Prenatal and Early-Life Exposure to Microbiome-Modulating Medications and the Risk of Childhood Food Allergy: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review of predominantly non-randomized, observational studies
PubMed 42074887 · doi:10.3390/jcm15083086
What was done
Authors searched EMBASE, PubMed, Cochrane, and Web of Science to assess the association between prenatal or early-life exposure to microbiome-modulating medications (antibiotics, antacids, and probiotics) and the risk of childhood food allergy. A random-effects meta-analysis was performed combining 25 studies involving 1,662,861 mothers and 5,164,280 children.
What was found
Prenatal antibiotic use was associated with increased odds of childhood food allergy (OR: 1.34; 95% CI [1.10, 1.63]), as was early-life antibiotic use up to 2 years of age (OR: 1.53; 95% CI [1.18, 1.98]). Proton pump inhibitors were also associated with elevated risk (OR: 2.65; 95% CI [1.22, 5.77]). H2-receptor antagonists showed a non-significant association (OR: 2.07; 95% CI [0.96, 4.45]). Probiotic use in the first two years was not associated with reduced risk (OR: 1.25; 95% CI [0.46, 3.38]).
Why it matters
This review synthesizes large-scale data linking common maternal and infant medications to increased risks of childhood food allergies, underscoring the need for careful prescribing during pregnancy and infancy.
Limits
The underlying studies were predominantly observational, so causality cannot be established and residual confounding by indication remains possible. The abstract does not report medication dosages, exposure durations, specific food allergen types, diagnostic confirmation methods, or heterogeneity statistics. Wide confidence intervals for proton pump inhibitors, H2-receptor antagonists, and probiotics reflect substantial statistical imprecision.
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