Should inhaled corticosteroids be stopped during specific inhalation challenges?
Published online July 31, 2024
Specific inhalation challenges (SIC) are the current reference tests to diagnose sensitizer-induced occupational asthma (OA). They consist of exposing a worker to a suspected occupational agent to induce an asthmatic reaction for confirming the diagnosis of OA. A large proportion of the workers suspected of OA are treated with moderate to high doses of inhaled corticosteroids (ICS). Inhaled corticosteroids have a protective effect on the asthmatic reaction triggered by allergen exposure. This effect has mainly been described in steroid-naïve subjects with mild asthma. A consensus statement published by the European Respiratory Society (ERS) regarding SIC testing recommends stopping ICS at least 72h prior to a SIC. However, the impact of an ongoing long-term treatment with a moderate to high dose of ICS on an asthmatic reaction triggered by occupational agents has not been well described.
In a recent study published in The Journal of Allergy and Clinical immunology: In Practice, Lavoie and Lemiere explored the effect of maintaining an ICS treatment during a SIC on the asthmatic reaction (magnitude of the asthmatic reaction, change in airway responsiveness or in eosinophilic inflammation) induced by the exposure to an occupational agent. They conducted a retrospective study, using a database of cases suspected of sensitizer-induced OA referred to the Hôpital du Sacré-Coeur de Montréal, Québec, Canada, between 1999 and 2022.
The study included 671 subjects who underwent a SIC. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The subjects treated with ICS had been taking a mean daily dose of 653 ± 338 mcg of fluticasone or equivalent for a mean of 1.59±3.54 years at the time of the SIC. The continuation of ICS during SIC did not have a significant impact on its outcomes including the magnitude of the asthmatic reaction, the change in airway responsiveness, or in eosinophilic inflammation.
These findings suggest that an ongoing ICS treatment during a SIC does not significantly affect the occurrence of an asthmatic reaction after exposure to the suspected agent in workers who have been treated with ICS for a long period of time. Therefore, clinicians can safely pursue a treatment with ICS during a SIC in patients whose asthma may be at risk of becoming uncontrolled in case of the interruption of treatment with ICS.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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