PROTON pump inhibitors (PPI) in infancy have been linked to an increased food allergy risk, according to data presented at the 2024 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting in Washington, D.C., USA. Primary author Julia Tanzo, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Ohio, USA, stated: “We found that early exposure to acid-suppressive medications was associated with a 5–6 times higher risk of food allergy and anaphylaxis, with similar trends observed for antimicrobials.”
Previous research has shown an association between acid-suppressive therapy and gut dysbiosis and allergy development, which is why the team analysed electronic health record data from the USA network in the TriNetX platform between January 2015–July 2021. This included 100 million patients, from which the researchers identified those who were prescribed histamine-2 receptor antagonists, antimicrobials, and PPIs during their first year of life. Patients with a previous allergy-related encounter were excluded from the study. Primary 2-year outcome was the diagnosis of food allergy, and secondary outcomes included diagnoses of atopic dermatitis, allergic rhinitis, and anaphylaxis.
Results showed that those who were prescribed histamine-2 receptor antagonists, antimicrobials, and PPIs had an increased risk of food allergy, with antimicrobials showing the lowest risk (antimicrobials ≥1 time: relative risk [RR]: 2.32; 95% confidence interval [CI]: 2.27–2.37; antimicrobials ≥3 times: RR: 2.93; 95% CI: 2.84–3.02), and PPIs the highest (RR: 6.41; 95% CI: 6.18–6.64). The results for secondary outcomes were similar (RR: 2.17–11.23; 95% CI: 2.10–2.25 to 10.87–11.61).
The team concluded that there was an approximately sixfold increased risk of food allergy diagnosis in early childhood after exposure to acid-suppressive medications, as well as a higher food allergy risk following antimicrobial use. These findings are significant, and will help to support better care options and appropriate disclosure of risks when prescribing medications to patients. “We hope that this association study will motivate future studies on the mechanisms underlying our findings and the role of potential confounding factors,” stated co-author Mohamad Chaaban, Cleveland Clinic.
