Can prenatal and infant exposure to acid-suppressive medications lead to a risk of allergic diseases?

Findings from a nationwide cohort study were published in JAMA Pediatrics and included data from South Korea’s National Health Insurance Service. The study comprised 4,149,257 mother-child pairs from January 1, 2007, to December 31, 2020, and neonates were born from April 1, 2008, to December 31, 2019. Researchers measured prenatal and infant exposure to ASMs (histamine 2 receptor antagonists [H2Ras] and proton pump inhibitors [PPIs]).

Researchers ultimately found no association between prenatal exposure to ASMs and allergic diseases in children. However, infant exposure to ASMs was associated with a higher risk of developing asthma, although it was more modest than previous research reported.

Researchers assessed composite and individual outcomes of allergic diseases—ashtma, allergic rhinitis, atopic dermatitis, and food allergy—in children and followed up with them up to 13 years of age. They compared the ASM-exposed individuals with unexposed individuals in propensity score (PS)-matched and sibling-matched analyses to control for potential confounders and within-familial factors.

For prenatal exposure, analyses included 808,067 PS-matched pairs (763,755 received H2RAs and 36,529 received PPIs) among women with a mean age of 31.8 years—standard deviation 4.2 years. The PS-matched hazard ratio (HR) was 1.01 (95% CI, 1.01-1.02) for allergic diseases overall (asthma: HR, 1.02 [95% CI, 1.01-1.03]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.02]; atopic dermatitis: HR, 1.02 [95% CI, 1.01-1.02]; food allergy: HR, 1.03 [95% CI, 0.98-1.07]).

For sibling-matched analyses, the HRs were similar to those of PS-matched analyses but were deemed insignificant (allergic diseases: HR, 1.01; 95% CI, 0.997-1.01). The infant exposure analyses included 84,263 PS-matched pairs (74,188 received H2Ras, 7,496 received PPIs).

Infant exposure analyses included 84 263 PS-matched pairs (74 188 received H2RAs, 7496 received PPIs). The PS-matched HR was 1.06 (95% CI, 1.05-1.07 for allergic diseases overall (asthma: HR, 1.16 [95% CI, 1.14-1.18]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.03]; atopic dermatitis: HR, 1.05 [95% CI, 1.02-1.08]; food allergy: HR, 1.28 [95% CI, 1.10-1.49]).

Asthma risk (HR, 1.13; 95% CI, 1.09-1.17) remained significantly higher among children exposed to ASMs during infancy in sibling-matched analyses. Findings were similar for H2RAs and PPIs analyzed separately and were robust across sensitivity analyses.

When prescribing ASMs to children, clinicians should be careful and monitor them closely for clinically relevant safety signals.

Reference

1. Noh Y, Jeong HE, Choi A, et al. Prenatal and Infant Exposure to Acid-Suppressive Medications and Risk of Allergic Diseases in Children. JAMA Pediatrics. Published online January 9, 2023. doi:10.1001/jamapediatrics.2022.5193