PPIs, H2RAs in infants raise later allergy risk

 

Children prescribed histamine₂-receptor antagonists (H₂RAs), proton pump inhibitors (PPIs), or antibiotics during the first 6 months of life may be at greater risk of developing allergic disease, research suggests.

A retrospective cohort study looked at the incidence of subsequent allergic disease in 792,130 children, 7.6% of whom were prescribed an H₂RA, 1.7% were prescribed a PPI, and 16.6% were prescribed an antibiotic during the first 6 months of life.

Children who were prescribed a H₂RA or a PPI had a greater than twofold higher incidence of food allergy (adjusted hazard ratios 2.18 and 2.59, respectively), reported Edward Mitre, MD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and his coauthors, reported in the April 2 online edition of JAMA Pediatrics.

In particular, the use of acid-suppressing medications was associated with a 2.4-fold increase in the risk of being diagnosed with cow’s milk allergy, while the risk of egg allergy was 74% higher in children prescribed an H₂RA and 35% higher in children prescribed a PPI. In children prescribed an H₂RA, the risk of peanut allergy was 21% higher, and in children prescribed a PPI, it was 27% higher.

There also was a dose-dependent interaction between the duration of medication and risk of food allergy. Children who were prescribed more than 60 days of PPIs had a 52% higher risk than did those who were prescribed 1-60 days, and a similar but slightly lower increased risk was seen in those prescribed more than 60 days of H₂RAs (hazard ratio, 1.32).

Acid-suppressing medication use also was associated with an increased risk of nonfood allergies, in particular medication allergy (adjusted HR, 1.70 for H₂RAs and 1.84 for PPIs), allergic rhinitis (aHR, 1.50 for H₂RAs and 1.44 for PPIs), anaphylaxis (aHR, 1.51 for H₂RAs and 1.45 for PPIs).

Infants prescribed acid-suppressing medication also showed higher rates of asthma, allergic conjunctivitis, and urticaria during childhood.

 

The use of antibiotics in the first 6 months of life was associated with a 14% higher incidence of food allergy but with a 24% higher risk of cow’s milk allergy and egg allergy. Children prescribed antibiotics also had a twofold greater risk of asthma, a 51% higher risk of anaphylaxis, 42% higher risk of allergic conjunctivitis, and a 34% higher risk of medication allergy.

“This study adds to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic disease,” said Dr. Mitre and his coauthors. “Thus, this study provides further impetus that antibiotics and acid-suppressive medications should be used during infancy only in situations of clear clinical benefit.”

No funding source or conflicts of interest were declared.

SOURCE: Mitre E et al. JAMA Pediatrics. 2018 Apr 2. doi: 10.1001/jamapediatrics.2018.0315.

 

Children prescribed histamine₂-receptor antagonists (H₂RAs), proton pump inhibitors (PPIs), or antibiotics during the first 6 months of life may be at greater risk of developing allergic disease, research suggests.

A retrospective cohort study looked at the incidence of subsequent allergic disease in 792,130 children, 7.6% of whom were prescribed an H₂RA, 1.7% were prescribed a PPI, and 16.6% were prescribed an antibiotic during the first 6 months of life.

Children who were prescribed a H₂RA or a PPI had a greater than twofold higher incidence of food allergy (adjusted hazard ratios 2.18 and 2.59, respectively), reported Edward Mitre, MD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and his coauthors, reported in the April 2 online edition of JAMA Pediatrics.

In particular, the use of acid-suppressing medications was associated with a 2.4-fold increase in the risk of being diagnosed with cow’s milk allergy, while the risk of egg allergy was 74% higher in children prescribed an H₂RA and 35% higher in children prescribed a PPI. In children prescribed an H₂RA, the risk of peanut allergy was 21% higher, and in children prescribed a PPI, it was 27% higher.

There also was a dose-dependent interaction between the duration of medication and risk of food allergy. Children who were prescribed more than 60 days of PPIs had a 52% higher risk than did those who were prescribed 1-60 days, and a similar but slightly lower increased risk was seen in those prescribed more than 60 days of H₂RAs (hazard ratio, 1.32).

Acid-suppressing medication use also was associated with an increased risk of nonfood allergies, in particular medication allergy (adjusted HR, 1.70 for H₂RAs and 1.84 for PPIs), allergic rhinitis (aHR, 1.50 for H₂RAs and 1.44 for PPIs), anaphylaxis (aHR, 1.51 for H₂RAs and 1.45 for PPIs).

Infants prescribed acid-suppressing medication also showed higher rates of asthma, allergic conjunctivitis, and urticaria during childhood.

 

The use of antibiotics in the first 6 months of life was associated with a 14% higher incidence of food allergy but with a 24% higher risk of cow’s milk allergy and egg allergy. Children prescribed antibiotics also had a twofold greater risk of asthma, a 51% higher risk of anaphylaxis, 42% higher risk of allergic conjunctivitis, and a 34% higher risk of medication allergy.

“This study adds to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic disease,” said Dr. Mitre and his coauthors. “Thus, this study provides further impetus that antibiotics and acid-suppressive medications should be used during infancy only in situations of clear clinical benefit.”

No funding source or conflicts of interest were declared.

SOURCE: Mitre E et al. JAMA Pediatrics. 2018 Apr 2. doi: 10.1001/jamapediatrics.2018.0315.

 

Children prescribed histamine₂-receptor antagonists (H₂RAs), proton pump inhibitors (PPIs), or antibiotics during the first 6 months of life may be at greater risk of developing allergic disease, research suggests.

A retrospective cohort study looked at the incidence of subsequent allergic disease in 792,130 children, 7.6% of whom were prescribed an H₂RA, 1.7% were prescribed a PPI, and 16.6% were prescribed an antibiotic during the first 6 months of life.

Children who were prescribed a H₂RA or a PPI had a greater than twofold higher incidence of food allergy (adjusted hazard ratios 2.18 and 2.59, respectively), reported Edward Mitre, MD, of the Uniformed Services University of the Health Sciences, Bethesda, Md., and his coauthors, reported in the April 2 online edition of JAMA Pediatrics.

In particular, the use of acid-suppressing medications was associated with a 2.4-fold increase in the risk of being diagnosed with cow’s milk allergy, while the risk of egg allergy was 74% higher in children prescribed an H₂RA and 35% higher in children prescribed a PPI. In children prescribed an H₂RA, the risk of peanut allergy was 21% higher, and in children prescribed a PPI, it was 27% higher.

There also was a dose-dependent interaction between the duration of medication and risk of food allergy. Children who were prescribed more than 60 days of PPIs had a 52% higher risk than did those who were prescribed 1-60 days, and a similar but slightly lower increased risk was seen in those prescribed more than 60 days of H₂RAs (hazard ratio, 1.32).

Acid-suppressing medication use also was associated with an increased risk of nonfood allergies, in particular medication allergy (adjusted HR, 1.70 for H₂RAs and 1.84 for PPIs), allergic rhinitis (aHR, 1.50 for H₂RAs and 1.44 for PPIs), anaphylaxis (aHR, 1.51 for H₂RAs and 1.45 for PPIs).

Infants prescribed acid-suppressing medication also showed higher rates of asthma, allergic conjunctivitis, and urticaria during childhood.

 

The use of antibiotics in the first 6 months of life was associated with a 14% higher incidence of food allergy but with a 24% higher risk of cow’s milk allergy and egg allergy. Children prescribed antibiotics also had a twofold greater risk of asthma, a 51% higher risk of anaphylaxis, 42% higher risk of allergic conjunctivitis, and a 34% higher risk of medication allergy.

“This study adds to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic disease,” said Dr. Mitre and his coauthors. “Thus, this study provides further impetus that antibiotics and acid-suppressive medications should be used during infancy only in situations of clear clinical benefit.”

No funding source or conflicts of interest were declared.

SOURCE: Mitre E et al. JAMA Pediatrics. 2018 Apr 2. doi: 10.1001/jamapediatrics.2018.0315.