Asthma Inhalers & Food Allergy: LABAs Safe During Challenges | National Jewish Health

For parents of children navigating both asthma and food allergies, a recent finding offers a measure of reassurance. Modern research suggests that long-acting beta-agonists (LABAs), medications commonly found in combination inhalers used to manage asthma, do not appear to worsen allergic reactions during oral food challenges. The study, published in the Annals of Allergy, Asthma &amp. Immunology, challenges long-held recommendations to temporarily halt LABA use before these diagnostic tests.

Oral Food Challenges and Existing Concerns

Oral food challenges (OFCs) are considered the gold standard for diagnosing food allergies. During an OFC, a patient is given gradually increasing amounts of a suspected allergen in a controlled medical setting to determine if a reaction occurs. While generally safe when conducted by trained professionals, OFCs can trigger allergic responses. For years, medical guidelines have advised withholding LABAs for at least eight hours prior to an OFC, based on the worry that these medications might mask early respiratory symptoms, potentially delaying recognition of a reaction. LABAs function by opening airways in the lungs, and the concern was that this effect could hide the wheezing or shortness of breath that might signal an allergic response.

This new study, conducted by researchers at National Jewish Health in Denver, Colorado, sought to investigate whether these concerns were justified. The research team retrospectively reviewed data from 91 pediatric patients with both asthma and food allergy who experienced an allergic reaction during an OFC between 2017 and 2023. They compared the severity of reactions in children who were taking inhaled corticosteroids alone to those who were using a combination of inhaled corticosteroids and LABA therapy.

Study Findings: No Significant Difference in Reaction Severity

The analysis of 108 oral food challenges revealed that there was no significant difference in the severity of reactions between the two groups. Most reactions observed were mild or moderate. “There has long been concern that LABA medications might mask respiratory symptoms during a food challenge,” explained 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.”

This is significant because interrupting asthma controller medications, even for a short period, can potentially lead to a worsening of asthma symptoms. For children with both conditions, maintaining stable asthma control is crucial. The study’s findings suggest that the potential benefits of continuing asthma medication may outweigh the theoretical risk of masking allergic symptoms during an OFC.

What the Study Doesn’t Tell Us

It’s crucial to note the limitations of this study. As a retrospective review, it analyzed existing data rather than being a controlled experiment. This means the researchers were looking back at what had already happened, and couldn’t randomly assign patients to different treatment groups. This type of study can identify associations, but it cannot definitively prove cause and effect. There may be other factors that influenced the severity of reactions that weren’t accounted for in the analysis. The study focused on pediatric patients; the findings may not be generalizable to adults.

The researchers also acknowledge that their study doesn’t entirely eliminate the possibility that LABAs could subtly alter the presentation of allergic reactions. It simply didn’t find evidence of a significant impact on overall severity. The study also did not assess the impact of different types or dosages of LABAs.

Implications for Clinical Practice and Future Research

The findings from National Jewish Health are likely to prompt a re-evaluation of current guidelines regarding the withholding of LABAs before OFCs. While the current recommendations aren’t changing immediately, this research provides a strong rationale for further investigation. The American Academy of Allergy, Asthma & Immunology (AAAAI) publishes the Annals of Allergy, Asthma & Immunology, and the organization will likely consider these findings as it updates its practice parameters. You can find more information about AAAAI and allergy/asthma resources on their website: https://www.annallergy.org/.

National Jewish Health, a leading facility dedicated to respiratory, cardiac, and immune health, continues to conduct research in this area. Their website (https://www.nationaljewish.org/home) provides updates on their latest studies and clinical advancements. The hospital also hosts several events throughout the year, including the 48th Annual Financial Industries Dinner on March 3, 2026, and the Beaux Arts Ball on March 7, 2026.

What Comes Next: Guideline Updates and Ongoing Surveillance

The process of updating clinical guidelines is typically rigorous, involving a thorough review of all available evidence, consideration of expert opinions, and a period of public comment. It’s likely that professional organizations will convene expert panels to assess the implications of this study and determine whether a change in recommendations is warranted. Ongoing surveillance of OFC outcomes will also be important to monitor for any potential trends or signals that might suggest a previously undetected effect of LABAs. Further prospective studies, designed to specifically address the questions raised by this research, will be needed to confirm these findings and refine our understanding of the interaction between asthma medications and allergic reactions.

Parents and caregivers should continue to follow the guidance of their healthcare providers regarding asthma management and allergy testing. If you have concerns about your child’s asthma or food allergies, it’s essential to discuss them with a qualified clinician. This study offers a hopeful sign, but it’s not a substitute for personalized medical advice.