Prospective associations between acid suppressive therapy and food allergy in early childhood

Seay, Hannah; Martin, Victoria M.; Virkud, Yamini; Marget, Michael; Shreffler, Wayne G.; Yuan, Qian

doi:10.1111/cea.14123

Cited by 1 publication

(6 citation statements)

References 9 publications

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“…Noh et al also observed null associations for pediatric exposure to both drugs for most allergic disease outcomes in sibling‐matched analyses, reporting only small associations for asthma (aHR 1.16, 95% CI 1.14–1.18) 42 . Another cohort study based on prospective parental reporting exposure data and clinician‐confirmed diagnosis of allergic disease showed negative associations for PPIs (aOR 0.21, 95% CI 0.03–1.56) and H2RAs (aOR 0.15, 95% CI 0.04–0.64) in relation to food allergy, albeit in a small sample ( n = 797) 54 …”

Section: Resultsmentioning

confidence: 98%

“…In their population‐based retrospective cohort study, Noh et al found null associations for prenatal and pediatric PPI and H2RA use and multiple allergic disease outcomes except for pediatric ASM exposure and asthma 42 . A recent, small, single‐center prospective cohort study also found that PPI‐ and H2RA‐exposed children had lower risks of developing clinician‐confirmed food allergies 54 . In contrast, three prior systematic reviews on ASMs and asthma included in our review (all omitting the study by Noh and colleagues) reported overall positive associations, with pooled effect sizes of 1.30–1.57 for prenatal exposure and pooled effect sizes of 1.52 and 1.40 for pediatric PPI and H2RA exposure, respectively 39,40,57 …”

Section: Discussionmentioning

confidence: 98%

“…42 A recent, small, single-center prospective cohort study also found that PPI-and H2RA-exposed children had lower risks of developing clinician-confirmed food allergies. 54 In contrast, three prior systematic reviews on ASMs and asthma included in our review (all omitting the study…”

Section: Discussionmentioning

confidence: 99%

“…42 Another cohort study based on prospective parental reporting exposure data and clinician-confirmed diagnosis of allergic disease showed negative associations for PPIs (aOR 0.21, 95% CI 0.03-1.56) and H2RAs (aOR 0.15, 95% CI 0.04-0.64) in relation to food allergy, albeit in a small sample (n = 797). 54 Studies whose designs allowed for better confounding control, such as self-controlled studies 45,46,48,50,55 and sibling-matched studies, 34,35 TA B L E 2 Methodologic details from prenatal studies. Including secondary analyses, 11 studies (42%) reported effect sizes greater than 2 in at least one model.…”

Section: Study Findingsmentioning

confidence: 99%

“…All systematic reviews did not find any evidence of publication bias. Some additional reported limitations included small sample sizes (4 studies with samples ≤1000) 41,45,54,56 and protopathic bias (one allergic disease study, 42 one asthma study, 52 two EoE studies, 45,50 and one IBD study 48 ).…”

Section: Countrymentioning

confidence: 99%

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Acid‐suppressive medication and incidence of chronic childhood immune‐mediated diseases: A scoping review

Madej,

Atanassova,

McGuire

et al. 2023

Pediatric Allergy Immunology

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BackgroundUse of acid‐suppressive medications (ASMs), for example, proton pump inhibitors (PPIs) and histamine‐2 receptor antagonists (H2RAs), has been rising along with the incidence of pediatric immune‐mediated diseases (IMDs). We conducted a scoping review to characterize the literature about prenatal or pediatric exposure to ASMs in relation to incident pediatric IMDs.MethodsElectronic searches were conducted to identify studies from 2001 to 2023 on (a) prenatal or pediatric exposure to PPIs and/or H2RAs and (b) the risk of developing chronic IMDs during childhood. Eligible studies after title/abstract and full‐text screening underwent data abstraction.ResultsOf 26 eligible studies, 11 focused on prenatal ASM exposure and 16 on pediatric exposure. Asthma was the most commonly investigated outcome (16 studies), followed by other allergic diseases (8), eosinophilic esophagitis (3), inflammatory bowel disease (2), and other autoimmune diseases (2). Positive associations between ASM exposure and pediatric IMD outcomes emerged in all but two recent studies, which reported null or negative associations with allergic diseases. The strength of associations was similar across exposure times (prenatal/pediatric), medications (PPIs/H2RAs), and outcomes. Dose–response relationships were often present (7/11 studies). Reported effects by trimester and age of exposure varied. Commonly reported limitations were residual confounding, exposure misclassification, and outcome misclassification.ConclusionIn summary, prenatal or pediatric exposure to PPIs and/or H2RAs has frequently, but not exclusively, been associated with the development of asthma, other allergic diseases, and chronic gastrointestinal IMDs. However, concerns remain about confounding and other sources of bias. Prescribers and families should be aware of these possible risks of ASMs.

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Section: Resultsmentioning

confidence: 98%