Infant exposure to Acid-suppressive Medication tied to increased risk of developing asthma: JAMA

Existing available observational data indicates a positive association between ASM use in prenatal and early life with allergic diseases in children. But there is a lack of studies accounting for confounding by indication or within-familial factors.

Are there chances of high-risk allergic diseases in children on prenatal or infant exposure to ASM?

The objective mentioned above has been investigated by a team of researchers led by Dr Yunha Noh from the School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.

The nationwide cohort study was of 4 149 257 mother-child pairs (controlled for underlying conditions and within-familial factors).

The study summary is given below:

• The data was collected from South Korea’s National Health Insurance Service mother-child–linked database.
• Participants were mother-child pairs of neonates born from April 01 2008 to December 31 2019.
• The exposure in the study was Prenatal and infant exposure to histamine two receptor antagonists and proton pump inhibitors.
• The individual outcomes of allergic diseases like asthma, food allergy, allergic rhinitis and atopic dermatitis were assessed.
• The children were followed up till 13 years of age.
• The researchers compared ASM-exposed individuals with unexposed individuals.
• The researchers included 4 149 257 mother-child pairs in the study.
• 808 067 PS-matched pairs, including 763 755 received H2Ras and 36 529 received PPIs, were included in the prenatal exposure. The women had a mean age of 31.8 years.

The PS-matched HR for allergic diseases overall was 1.01. For asthma, allergic rhinitis, atopic dermatitis and food allergy, HR was 1.02, 1.02, 1.02 and 1.03.

• 84 263 PS-matched pairs, including 74 188 received H2RAs, and 7496 received PPIs, were in the infant exposure analyses. The PS-matched HR for overall allergic diseases was 1.06. The HR values for asthma, allergic rhinitis, atopic dermatitis, food allergy and asthma risk were 1.16, 1.02,1.05, 1.28 and 1.13.

To conclude, infant exposure to ASMs is tied to a higher risk of developing asthma with a modest magnitude compared to the previous reports.

Clinicians need to weigh the benefits of prescribing ASMs to children. This should be accompanied by subsequent close monitoring for clinically relevant safety signals.

Further reading:

Noh Y et al. Prenatal and Infant Exposure to Acid-Suppressive Medications and Risk of Allergic Diseases in Children. JAMA Pediatr. Published online January 09, 2023. doi:10.1001/jamapediatrics.2022.5193