Allergic diseases, particularly in childhood, are becoming more and more common, as we all know. It's not just that we are becoming more aware of allergic diseases by the frequent announcements on airplanes that someone has a peanut allergy, or being asked by a waiter in a restaurant if anyone has a particular food allergy. The reality of the situation is that, by and large, allergies are far more common than they used to be.
So, why is this happening? Let's take a step back and recognize that the intestines, oddly enough, actually play an important role in determining our immune responsiveness. Specifically, we now understand that the gut lining itself actually plays an important role in regulating immune function. Permeability or leakiness of the gut lining is associated with alteration in immune function as well as changes to the set point of inflammation.
The maintenance of the integrity of the intestinal lining is one of the important tasks of our intestinal microbes. This is just one of the many wonderful things our gut bacteria do to keep us healthy. When the intestinal microbes are altered, as may occur when they are exposed to certain medications, we might expect to see changes in immune function, possibly even increased risk for allergy.
In a new study, published in the Journal JAMA Pediatrics, entitled Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood, researchers, in recognizing the fact that allergic diseases are so highly prevalent in childhood, wanted to determine if acid-blocking drugs or antibiotics may influence the likelihood of allergy. Their justification for their study focused on the fact that early exposure to medications can alter the gut organisms.
The study was retrospective, meaning that it looked back at health records, in this case of close to 800,000 children, and tried to make associations between allergies and exposure to either acid-blocking drugs or antibiotics during the first six months of life. Risk for allergy was determined during a period of up to 4.6 years.
The results of the study were indeed profound. The risk of developing food allergy was more than doubled in children receiving acid-blocking drugs during their first six months of life, while the risk for asthma was increased by 41% in these children.
In those children who received antibiotics during their first six months of life, risk for asthma was doubled, while there was a 75% increase in risk for allergic rhinitis, a 51% increase in risk for anaphylaxis and a 42% increase in risk for allergic conjunctivitis.
The conclusion of the study stated: “This study found associations between the use of acid-suppressive medication and antibiotics during the first six months of infancy and subsequent development of allergic disease. Acid suppressive-medications and antibiotics should be used during infancy only in situations of clear clinical benefit.”
The authors further explained how changes induced in the gut microorganisms may well be responsible for these changes in the immune system that result in allergy.
So once again, we are seeing well-respected literature focused on providing information that can allow us to make decisions that have lifelong implications. In this case, early life changes in the gut organisms brought on by medication exposure might well increase the risk for lifelong disease.