한빛사논문
- 조회562
Yunha Noh, PharmD, PhD1,2; Han Eol Jeong, MPH, PhD1,2; Ahhyung Choi, PharmD1; Eun-Young Choi, PharmD1; Björn Pasternak, MD, PhD3,4; Hedvig Nordeng, PhD5,6; Mette Bliddal, PhD7,8; Kenneth K. C. Man, PhD9,10,11; Ian C. K. Wong, PhD9,10,11,12; Dong Keon Yon, MD13,14; Ju-Young Shin, PhD1,2,15
1School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
2Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
3Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
4Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
5Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
6Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
7Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
8Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
9Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, England
10Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
11Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
12Aston Pharmacy School, Aston University, Birmingham, England
13Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
14Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
15Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
Corresponding Author: Ju-Young Shin
Abstract
Importance Existing observational data have indicated positive associations of acid-suppressive medication (ASM) use in prenatal and early life with allergic diseases in children; however, no study to date has accounted for confounding by indication or within-familial factors.
Objective To evaluate the association of prenatal or infant exposure to ASMs with risk of allergic diseases in children.
Design, Setting, and Participants This nationwide, cohort study included data from South Korea’s National Health Insurance Service mother-child–linked database from January 1, 2007, to December 31, 2020. Participants included mother-child pairs of neonates born from April 1, 2008, to December 31, 2019.
Exposures Prenatal and infant exposure to ASMs (histamine 2 receptor antagonists [H2RAs] and proton pump inhibitors [PPIs]).
Main Outcomes and Measures Composite and individual outcomes of allergic diseases (asthma, allergic rhinitis, atopic dermatitis, and food allergy) in children (followed up to 13 years of age) were assessed. The ASM-exposed individuals were compared with unexposed individuals in propensity score (PS)–matched and sibling-matched analyses to control for various potential confounders and within-familial factors. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards regression models.
Results The study included 4 149 257 mother-child pairs. Prenatal exposure analyses included 808 067 PS-matched pairs (763 755 received H2RAs, 36 529 received PPIs) among women with a mean (SD) age of 31.8 (4.2) years. The PS-matched HR was 1.01 (95% CI, 1.01-1.02) for allergic diseases overall (asthma: HR, 1.02 [95% CI, 1.01-1.03]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.02]; atopic dermatitis: HR, 1.02 [95% CI, 1.01-1.02]; food allergy: HR, 1.03 [95% CI, 0.98-1.07]); in sibling-matched analyses, the HRs were similar to those of PS-matched analyses but were not significant (allergic diseases: HR, 1.01; 95% CI, 0.997-1.01). Infant exposure analyses included 84 263 PS-matched pairs (74 188 received H2RAs, 7496 received PPIs). The PS-matched HR was 1.06 (95% CI, 1.05-1.07) for allergic diseases overall (asthma: HR, 1.16 [95% CI, 1.14-1.18]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.03]; atopic dermatitis: HR, 1.05 [95% CI, 1.02-1.08]; food allergy: HR, 1.28 [95% CI, 1.10-1.49]); asthma risk (HR, 1.13; 95% CI, 1.09-1.17) remained significantly higher among children exposed to ASMs during infancy in sibling-matched analyses. The findings were similar for H2RAs and PPIs analyzed separately and were robust across all sensitivity analyses.
Conclusions and Relevance The findings of this cohort study suggest that there is no association between prenatal exposure to ASMs and allergic diseases in offspring. However, infant exposure to ASMs was associated with a higher risk of developing asthma, although the magnitude was more modest than previously reported. Clinicians should carefully weigh the benefits of prescribing ASMs to children, accompanied by subsequent close monitoring for any clinically relevant safety signals.
논문정보
- Research article
- 2023년 01월 (BRIC 등록일 2023-01-10)
- 국내 연구진
- 의약학 > 약학
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