Mitre E, Susi A, Kropp LE, Schwartz DJ, Gorman GH, Nylund CM. Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood. JAMA Pediatr. 2018; [online first] doi:10.1001/jamapediatrics.2018.0315.
Alterations of the early-life microbiome with antacid and antibiotic medications may increase the risk of allergies and asthma for children, which are increasing in prevalence in the US. In this study of over 790,000 child dependents of uniformed service members, children who were prescribed H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), or antibiotics in the first 6 months of life were approximately 1.5-2 times more likely to have developed asthma, food allergy, medication allergy, allergic rhinitis, and anaphylaxis than their peers who had not been prescribed such medications.
Through analyses of billing records for children born with coverage in the TRICARE system between October 2001 and September 2013 and followed until at least 1 year old, prescription data indicated that 7.6% of children were prescribed an H2RA (mostly ranitidine), 1.7% were prescribed a PPI (mostly lansoprazole), and 16.6% were prescribed an antibiotic (mostly amoxicillin). Median follow-up time was 4.6 years. Based on diagnosis-specific billing codes, 3.1% of the cohort had at least one diagnosed food allergy and 14.1% had asthma; 0.7% had anaphylaxis. Controlling for prematurity, Cesarean section, and sex, the adjusted hazard (ie, risk) ratio (aHR) related to antibiotic use in the first 6 months of life was for asthma (aHR = 2.09; 95% confidence interval 2.05-2.13), related to H2RA use was for cow's milk allergy (aHR = 2.42; 2.22-2.64), and related to PPI use was for cow's milk also (aHR = 4.43; 3.48-5.65). Risks of anaphylaxis were approximately 1.5 times greater for children exposed to antacids and antibiotics. This study is believed to be the largest to date examining the risk of early-life exposure to antacids and antibiotics for later development of allergic conditions and asthma.