Allergic disease is one of the most common conditions that I see in children today. Thankfully, in most cases there is a lot I can do to help these children reduce there level of reaction or even reverse their allergies completely just with diet alone.
Allergic disease is typically like a bucket ….. when the bucket is full, many symptoms of histamine overload can result, such as poor sleep, congestion, indigestion, stomach cramps, diarrhea, anxiety and frequent colds. These symptoms are the most common complaints that I hear from parents about their kids.
The following article just published in The Journal of the American Medical Association (JAMA) outlines the dramatic increase in risk that both antibiotic and acid-suppressing medication use have on the the risk of allergic disease when given in the first 6 months of life. According to this retrospective study, which included over three quarters of a million children, increases in risk of allergic disease where elevated by 22-160%! There was over 2.5 times the risk of developing a food allergy in the children given acid suppressing medication and double the risk of developing asthma after antibiotics in the first 6 months of life.
Of course antibiotics are needed on occasion, but it often surprises parent to know that antibiotics are actually not that effective nor required the majority of the time. For example, in “ear infections”, 82% resolve on there own, in sinus infections antibiotics barely work and this is the same for bronchial infections. So ….. anyone out there family planning? It is fairly stressful to see your non-communicative infant struggling with reflux or battling their first cold, but it may be wise to do some close monitoring instead of giving drugs.
Mitre E, Susi A, Kropp LE, et al. Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood. JAMA Pediatr. 2018 Jun 4;172(6):e180315. doi: 10.1001/jamapediatrics.2018.0315. Epub 2018 Jun 4. (Original) PMID: 29610864
Importance: Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy.
Objective: To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood.
Design, Setting, and Participants: A retrospective cohort study was conducted in 792130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018.
Exposures: Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI), or antibiotic.
Main Outcomes and Measures: The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy.
Results: Of 792?130 children (395?215 [49.9%] girls) included for analysis, 60?209 (7.6%) were prescribed an H2RA, 13?687 (1.7%) were prescribed a PPI, and 131?708 (16.6%) were prescribed an antibiotic during the first 6 months of life. Data for each child were available for a median of 4.6 years. Adjusted hazard ratios (aHRs) in children prescribed H2RAs and PPIs, respectively, were 2.18 (95% CI, 2.04-2.33) and 2.59 (95% CI, 2.25-3.00) for food allergy, 1.70 (95% CI, 1.60-1.80) and 1.84 (95% CI, 1.56-2.17) for medication allergy, 1.51 (95% CI, 1.38-1.66) and 1.45 (95% CI, 1.22-1.73) for anaphylaxis, 1.50 (95% CI, 1.46-1.54) and 1.44 (95% CI, 1.36-1.52) for allergic rhinitis, and 1.25 (95% CI, 1.21-1.29) and 1.41 (95% CI, 1.31-1.52) for asthma. The aHRs after antibiotic prescription in the first 6 months of life were 2.09 (95% CI, 2.05-2.13) for asthma, 1.75 (95% CI, 1.72-1.78) for allergic rhinitis, 1.51 (95% CI, 1.38-1.66) for anaphylaxis, and 1.42 (95% CI, 1.34-1.50) for allergic conjunctivitis.
Conclusions and Relevance: This study found associations between the use of acid-suppressive medications and antibiotics during the first 6 months of infancy and subsequent development of allergic disease. Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit.