Associations of aeroallergen testing with reduced oral corticosteroid bursts among adults with asthma

Background

Aeroallergen testing can improve precision care for persistent asthma. How testing benefits diverse populations of adults with asthma and the importance of the aeroallergen sensitization and test modality used remain poorly understood.

Objective

We evaluated whether aeroallergen testing was associated with a reduction in oral corticosteroid (OCS) bursts.

Methods

We used electronic health record data to conduct a retrospective cohort study of adults with asthma who were prescribed an inhaled corticosteroid and had an allergy/immunology visit in a large health system between January 1, 2017, and June 30, 2022. We used negative binomial regression models to evaluate whether testing was associated with fewer OCS bursts in the 12-month period after an initial visit among all patients and those without chronic obstructive pulmonary disease (COPD) and smoking histories. We then repeated these analyses while considering effects of sensitization to aeroallergen categories and whether the testing was via skin prick or serum-specific IgE.

Results

A total of 684 (48.4%) of 1,412 patients underwent testing. Testing was not associated with fewer bursts overall (incidence rate ratio [IRR] = 0.84 vs no testing, P = .08), but it was among never smokers without COPD (461 of 927 tested, IRR = 0.69, P = .005). Among never smokers without COPD, sensitization to 5-7 aeroallergen categories (IRR = 0.57 vs no test, P = .003) and receipt of skin prick tests (IRR = 0.58 vs no test, P < .0005) were associated with fewer bursts.

Conclusion

Aeroallergen testing was associated with reduced OCS bursts among adults with asthma who were never smokers without COPD. This association varied according to aeroallergen sensitization and test modality used.