Acid-suppressive medications during pregnancy and risk of asthma and allergy in children: A systematic review and meta-analysis

Devine, Rebecca E; McCleary, Nicola; Sheikh, Aziz; Nwaru, Bright I.

doi:10.1016/j.jaci.2016.09.046

Cited by 24 publications

(33 citation statements)

References 18 publications

(6 reference statements)

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“…Our findings confirm an epidemiological association between gastric acid suppression and development of allergic symptoms, in line with previous mechanistic animal trials and human observational studies. The evidence provided herein concurs with the emerging concern in terms of adults 10,26 and especially of pregnant females treated with antacid drugs 18,20-22 .…”

Section: Discussionsupporting

confidence: 84%

“…Over the past years, our group developed the concept that gastric acid inhibitors also promote the development of allergic disease not only in adults 11–16 , but even imprinting the next generation for allergy 17 . Subsequent pregnancy, birth cohort studies, and meta-analyses fueled emerging concerns 18–20 , reported also by pediatricians 21,22 .…”

Section: Introductionmentioning

confidence: 99%

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Country-wide medical records infer increased allergy risk of gastric acid inhibition

et al. 2019

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Gastric acid suppression promotes allergy in mechanistic animal experiments and observational human studies, but whether gastric acid inhibitors increase allergy incidence at a population level remains uncharacterized. Here we aim to assess the use of anti-allergic medication following prescription of gastric acid inhibitors. We analyze data from health insurance records covering 97% of Austrian population between 2009 and 2013 on prescriptions of gastric acid inhibitors, anti-allergic drugs, or other commonly prescribed (lipid-modifying and antihypertensive) drugs as controls. Here we show that rate ratios for anti-allergic following gastric acid-inhibiting drug prescriptions are 1.96 (95%CI:1.95–1.97) and 3.07 (95%-CI:2.89–3.27) in an overall and regional Austrian dataset. These findings are more prominent in women and occur for all assessed gastric acid-inhibiting substances. Rate ratios increase from 1.47 (95%CI:1.45–1.49) in subjects <20 years, to 5.20 (95%-CI:5.15–5.25) in > 60 year olds. We report an epidemiologic relationship between gastric acid-suppression and development of allergic symptoms.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Country-wide medical records infer increased allergy risk of gastric acid inhibition

et al. 2019

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“…3,4 Recent evidence from outside the United States suggests that prenatal exposure to ASMs may be associated with an increased risk of asthma in children. 5,6 These previous studies were performed in mostly European populations and were conducted retrospectively in large databases and thus relied primarily on prescription records and diagnosis codes to identify exposures and outcomes. 7 Despite efforts to control for bias and confounding, these retrospective observational studies were potentially affected by misclassification of both the exposure and outcome and inability to adjust for various factors, including maternal atopy.…”

Section: To the Editormentioning

confidence: 99%

Prenatal exposure to acid-suppressant medications and the risk of recurrent wheeze at 3 years of age in children with a history of severe bronchiolitis

Robinson

Arroyo

Dantas

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

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“…Recently two comprehensive meta-analyses have been published [35,36]. These well-conducted studies were only able to assess prenatal exposure to ASM and the risk of childhood asthma as there was not enough data to assess for the risk of other allergic diseases.…”

Section: Asm and The Development Of Allergic Diseasesmentioning

confidence: 99%

“…Neither study found evidence of publication bias. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach Devine et al found the overall quality of evidence to be moderate [35]. These analyses strengthen inferences about the association observed in the individual studies.…”

Section: Asm and The Development Of Allergic Diseasesmentioning

confidence: 99%

Acid suppressant medications and the risk of allergic diseases

Robinson

Camargo

2018

Expert Review of Clinical Immunology

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Acid suppressant medications (ASMs), such as proton pump inhibitors and histamine-2 receptor antagonists, are used often and throughout the lifespan. These medications have been linked to the development of a variety of allergic diseases. Areas covered: This review discusses prior studies investigating the association between acid ASM exposure and the development of allergic diseases. We performed a thorough literature search to identify potentially relevant studies for inclusion. In summary, exposure to these medications prenatally, in childhood and in adulthood, may increase the risk of allergic diseases. The current evidence is limited by primarily observational study design and potential bias and confounding. The mechanism of action is not yet known, but there are several proposed theories. Expert commentary: There is a growing body of evidence to support that exposure to acid ASMs increases the risk of developing allergic diseases. Further research is needed to not only clarify this relationship but to define the potential mechanism of action. If further research confirms these observations, we believe that could warrant changes in the patterns of prescribing and use of acid ASMs.

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Acid-suppressive medications during pregnancy and risk of asthma and allergy in children: A systematic review and meta-analysis

Cited by 24 publications

References 18 publications

Country-wide medical records infer increased allergy risk of gastric acid inhibition

Country-wide medical records infer increased allergy risk of gastric acid inhibition

Prenatal exposure to acid-suppressant medications and the risk of recurrent wheeze at 3 years of age in children with a history of severe bronchiolitis

Acid suppressant medications and the risk of allergic diseases

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