Allergies, Asthma, Antibiotics, Antacids…and Children

About 20 years ago, I was sitting in a waiting room at a doctor’s office and spotted an article in one of the magazines (maybe Time or Newsday?) on the coffee table that described recent research that showed that antibiotic use in the first 3 months of life was associated with an increased risk of allergy and asthma.  Alex was probably 4 or 5 at the time and we’d been doing the whole autism thing for a few years.  It was like a knife in my heart, thinking back to those 5 days of IV antibiotics he received in the hospital starting at 36 hours old.

I did a search this morning on PubMed and found research dating back to 1999, which would be about right, time-wise, which analyzed the risk of asthma in children given antibiotics:  “…antibiotic use was significantly associated with having a history of asthma…The adjusted odds ratio for asthma was 4.05 if antibiotics were used in the first year of life and 1. 64 if antibiotics had been used only after the first year of life when compared with children who had never used antibiotics. The number of courses of antibiotics during the first year of life was also associated with increased odds ratios for asthma…”[i]

That is, early use of antibiotics, in the first year, led to a greatly increased risk of developing asthma.

Over the 2 decades since, I’ve read many such articles.  I remember, a couple of years ago, it was big news when a study showed that there is a distinct relationship with the use of antibiotics in the first year of life and the development of food allergies:  “Receipt of antibiotic prescription in the first year of life is associated with FA [food allergies] diagnosis code in young children after controlling for common covariates. Multiple antibiotic prescriptions are more strongly associated with increases in the odds of FA diagnosis.”[ii]

Then, yesterday evening, I read about yet another study[iii], this one getting huge press as it appeared in JAMA Pediatrics.  Almost 800,000 children were followed for 4 years.  Those given antacids (H2 blockers or proton pump inhibitors) were more than twice as likely to develop food allergy (especially to cow milk).  Those given antibiotics were 14% more likely to develop food allergy, at a 51% increased risk for anaphylaxis (holy COW) and at more than double the risk for developing asthma.  The proposed mechanism is, of course, that disrupting the gut flora early in life is a problem.

Says the senior author of the paper, “Let’s not prescribe these medicines for things that are very common in babies…”[iv]

Ya think?

p.s. I would love to know what percentage of children diagnosed with autism and ADHD had antibiotics in the first year or two of life too.

______________________________________________

[i] Wickens, K, Pearce, N, Crane, J, Beasley, R.  Antibiotic use in early childhood and the development of asthma.  Clinical and Experimental Allergy. 1999.  29(6):766-71.

[ii] Love, BL, Mann, JR, Hardin, JW, Lu, ZK, Cox, C, Amrol, DJ. Antibiotic prescription and food allergy in young children.  Allergy, Asthma & Clinical Immunology. 2016.  12:41. doi:  10.1186/s13223-016-0148-7

[iii] Mitre,E, Susi,A, Kropp, LE. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood. JAMA Pediatrics. Published online April 2, 2018. doi:10.1001/jamapediatrics.2018.0315

[iv] https://www.nytimes.com/2018/04/02/well/family/giving-babies-antibiotics-or-antacids-may-increase-allergy-risk.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=sectionfront


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