Prenatal or infant exposure to acid-suppressive medications (ASMs) was not associated with allergic diseases in offspring, researchers report. “However, infant exposure to ASMs was associated with a higher risk of developing asthma, although the magnitude was more modest than previously reported,” the authors conclude. “Clinicians should carefully weigh the benefits of prescribing ASMs to children, accompanied by subsequent close monitoring for any clinically relevant safety signals.”
Using South Korea’s National Health Insurance Service database, the nationwide cohort study looked at mother-child pairs from 2007 to 2019 in which children were exposed to H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). ASM-exposed individuals were compared with unexposed individuals in propensity score (PS)–matched and sibling-matched analyses, with these results: “The study included 4,149,257 mother-child pairs. Prenatal exposure analyses included 808,067 PS-matched pairs (763 755 received H2RAs, 36 529 received PPIs) among women with a mean (SD) age of 31.8 (4.2) years. The PS-matched HR was 1.01 (95% CI, 1.01-1.02) for allergic diseases overall (asthma: HR, 1.02 [95% CI, 1.01-1.03]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.02]; atopic dermatitis: HR, 1.02 [95% CI, 1.01-1.02]; food allergy: HR, 1.03 [95% CI, 0.98-1.07]); in sibling-matched analyses, the HRs were similar to those of PS-matched analyses but were not significant (allergic diseases: HR, 1.01; 95% CI, 0.997-1.01). Infant exposure analyses included 84 263 PS-matched pairs (74 188 received H2RAs, 7496 received PPIs). The PS-matched HR was 1.06 (95% CI, 1.05-1.07) for allergic diseases overall (asthma: HR, 1.16 [95% CI, 1.14-1.18]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.03]; atopic dermatitis: HR, 1.05 [95% CI, 1.02-1.08]; food allergy: HR, 1.28 [95% CI, 1.10-1.49]); asthma risk (HR, 1.13; 95% CI, 1.09-1.17) remained significantly higher among children exposed to ASMs during infancy in sibling-matched analyses. The findings were similar for H2RAs and PPIs analyzed separately and were robust across all sensitivity analyses.”