Associations Between Acid-Suppressing Medications, Antibiotics in Infancy and Later Allergic Diseases

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, APRIL 2, 2018

Media advisory: To contact corresponding author Edward Mitre, M.D., email Sharon Holland at sharon.holland@usuhs.edu. The full study is available on the For The Media website.

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Bottom Line: The use of acid-suppressing medications or antibiotics in the first 6 months of infancy was associated with an increased risk for the subsequent development of allergic diseases in childhood.

Why The Research Is Interesting: Allergic diseases and asthma have been on the rise over several decades. Medications that can alter the human microbiome may contribute to the rise of allergic diseases. Acid-suppressing medicines and antibiotics can contribute to a microbial imbalance in the gut (intestinal dysbiosis).

Who and When: 792,130 children born between October 2001 and September 2013 and enrolled in the military health system until at least age 1

What (Study Measures): Any dispensed prescription for a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI) or antibiotic (exposures) in the first six months of life; allergic disease defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis (eczema), allergic rhinitis (hay fever). allergic conjunctivitis (eye inflammation), urticaria (rash), contact dermatitis (skin rash), medication allergy or other allergy (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and they cannot control natural differences that could explain the study findings.

Authors: Edward Mitre, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and coauthors

Results: 

The use of acid-suppressing medicines was associated with increased risks for all major categories of allergic disease, especially food allergy. Antibiotics also were associated with increased risk of all major categories for allergic disease.

Study Limitations: It is possible that acid-suppressing medicines or antibiotics were given for allergic diseases that were misdiagnosed, although the authors doubt this can explain all their findings. The mechanisms by which acid-suppressing medicines and antibiotics might increase allergic sensitization also are not fully understood but potential ones could include intestinal dysbiosis and, for acid-suppressing medicines, decreased protein digestion in the stomach.

Study Conclusions:

 

Related Material: An editor article review podcast with Aaron E. Carroll, M.D., M.S., JAMA Pediatrics digital media editor, also is available on the For The Media website. The audio transcript is available here.

 

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamapediatrics.2018.0315)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Translation in Simplified Chinese

 

禁止提前报道指令解除时间:201842 星期一,美国东部时间上午11

媒体咨询:联系通讯作者Edward Mitre, M.D.,请发电子邮件到Sharon Holland sharon.holland@usuhs.edu

 

婴儿期服用抑酸药物,抗生素和其后过敏性疾病之间的关联

概要: 在婴儿期前6个月使用抑酸药物或抗生素与后来儿童期发生过敏性疾病的风险增加有关联。

为何对该问题感兴趣:近几十年来,过敏性疾病和哮喘的患病人数一直在增加。 可以改变人类微生物群系的药物可能是导致过敏性疾病增加的原因之一。抑酸药物和抗生素可能会导致肠道微生物失衡(肠道生态失调)。

研究参与者及时间:792,130名在2001年10月至2013年9月期间出生并在一岁以前参加了军方提供的卫生保健系统的儿童。

研究什么(研究内容):(暴露因素)为在出生后的头六个月,服用任何组胺-2受体拮抗剂(H2RA),质子泵抑制剂(PPI)或抗生素;(结果)为过敏性疾病

作者:Edward Mitre, M.D., 军事医学科学大学,贝塞斯达,马里兰州,以及共同作者。

研究结果:抑酸药物的使用与所有主要类别的过敏性疾病,尤其是食物过敏的风险增加有关联。 抗生素也与所有主要类别过敏性疾病的风险增加有关联。

研究局限:虽然作者怀疑这可以解释他们的所有发现,但抑酸药物或抗生素可能被用来治疗被误诊的过敏性疾病。

研究结论:据我们所知,这是目前显示婴幼儿H2RAs,PPIs和抗生素与后续发展的过敏性疾病之间有关联的最大规模的研究,其结果与以前的研究结果一致,具有生物学上的合理性。 因此,这项研究提供了进一步的证据来促进只在有明确临床获益的情况下,才应在婴儿期使用抗生素和抑酸药物。但仍需要进一步的研究来确定其因果关系以及内在机制。

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