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Childhood Acid Suppressants May Increase Allergy Risk-A Systematic Review and Meta-Analysis
Harris Jun Jie Muhammad Danial Song1, Charlotte Tze Min Lee1, Faye Yu Ci Ng1
1Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.
Insights
Childhood use of acid suppressants is linked to a higher risk of asthma, atopic dermatitis, and allergic rhinitis. More research, including randomized controlled trials, is needed to confirm these associations.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Epidemiology
Background:
- Emerging evidence suggests a potential link between early childhood acid suppressant use and increased risk of allergic diseases.
- This systematic review aims to synthesize current research on this association.
Approach:
- A systematic search of major databases (PubMed, Embase, Cochrane Library, Scopus) was conducted.
- Included studies were observational or interventional, focusing on pediatric acid suppressant use and allergic outcomes.
- Data extraction, risk of bias assessment (PRISMA), and meta-analysis (mixed-effects models) were performed.
Key Points:
- Five observational studies (1977 records) were included, with low-to-moderate risk of bias.
- Childhood acid suppressant use showed significant associations with increased asthma (HR=1.44), atopic dermatitis (HR=1.12), and allergic rhinitis (HR=1.40).
- Associations remained significant after adjusting for confounders like antibiotic use and demographics.
Conclusions:
- Childhood acid suppressant use may elevate the risk of developing asthma, atopic dermatitis, and allergic rhinitis.
- The overall quality of evidence is low, necessitating larger studies, particularly randomized controlled trials, to establish causality.
- Judicious use of these medications in pediatric patients and stricter guidelines are recommended.
Background:
Recent studies suggest that the use of acid suppressants in early childhood may increase the risk of allergic diseases.
Objective:
To systematically review and synthesize associations between the childhood use of acid suppressants and development of allergic diseases.
Methods:
PubMed, Embase, The Cochrane Library, and Scopus were searched using a systematic search strategy. We included observational or interventional studies that looked at the use of acid suppressants in the pediatric population, in association with allergic outcomes such as asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and food allergies. Key data were extracted and risk of bias was evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a PROSPERO-registered protocol. Maximally adjusted estimates were pooled using mixed-effects models, and heterogeneity was measured using I2. Further subgroup and sensitivity analyses were conducted. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework.
Results:
This review included 5 observational studies from 1977 records with low-to-moderate risk of bias. Childhood acid-suppressant use was associated with significantly increased hazards of asthma (hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.31-1.58), atopic dermatitis (HR = 1.12, 95% CI = 1.10-1.14), and allergic rhinitis (HR = 1.40, 95% CI = 1.24-1.58). These associations were adjusted for confounders such as demographics, parental educational level, and use of antibiotics. Overall quality of evidence was low.
Conclusions:
Childhood use of acid suppressants may increase the risk of incident asthma, atopic dermatitis, and allergic rhinitis. However, larger studies such as randomized controlled trials are needed to determine causality. These drugs should be used judiciously in pediatric patients, and more stringent guidelines should be advocated.
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