Infants exposed to acid reducers may be at increased risk of developing childhood asthma and recurrent wheezing.
Acid inhibitors, particularly proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers), are commonly prescribed to treat gastroesophageal reflux and gastroesophageal reflux disease (GERD) in infants. PPIs include drugs such as lansoprazole, sold under the brand name Prevacid, and omeprazole (Prilosec (omeprazole). H2 blockers include cimetidine, sold as Tagamet, and famotidine, sold as Pepcid AC. Evidence of the Efficacy of acid blockers in this young population is limited. Clinical practice guidelines recommend their use for no longer than 4 to 8 weeks and only when other options have failed.
In addition, in utero exposure to antacids has been associated with an increased risk of recurrent wheezing and childhood asthma. However, it is not known whether exposure to these drugs in infancy poses the same risk.
To gain more understanding, researchers conducted a longitudinal observational study of infants who are at increased risk of developing recurrent wheezing or asthma because of a history of severe bronchiolitis. The study was published in The Journal of Allergy and Clinical Immunology: In Practice in July 2022. The primary endpoints included recurrent wheezing at age 3, asthma at age 6, and allergen sensitization as measured by serum immunoglobulin E (IgE). Evidence of exposure to acid suppressants was confirmed by parental reports and review of medical records.
Lacey B. Robinson, MD, MPH, in the Department of Rheumatology, Allergy, and Immunology at Massachusetts General Hospital in Boston, and her colleagues found that a higher percentage of children who developed asthma by age 6 compared those who did not receive acid-reducing agents for infants (34% versus 26%). Similarly, more children exposed to the acid reducers developed recurrent wheezing by age 3 years than those unexposed (43% vs. 29%). The study found no significant difference in risk of allergen sensitization between the two groups.
The limitations of the study included the study’s observational design and that all study participants had a history of severe bronchiolitis and were therefore at high risk of developing asthma and recurrent wheezing.
The researchers intend to confirm the results of this study in a patient population that includes healthy children. However, they advise that the potential benefits and risks of gastroesophageal reflux and GERD therapy in infants should be weighed when considering treatment in this population. “Consistent with pediatric guidelines, physicians should exercise caution when prescribing acid-suppressing drugs in infants. As always, physicians should carefully weigh the potential risks and benefits of therapy,” commented Robinson and her colleagues.