar between both groups, suggesting that ICS/LABA therapy may not increase reaction risk.
These results, published in the Annals of Allergy, Asthma & Immunology, provide reassurance regarding the safety profile of ICS/LABA in this context.
Oral food challenges are the gold standard for diagnosing IgE-mediated food allergies. Although generally safe, severe reactions can occur, particularly in individuals with poorly controlled asthma, adolescents and young adults, or when reactions happen outside supervised settings.
Current guidelines recommend withholding long-acting beta-agonists (LABAs) for at least eight hours before an OFC, but this advice is based on limited evidence. Earlier studies showed that LABAs like salmeterol can produce prolonged bronchodilation for up to 12 hours, raising concerns that they might delay or mask early respiratory symptoms during an allergic reaction.
However, this creates a clinical challenge, as good asthma control is crucial for safe and accurate OFC interpretation. For many patients, especially those with moderate to severe asthma, LABAs are essential for maintaining stability. Withholding them before testing may therefore compromise respiratory control and introduce additional risks.
To address this gap, the study led by Kyle Robillard and colleagues from the University of Texas Southwestern Medical Center evaluated whether LABA use influences the severity of reactions during OFCs. The researchers compared outcomes between patients receiving ICS/LABA combination therapy and those treated with ICS alone.
The analysis found the following:
- No significant difference in reaction severity was observed between patients using ICS/LABA and those using ICS alone.
- The likelihood of experiencing more severe reactions was similar in both groups.
- LABA use did not worsen or intensify allergic responses during oral food challenges.
- The findings question the routine practice of withholding LABAs before OFCs.
- Continuing LABA therapy may not adversely affect the safety of oral food challenges.
The results hold practical implications for clinical practice. By demonstrating that LABAs do not appear to increase the severity of OFC reactions, the study provides clinicians with evidence that may help refine existing guidelines. It also highlights the importance of balancing medication adjustments with the need to maintain adequate asthma control.
The authors emphasize that a clearer understanding of how asthma therapies interact with allergy testing protocols is essential for improving patient care. Further research may help determine whether current recommendations regarding LABA withholding should be reconsidered, potentially simplifying pre-test preparation while ensuring patient safety.
Reference:
Robillard K, Crooks JL, Leung D, Hui-Beckman JW, Lanser BJ. Long-acting β-agonist (LABA) use in individuals with asthma is not associated with an increased severity of oral food challenge (OFC) reactions. Ann Allergy Asthma Immunol. 2026 Jan 18:S1081-1206(26)00023-2. doi: 10.1016/j.anai.2026.01.006. Epub ahead of print. PMID: 41558625.
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