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

Morana Kosanoviæ-Bajiæ; Andrea Tešija; Maja Štrajtenberger; Ivica Lokner; Liborija Lugoviæ-Mihiæ

doi:10.5114/ada.2025.158100

eISSN: 2299-0046
ISSN: 1642-395X

Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii

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6/2025
vol. 42

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abstract:

Original paper

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

Morana Kosanoviæ-Bajiæ

¹

,

Andrea Kuna Tešija

²

,

Maja Štrajtenberger

¹

,

Ivica Lokner

¹

,

Liborija Lugoviæ-Mihiæ

³

Special Hospital for Pulmonary Diseases, Zagreb, Croatia
UHC Sisters of Mercy, Zagreb, Croatia
UHC Sisters of Mercy, School of Dental Medicine, University of Zagreb, Croatia

Adv Dermatol Allergol 2025; XLII (6): 594–598

DOI: https://doi.org/10.5114/ada.2025.158100

Online publish date: 2026/01/12

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AMA

Kosanoviæ-Bajiæ M, Tešija AK, Štrajtenberger M, Lokner I, Lugoviæ-Mihiæ L. Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2025;42(6):594-598. doi:10.5114/ada.2025.158100.

APA

Kosanoviæ-Bajiæ, M., Tešija, A. K., Štrajtenberger, M., Lokner, I.,  & Lugoviæ-Mihiæ, L. (2025). Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 42(6), 594-598. https://doi.org/10.5114/ada.2025.158100

Chicago

Kosanoviæ-Bajiæ, Morana, Andrea K Tešija, Maja Štrajtenberger, Ivica Lokner,  and Liborija Lugoviæ-Mihiæ. 2025. "Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 42 (6): 594-598. doi:10.5114/ada.2025.158100.

Harvard

Kosanoviæ-Bajiæ, M., Tešija, A., Štrajtenberger, M., Lokner, I.,  and Lugoviæ-Mihiæ, L. (2025). Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 42(6), pp.594-598. https://doi.org/10.5114/ada.2025.158100

MLA

Kosanoviæ-Bajiæ, Morana et al. "Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 42, no. 6, 2025, pp. 594-598. doi:10.5114/ada.2025.158100.

Vancouver

Kosanoviæ-Bajiæ M, Tešija A, Štrajtenberger M, Lokner I, Lugoviæ-Mihiæ L. Effects of inhaled corticosteroids on skin prick test
reactivity and adrenal function: a pilot assessment
of histamine response and cortisol biomarkers. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2025;42(6):594-598. doi:10.5114/ada.2025.158100.

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.

keywords:

inhaled corticosteroids, skin prick test, histamine reactivity, salivary cortisol, adrenal suppression, hypothalamic–pituitary–adrenal axis, asthma, allergy diagnostics

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

Morana Kosanoviæ-Bajiæ 1 , Andrea Kuna Tešija 2 , Maja Štrajtenberger 1 , Ivica Lokner 1 , Liborija Lugoviæ-Mihiæ 3

inhaled corticosteroids, skin prick test, histamine reactivity, salivary cortisol, adrenal suppression, hypothalamic–pituitary–adrenal axis, asthma, allergy diagnostics

Morana Kosanoviæ-Bajiæ

¹

,

Andrea Kuna Tešija

²

,

Maja Štrajtenberger

¹

,

Ivica Lokner

¹

,

Liborija Lugoviæ-Mihiæ

³