Medications During Infancy May Shape Future Allergy Risk
METHODOLOGY:
Researchers conducted a retrospective study using the US TriNetX Network to examine whether the use of acid-suppressive medications or antimicrobials during infancy influences the risk of developing allergic diseases in childhood.
They identified infants who were prescribed proton pump inhibitors (PPIs; n = 15,375), histamine 2 receptor antagonists (H2RAs; n = 42,913), at least one antibiotic course (n = 740,121), or three or more antibiotic courses (n = 163,098) during the first year of life and compared them with 1,510,074 infants who received none of these medications during their first 2 years.
Three allergic outcomes, namely anaphylaxis, food allergy, and atopic dermatitis, were assessed at 2 years of age.
TAKEAWAY:
Infants prescribed PPIs during their first year of life had more than a fivefold higher risk for food allergy (risk ratio [RR], 5.33; 95% CI, 4.97-5.71) and nearly a 2.5-fold higher risk for anaphylaxis (RR, 2.49; 95% CI, 1.40-4.41) by 2 years of age than unexposed infants.
Similarly, infants prescribed H2RAs had a 4.2-fold higher risk for food allergy (RR, 4.21; 95% CI, 4.01-4.41), a 1.4-fold higher risk for atopic dermatitis (RR, 1.41; 95% CI, 1.35-1.48), and nearly a 4.5-fold higher risk for anaphylaxis (RR, 4.48; 95% CI, 3.43-5.86) than unexposed infants.
Infants with at least one antimicrobial prescription during infancy showed nearly twice the risk for food allergy and more than twice the risk for both atopic dermatitis and anaphylaxis than unexposed infants.
Infants who received three or more antimicrobial prescriptions in their first year faced sharply elevated 2-year risks compared with unexposed infants — nearly 2.8-fold for food allergy, 3.4-fold for atopic dermatitis, and 3.7-fold for anaphylaxis.
IN PRACTICE:
'The composition of the gut microbiota is strongly associated with allergic manifestations, as the commensal bacteria in the gastrointestinal tract promote healthy development of the gut immune system with promotion of food tolerance,' the study authors wrote. 'Antibiotic exposure disrupts these microbial communities, which in turn affects individuals' immune response and likely increases their susceptibility for allergic manifestations,' they added.
SOURCE:
Mohamad R. Chaaban, with the Head & Neck Institute, Cleveland Clinic, Cleveland, was the corresponding author of the study, which was published online on May 30 in the Journal of Clinical Medicine .
LIMITATIONS:
The misdiagnosis of infant food allergies as gastroesophageal reflux disease and higher acid-suppressive medication use in more severe cases may have confounded the associations between these medications and food allergy.
DISCLOSURES:
This project was supported in part by the Clinical and Translational Science Collaborative of Northern Ohio, which is funded by the National Center for Advancing Translational Sciences of the National Institutes of Health. The authors reported having no conflicts of interest.
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