Pediatric Acid Suppressant Use May Increase Asthma, Allergy Risk

Acid suppressant use in early childhood may increase the risk for asthma, allergic rhinitis, and atopic dermatitis.

Pediatric patients who receive treatment with acid suppressants may have an increased risk for incident asthma, atopic dermatitis, and allergic rhinitis, according to study findings in The Journal of Allergy and Clinical Immunology: In Practice.

Researchers conducted a systematic review and meta-analysis of observational or interventional trials, studying the association between pediatric acid suppressant use and allergic outcomes. Using data from PubMed, Embase, the Cochrane Library, and Scopus, researchers screened 1,977 records and included 5 observational studies (N=1,160,200) in the analysis. The inclusion study criteria were the following:

  • pediatric patient population (≤ 18 years);
  • interventions with or exposure to proton pump inhibitors, histamine-2 receptor antagonists, antacids, or potassium competitive acid blockers;
  • studies with comparator groups;
  • allergy outcomes of asthma, atopic dermatitis or eczema, allergic rhinitis or hay fever, allergic conjunctivitis, and food allergies;
  • observational studies, randomized and nonrandomized controlled prospective clinical trials, and any other relevant peer-reviewed articles.

Across all studies, patients were exposed to acid-suppressive medications before the age of 18, with 4 studies documenting exposure within the first 6 months of life. Allergy outcomes included asthma, food allergies, atopic dermatitis, and allergic rhinitis.

Childhood acid suppressant use was associated with significantly increased risk for asthma (hazard ratio [HR], 1.44; 95% CI, 1.31-1.58), atopic dermatitis (HR, 1.12; 95% CI, 1.1-1.14) and allergic rhinitis (HR, 1.40; 95% CI, 1.24-1.58).

The risk may be more significant with a younger age at first exposure, particularly the first two years of life…

A cross-sectional study excluded from the meta-analysis assessed the relationship between antacid use and the prevalence of diagnosed food allergies in children. Findings from this study suggested that children with a history of antacids have a higher prevalence of food allergies compared with children without antacid history (95% CI, 1.1-2.5).

Subgroup analysis revealed that proton pump inhibitors (HR, 1.52; 95% CI, 1.37-1.68; n=3) and histamine-2 receptor antagonists (HR, 1.4; 95% CI, 1.11-1.78; n=2) had higher hazard ratios for asthma compared to the control population.

Three studies suggested that even low dosing of acid suppression could lead to the development of allergic conditions.

Study limitations include low quality of evidence, low number of studies included, and lack of randomized control studies. 

“Our findings also showed that the risk may be more significant with a younger age at first exposure, particularly the first two years of life which is a crucial time period of establishment of immune tolerance and gut microbiome development, and suggested the role of a dose-dependent effect,” the study authors noted.

References:

Song HJ, Lee CT, Ng FY, Tan BK, Siah KT, Tham EH. Childhood acid suppressants may increase allergy risk-a systematic review and meta-analysis.  J Allergy Clin Immunol Pract. Published online October 15, 2022. doi:10.1016/j.jaip.2022.09.042