March 18, 2020
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Acid suppressants increase risk for wheeze by age 3 in high-risk children

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Among children with a history of severe bronchiolitis, exposure to acid suppressant medications during infancy increased their risk for developing recurrent wheeze by age 3 years, according to findings presented during the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“Children with a history of severe bronchiolitis during infancy are at an increased risk of developing recurrent wheeze and subsequent asthma,” Lacey Robinson, MD, an allergist-immunologist at Massachusetts General Hospital, told Healio.

Robinson and colleagues enrolled 921 infants hospitalized with bronchiolitis between 2011 and 2014 in a multicenter prospective cohort study, and included 95% (n = 879) in the analysis.

Children with incomplete exposure or outcome data, and those who developed the outcome before exposure, were excluded.

Of the children included in the analysis, 18% (n = 159) were exposed to acid suppressant medications, such as proton pump inhibitors and histamine-2 receptor antagonists, during infancy. Recurrent wheeze developed in 68 (43%) exposed children compared with 206 of 720 (29%) unexposed children (unadjusted HR, 1.63, 95% CI, 1.24-2.14).

“We were slightly surprised by the fact that 18% of children in our study were exposed to acid suppressant mediations prior to age 1 year,” Robinson said. “Acid suppressant medications are commonly used, but the rates of use in the United States are not well characterized.”

After adjusting for 10 potential confounders, Robinson and colleagues found that the association persisted (adjusted HR, 1.54, 95% CI, 1.15-2.07).

“More research is needed to understand this important association,” Robinson said. “We encourage future research to focus on the risks of exposure in healthy children and the potential underlying mechanisms. We encourage clinicians and parents to continue to discuss the risks and benefits of using acid suppressant medications during infancy.” – by Ken Downey Jr.

Reference:
Robinson L, et al. Abstract 2611LB. Presented at: American Academy of Allergy, Asthma & Immunology; March 13-16, 2020; Philadelphia.

Disclosures: The authors report no relevant financial disclosures.