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Clinical & Experimental Allergy

First evidence of a possible association between gastric acid suppression during pregnancy and childhood asthma: a population-based register study

Authors

  • E. Dehlink,

    1. Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
    2. Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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  • E. Yen,

    1. Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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  • A. M. Leichtner,

    1. Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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  • E. J. Hait,

    1. Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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    • 1Both the authors hold shared last authorship.

  • E. Fiebiger

    1. Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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    • 1Both the authors hold shared last authorship.


Correspondence:
Edda Fiebiger and Elizabeth J. Hait, Division of Gastroenterology and Nutrition, Children's Hospital, 300 Longwood Avenue, Enders 724, Boston, MA 02115, USA.
E-mail: edda.fiebiger@childrens.harvard.edu, elizabeth.hait@childrens.harvard.edu

Summary

Background Recent data in mice suggest that acid suppression during pregnancy yields offspring with type 2 T helper-dominant immunity, suggesting a predisposition for allergy.

Objective To determine the association of in utero exposure to acid-suppressive medications and the subsequent development of allergic diseases in children.

Methods We studied a population-based observational cohort formed by linking data from three Swedish national healthcare registers: the Medical Birth Register, the Hospital Discharge Register, and the Swedish Prescribed Drug Register. Main outcome measures included a hospital discharge diagnosis of an allergic disease or prescription for asthma medications, epinephrine auto-injectors, antihistamines or steroid ointments in children. Data were analysed using the Mantel–Haenszel procedure.

Results Twenty-nine thousand four hundred and ninety (5.03%) children had a discharge diagnosis of allergy or prescriptions for allergy medications. Five thousand six hundred and forty-five (0.96%) children had been exposed to acid suppression therapy during pregnancy; of these, 405 (0.07%) were treated for allergic diseases. Exposure to acid-suppressive medications in utero was associated with an increased odds ratio (OR) for developing allergy (OR 1.43, 95% confidence interval (95% CI) 1.29–1.59). We observed this association irrespective of the type of drug, time of exposure during pregnancy, and maternal history of allergy. The use of maternal acid-suppressive medication was associated with an increased OR for the development of childhood asthma (3.7% in the population at large vs. 5.6% in exposed children, OR 1.51, 95% CI 1.35–1.69), but not for other allergic diseases.

Conclusion These data provide first evidence of a significant association between in utero exposure to acid-suppressive drugs and the risk of developing childhood asthma.

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