Prenatal and Early-Life Exposure to Microbiome-Modulating Medications and the Risk of Childhood Food Allergy: A...

Background/Objectives: Several recent human studies have associated the use of certain medicines, such as antibiotics and antacids, with allergic conditions, potentially through microbiome disruption. In contrast, probiotics which may prevent dysbiosis, could have protective effects. Our meta-analysis aimed to evaluate the impact of these drugs (consumed during pregnancy or early life) on the risk of childhood food allergy, based on the available literature. Methods: Literature searches were conducted in the EMBASE, PubMed, Cochrane, and Web of Science databases using predefined PICO criteria. Overall, our meta-analysis included 25 studies involving 1,662,861 mothers and 5,164,280 children. Results: Using the random-effects model, we found that prenatal and early life antibiotic use (up to 2 years of age) was associated with higher odds of food allergy in childhood (OR: 1.34; 95% CI [1.10, 1.63], OR: 1.53; 95% CI [1.18, 1.98], respectively). Proton pump inhibitors were also associated with a risk of food allergies (OR: 2.65; 95% CI [1.22-5.77]), whereas the impact of H2-receptor antagonists was non-significant (OR: 2.07; 95% CI [0.96-4.45]). Probiotic use during the first two years of life was not associated with decreased risk for food allergy in children (OR: 1.25; 95% CI [0.46, 3.38]). Conclusions: These findings suggest an association between microbiome-disrupting medications during pregnancy and early childhood and an increased risk of childhood food allergy, especially those with a family history of food allergy. However, due to the predominantly observational design of the included studies, causality cannot be established. These results highlight the need for cautious and judicious use of such medications in these populations.