By Jane Lewis
The use of microbiome-altering medications – including acid-suppressive medications and antibiotics – during the first six months of life may be associated with the development of allergic disease, suggests new research published in JAMA Pediatrics.
‘This study adds to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic diseases,’ the authors stated.
Professor Dianne Campbell, Head of the Department of Allergy and Immunology at the Children’s Hospital at Westmead, Sydney, said the finding was an epidemiological association from a retrospective cohort study and so could not prove causality.
However, she told Medicine Today that early exposure to antibiotics and acid-suppressive medicines resulting in a possible increased risk of allergy had mechanistic plausibility and this was not necessarily limited to the potential to alter the micro-biome. Acid-suppressive treatment might also change the handling and presentation of key allergens, she noted.
The study included 792,130 children born between 2001 and 2013 and enrolled in the US military health system. Of these, 131,708 (16.6%) were prescribed an antibiotic, 60,209 (7.6%) a histamine-2 receptor antagonist and 13,687 (1.7%) a proton pump inhibitor in the first six months of life. Data for each child were available for a median of 4.6 years. During this time, both antibiotics and acid-suppressive medicines were found to be associated with increased risk of all major categories of allergic disease, including asthma, food allergy, anaphylaxis, allergic rhinitis and allergic conjunctivitis.
The authors said their results provided ‘further impetus that antibiotics and acid-suppressive medications should be used during infancy only in situations of clear clinical benefit.’
JAMA Pediatr 2018; doi:10.1001/jamapediatrics.2018.0315.