Effects of inhaled corticosteroids on skin prick test reactivity and adrenal function: a pilot assessment of histamine response and cortisol biomarkers.

INTRODUCTION

Inhaled corticosteroids (ICS) are the cornerstone of asthma and allergic rhinitis management, but concerns regarding their potential systemic effects, including suppression of skin reactivity and hypothalamic-pituitary-adrenal (HPA) axis function.

AIM: To evaluate the impact of ICS on skin prick test (SPT) results and endogenous cortisol levels in adults with allergic conditions.

MATERIAL AND

METHODS

This pilot observational study included 24 adults with allergic conditions. Clinical data, ICS therapy parameters, SPT with histamine control, and salivary and serum cortisol levels were collected and analysed.

RESULTS

ICS use was not associated with significant alterations in histamine-induced skin reactivity. A borderline inverse correlation was observed between ICS duration and salivary cortisol levels (r = -0.405, p = 0.05), while serum cortisol remained unaffected. Salivary and serum cortisol levels were strongly correlated (r = 0.719, p < 0.001). Participants using additional corticosteroid-containing medications had significantly lower salivary cortisol (p = 0.049).

CONCLUSIONS

ICS at standard doses do not appear to suppress skin reactivity on SPT, supporting their continued use during allergy evaluation. However, prolonged ICS use may lead to subtle HPA axis suppression, highlighting the utility of salivary cortisol as a noninvasive monitoring tool.