Chaaban Mohamad R, Tanzo Julia T, Thatte Shvetali, Kabalan Matthew, Kaelber David C
Head & Neck Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
J Clin Med. 2025 May 30;14(11):3872. doi: 10.3390/jcm14113872.
The incidence of food allergies and other allergic diseases is rising. Emerging evidence links both antimicrobials and acid-suppressive therapy with gut dysbiosis, which is implicated in allergy development. We investigated the relationship between the use of acid-suppressive medications or antimicrobials in infancy and the risk of developing childhood allergic diseases. The US network in the TriNetX platform was used to identify patients prescribed proton pump inhibitors (PPIs), histamine-2 receptor antagonists (HRAs), antimicrobials ≥1, or antimicrobials ≥3 times during their first year of life from October 2015 to January 2022. ICD-10 diagnoses were used to assess two-year outcomes of anaphylaxis, food allergy, and atopic dermatitis. A sub-analysis in gastroesophageal reflux (GERD) patients was also performed. Risks of anaphylaxis and food allergy increased with the prescription of PPIs (risk ratio [95% CI], 2.49 [1.40-4.41], 5.33 [4.97-5.71]), HRAs (4.48 [3.43-5.86], 4.21 [4.01-4.41]), and antimicrobials ≥1 (2.41 [2.13-2.72], 1.90 [1.86-1.94]), or ≥3 times (3.69 [3.12-4.37], 2.79 [2.70-2.88]). Risk of atopic dermatitis was increased in both HRA (1.41 [1.35-1.48]) and antimicrobial groups (2.25 [2.22-2.28], 3.35 [3.29-3.41]), but not in the PPI group. In the GERD sub-analysis, anaphylaxis risk was not significantly different, food allergy risk was increased in both PPI (2.30 [2.08-2.53]) and HRA groups (1.77 [1.63-1.92]), and atopic dermatitis decreased in the PPI group (0.76 [0.67-0.85]) but slightly increased in the HRA group (1.11 [1.03-1.20]). Exposure to acid-suppressive or antimicrobial medications during infancy was associated with increased risk of food allergy and anaphylaxis in early childhood. In infants diagnosed with GERD, exposure to acid-suppressive medications was still associated with increased food allergy risk.
食物过敏和其他过敏性疾病的发病率正在上升。新出现的证据将抗菌药物和抑酸治疗与肠道菌群失调联系起来，而肠道菌群失调与过敏的发生有关。我们调查了婴儿期使用抑酸药物或抗菌药物与儿童期发生过敏性疾病风险之间的关系。利用TriNetX平台中的美国网络，确定在2015年10月至2022年1月期间，在出生后第一年开具质子泵抑制剂（PPI）、组胺-2受体拮抗剂（HRA）、≥1次抗菌药物或≥3次抗菌药物的患者。使用国际疾病分类第十版（ICD-10）诊断来评估过敏反应、食物过敏和特应性皮炎的两年结局。还对胃食管反流（GERD）患者进行了亚分析。PPI处方（风险比[95%可信区间]，2.49[1.40 - 4.41]，5.33[4.97 - 5.71]）、HRA（4.48[3.43 - 5.86]，4.21[4.01 - 4.41]）以及≥1次抗菌药物（2.41[2.13 - 2.72]，1.90[1.86 - 1.94]）或≥3次抗菌药物（3.69[3.12 - 4.37]，2.79[2.70 - 2.88]）会增加过敏反应和食物过敏的风险。HRA组（1.41[1.35 - 1.48]）和抗菌药物组（2.25[2.22 - 2.28]，3.35[3.29 - 3.41]）中特应性皮炎的风险增加，但PPI组未增加。在GERD亚分析中，过敏反应风险无显著差异，PPI组（2.30[2.08 - 2.53]）和HRA组（1.77[1.63 - 1.92]）的食物过敏风险均增加，PPI组中特应性皮炎风险降低（0.76[0.67 - 0.85]），而HRA组略有增加（1.11[1.03 - 1.20]）。婴儿期接触抑酸或抗菌药物与儿童早期食物过敏和过敏反应风险增加有关。在诊断为GERD的婴儿中，接触抑酸药物仍与食物过敏风险增加有关。
