Children with a history of severe bronchiolitis, who were exposed to acid-suppressing medications during infancy were at a significantly higher risk of recurrent wheeze and asthma during childhood, according to a recent study reported in The Journal of Allergy and Clinical Immunology: In Practice.^1,2

For this study, researchers examined data of 921 infants with a history of bronchiolitis from the 35th Multicenter Airway Research Collaboration multicenter cohort study. These children had been admitted to hospital for severe bronchiolitis between 2011 and 2014. Medical records were reviewed to determine exposure to acid-suppressing medications. Parents too were enquired about the exposure to these medications.

Out of the 921 children, 202 (22%) had been administered acid suppressing medications - histamine-2 receptor antagonists (H2Ras) and/or proton pump inhibitors (PPIs) - during infancy. Compared to those who had not been exposed, the probability of developing recurrent wheeze by the age of 3 years was higher in infants exposed to these medications with hazard ratio of 1.65. This association persisted even after association with aHR of 1.58. Likewise, they were also significantly more likely to develop asthma by 6 years of age with unadjusted OR of 1.45 and aOR of 1.66. Twenty-eight percent of children developed asthma by 6 years of age; 34% exposed to acid-suppressing medications during infancy compared to 26% of infants who had not been given the acid-suppressing medications.

A total of 610 children were evaluated for allergen sensitization. Of these 27% developed aeroallergen sensitization, 29% developed food sensitization, while sensitization to a food or aeroallergen was noted in 42%. However, the risk for allergen sensitization in early childhood was comparable between the two groups; 40% in those exposed to acid-suppressing medications vs. 42% in infants who did not receive these medications.

An earlier study published in 2019 had concluded that children born to mothers who were prescribed acid-suppressant medications during pregnancy were at risk of developing recurrent wheeze.² The current study has now shown that exposure to acid suppressant medications during infancy is also associated with a further high risk of asthma during childhood. Hence, clinicians should carefully weigh the risk-benefits of these medications before prescribing them during infancy.

References

1. Lacey B Robinson, et al. Infant exposure to acid suppressant medications increases risk of recurrent wheeze and asthma in childhood. J Allergy Clin Immunol Pract. 2022 Jul 21;S2213-2198(22)00713-9. doi: 10.1016/j.jaip.2022.07.013.
2. https://www.healio.com/news/allergy-asthma/20220729/use-of-acid-suppressant-medications-in-infancy-raises-childhood-risk-for-wheeze-asthma.
3. Lacey B Robinson, et al. Prenatal exposure to acid-suppressant medications and the risk of recurrent wheeze at 3 years of age in children with a history of severe bronchiolitis. J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2422-2424.e4.