Children who receive acid-suppressive medications or antibiotics within the first 6 months after birth may have an elevated risk for developing allergic disease, according to a study published in JAMA.

Edward Mitre, MD, of the Department of Microbiology and Immunology at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Maryland, and associates conduced a retrospective group analysis to understand the impact of certain medications on infant normal flora.

In the study, 792,130 children with birth medical records between 2001 and 2013 were administered either a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI), or antibiotics.

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The primary outcome was allergic disease, including food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticarial, contact dermatitis, medication allergy, or another allergy.

Half of the participants were girls (n= 395,215). The percentage of the cohort receiving prescribed H2RA, PPI, and antibiotics was 7.6%, 1.7%, and 16.6%, respectively. Adjusted hazard ratios (HR) associated with food allergies were 2.18 for H2RA and 2.59 for PPIs.

H2RA and PPI ratios were further calculated for medication allergies (HR, 1.70 and 1.84, respectively), anaphylaxis (HR, 1.5 and 1.45, respectively), allergic rhinitis (HR, 1.50 and 1.4, respectively), and asthma (HR, 1.25 and 1.41, respectively).

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The ratios for infants 6 months and younger were also recorded for those who were prescribed antibiotics: asthma (HR, 2.09), allergic rhinitis (HR, 1.75), anaphylaxis (HR, 1.51), and allergic conjunctivitis (HR, 1.42).

“This study found associations between the use of acid-suppressive medications and antibiotics during the first 6 months of infancy and subsequent development of allergic disease,” reported the authors. “Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit.”


Mitre E, Susi A, Kropp LE, Schwartz DJ, Gorman GH, Nylund CM. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood. [published online April 2, 2018 ] JAMA Pediatr. doi:10.1001/jamapediatrics.2018.0315.