Acid suppressants, particularly proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers), are often prescribed to treat gastroesophageal reflux and gastroesophageal reflux disease (GERD) in infants. The PPIs include drugs such as lansoprazole, which is sold under the brand name Prevacid, and omeprazole, sold under the brand name Prilosec. The H2 blockers include cimetidine, sold as Tagamet, and famotidine, sold as Pepcid AC. Evidence of the efficacy of the acid blockers in this young population is limited. Clinical practice guidelines recommend their use for no longer than 4 to 8 weeks and only if other avenues have failed.
In addition, in utero exposure to acid suppressants has been associated with an increased risk of recurrent wheeze and asthma in childhood. It is not known, though, if exposure to these drugs in infancy poses the same risk.
To gain more understanding, researchers conducted a longitudinal observational study of infants with an increased risk of developing recurrent wheeze or asthma due to a history of severe bronchiolitis. The study was published in The Journal of Allergy and Clinical Immunology: In Practice in July 2022. The primary outcomes included recurrent wheeze by age 3 years, asthma by age 6 years, and allergen sensitization as measured by serum immunoglobulin E (IgE). Evidence of acid suppressant exposure was confirmed by parental reports and review of medical records.
Lacey B. Robinson, M.D., M.P.H., in the Division of Rheumatology, Allergy and Immunology at the Massachusetts General Hospital in Boston, and her colleagues found that a higher percentage of children who developed asthma by age 6 had received acid reducers during infancy compared with those who did not receive (34% versus 26%). Similarly, more children exposed to the acid reducers developed recurrent wheeze by 3 years of age than those who were not exposed (43% versus 29%). The study found no significant difference in the risk for allergen sensitization between the two groups.
Study limitations included the observational design of the study and that all the study participants had a history of severe bronchiolitis and were, therefore, at high risk of developing asthma and recurrent wheeze.
The researchers intend to confirm the results of this study using 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. “In line with pediatric guidelines, doctors should use caution when prescribing acid suppressant medications during infancy. As always, doctors should carefully consider the potential risks and benefits of the therapy,” commented Robinson and her colleagues.