Infant Exposure to Acid Suppressants and Early Risk for Asthma, Chronic Wheeze

Infants exposed to acid suppressant medications may face greater risk during early childhood for recurrent wheeze and asthma, but not for allergen sensitization, according to study findings published in The Journal of Allergy and Clinical Immunology: In Practice.

Acid suppressant medication (ASM) is often prescribed for infants with acid reflux, despite little evidence of its efficacy. Moreover, prenatal ASM exposure is linked with increased risk of recurrent wheeze, asthma, and other atopic conditions. Researchers sought to explore whether ASM exposure during infancy was also associated with the risk for developing recurrent wheeze, asthma, and allergen sensitization. Primary outcomes were recurrent wheeze by 3 years of age, and asthma and early childhood allergen sensitization by 6 years of age.

The researchers initiated a longitudinal observational study of infants with a predisposed high risk for developing recurrent wheeze and asthma in childhood due to history of severe bronchiolitis. Among the 921 children with severe bronchiolitis history, 202 (22%) were exposed to ASMs (ie, histamine-2 receptor antagonists and/or proton pump inhibitors) prior to 12 months of age according to parental reports and medical records. Characteristic differences of the ASM exposed vs ASM unexposed cohorts were noted, respectively, as 56% vs 40% nonHispanic White; 19% vs 24% nonHispanic Black; and 23% vs 32% Hispanic; 50% vs 62% public or no insurance; 29% vs 12% prenatal ASM exposure; and 26% vs 17% premature birth, respectively (all P <.004).

Researchers found that children exposed to ASMs in infancy had a greater risk for developing recurrent wheeze by 3 years of age (adjusted hazard ratio 1.58; 95% CI, 1.20-2.08; P =.001) and asthma by 6 years of age (adjusted odds ratio 1.66; 95% CI, 1.22-2.27, P =.001) compared with children unexposed to ASMs. They noted there was no significant link between ASM exposure during infancy and early childhood allergen sensitization development (adjusted odds ratio 1.00; 95% CI, 0.70-1.44, P =.99).

Study limitations included the observational nature of the study precluding causality, unmeasured confounding, misclassification of exposure, and that 100% of study children were at high risk of developing recurrent wheeze and asthma due to severe bronchiolitis history, thus limiting generalizability.

Researchers concluded, “While exposure to ASMs during infancy does not increase the risk of allergen sensitization in early childhood, ASM exposure during infancy increases the risk of recurrent wheeze and asthma during early childhood.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Robinson LB, Arroyo AC, Qi YS, et al. Infant exposure to acid suppressant medications increases risk of recurrent wheeze and asthma in childhood. J Allergy Clin Immunol Pract. Published online July 21, 2022. doi:10.1016/j.jaip.2022.07.013