Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

Abstract

IMPORTANCE Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy. OBJECTIVE To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted in 792 130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018. EXPOSURES Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H 2 RA), proton pump inhibitor (PPI), or antibiotic. MAIN OUTCOMES AND MEASURES The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy. RESULTS Of 792 130 children (395 215 [49.9%] girls) included for analysis, 60 209 (7.6%) were prescribed an H 2 RA, 13 687 (1.7%) were prescribed a PPI, and 131 708 (16.6%) were prescribed an antibiotic during the first 6 months of life. Data for each child were available for a median of 4.6 years. Adjusted hazard ratios (aHRs) in children prescribed H 2 RAs and PPIs, respectively, were 2.18 (95% CI, 2.04-2.33) and 2.59 (95% CI, 2.25-3.00) for food allergy, 1.70

Association between antibiotic treatment during pregnancy and infancy and the development of allergic diseases

“…Most studies, which have been carried out on antibiotic use during pregnancy and infancy, found an increased risk for asthma, whereas our results only provide evidence for a weak positive association after antibiotic use in the first year of life but not with prenatal exposure. Discrepancies in these findings might be explained by different outcome definitions.…”

“…Similar to our results, several studies found significant positive associations between atopic dermatitis and antibiotic exposure in utero 12,13 or in the first year of life. [14][15][16] In contrast, the study by Bisgaard et al,17 where in contrast to our study only children of mothers with history of asthma were included, did not see an increased risk for atopic dermatitis after maternal use of antibiotics in pregnancy. Dom et al, 13 who defined atopic dermatitis as parent-reported symptoms, did not find a relationship with antibiotics in the first year of life.…”

“…Most studies, 5,12,14,16,[18][19][20][21] To our knowledge, only one study has so far analysed the association between prenatal antibiotics and food allergy. 22 In contrast to our results, they did not find a relationship between maternal antibiotics and food allergy, which might be explained as they only included a small number of children who were exposed and developed food allergy.…”

The Role of Lung and Gut Microbiota in the Pathology of Asthma

“…During in utero development and later in life, there are several direct and indirect factors that affect healthy microbiota colonization and subsequent host-microbiota interactions. These factors include mother's health status (Stokholm et al, 2018), diet (Frei et al, 2012;Barcik et al, 2015), transfer of maternal antibodies and microbial molecules (Gomez de Ag€ uero et al, 2016;Koch et al, 2016), mode of delivery (Bosch et al, 2016), and breastfeeding and early-life environment (day care, siblings [Wolsk et al, 2016], pets at home [Sitarik et al, 2018;Tun et al, 2017], traditional farm-like dust at home [Stein et al, 2016;Kirjavainen et al, 2019], and smoking and antibiotic and other drug usage in pregnancy and early childhood [Mitre et al, 2018;Loewen et al, 2018]).…”

AllergoOncology: Microbiota in allergy and cancer—A European Academy for Allergy and Clinical Immunology position paper

“…Increasing use of antibiotics has been linked with dysbiosis and enhanced prevalence of allergies and asthma . Also, the pharmacologic impairment of gastric digestion is associated with gut dysbiosis and has been correlated with allergy in mice and humans . However, study results of probiotic supplementation in childhood asthma or wheeze are inconclusive …”