Acid suppressants up kids’ risk of asthma, atopic dermatitis

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Researchers found significantly higher rates of allergic diseases in those prescribed these medications as children.

Children who use acid suppressants are more likely to develop asthma, atopic dermatitis and allergic rhinitis, according to a new meta-analysis.

The analysis of five studies  from the US and Europe, including more than one million children aged up to 13, found that children who took the medication had a 44% higher risk of asthma, a 12% higher risk of atopic dermatitis and a 40% higher risk of allergic rhinitis than children who didn’t.

The researchers found that even a low dose of acid suppressants could increase risk of developing these allergic diseases.

“The risk may be more significant with a younger age at first exposure, particularly the first two years of life, and there is a possible dose-dependent effect,” the authors wrote in The Journal of Allergy and Clinical Immunology: In Practice.

“There is a need for the judicious use of acid suppressants in paediatric patients, and to advocate for the development of more stringent guidelines to direct their prescription.”

The study included proton-pump inhibitors (PPIs), histamine-2 receptor antagonists (H2-RAs), antacids and potassium competitive acid blockers (PCABs).  

Children taking the medication didn’t appear to have any increased risk of food allergies, and the duration of treatment didn’t appear to significantly change how likely children were to develop one of the conditions.

Children exposed in the first six months had a slightly higher risk of developing asthma (HR = 1.66) than those exposed in the first 12 months (HR = 1.58).

Acid suppressant prescriptions for children are common and increasing around the world, though these medications are known to alter the gut microbiome. The first two years of life are a crucial stage for gut microbiome development and the establishment of immune tolerance.

It has been suggested that intestinal dysbiosis may lead to impaired Th1 and Th2 regulation. The decreased acidity in the gut from antacid use could impede upon protein digestion and increase sensitivity and intolerance. 

Previous studies have found that use of these medications during pregnancy is associated with a greater risk of children developing asthma, and there is emerging evidence that the development of allergic diseases such as asthma, eczema and rhinitis are related to disruption in immune-microbial crosstalk in early life.

Animal studies have shown an increased risk of allergic diseases in neonatal mice exposed to microbiome-modifying medications compared with mice exposed as adults, further corroborating the risks associated with the disruption of the gut in early life.

There was insufficient data to analyse development of asthma, atopic dermatitis, or allergic rhinitis in paediatric patients with GERD.

The Journal of Allergy and Clinical Immunology: In Practice 2022, online 15 October

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