哮喘联盟

   背景：最近关于小鼠的研究数据表明怀孕期间胃酸抑制的母鼠，其子鼠会发生2型辅助性T（TH2）细胞的优势免疫应答，这提示子鼠有发生过敏的倾向。
   目的：检测子宫内抑酸药物的暴露和之后儿童发生过敏性疾病的相关性。
   方法：我们对3个瑞典国家卫生保健登记（医疗分娩登记、医院出院登记和瑞典处方药物登记）数据中得到的以人群为基础的观察队列进行了研究。检测的主要结局包括儿童出院诊断为过敏性疾病或处方为哮喘药物治疗、肾上腺素自动注射器、抗组胺剂或类固醇软膏。应用Mantel-Haenszel方法分析数据。
   结果：有29490名儿童（5.03%）的出院诊断为过敏或有处方过敏药物的治疗。5645名儿童（0.96%）其母亲在怀孕期间进行了抑酸治疗，这些儿童中405人（0.07%）进行了过敏性疾病的治疗。子宫内抗酸药物暴露与发生过敏的比值比（OR）增加（OR 1.43；95% CI，1.29-1.59），提示两者有关。我们是在忽略了药物类型、怀孕期间暴露的时间和母亲过敏病史的情况下得到这种的相关性。母亲服用抑酸药物和其子女儿童期发生哮喘的比值比增加（整个人群3.7% vs. 暴露儿童5.6%, OR 1.51, 95% CI 1.35-1.69），提示两者相关，但是和其他过敏性疾病无关。
    结论：这些数据首次表明子宫内抑酸药物暴露和儿童期发生哮喘的风险显著相关。

                                                           （苏楠  审校）
   Dehlink E, et al. Clin Exp Allergy. 2008 Dec 9. [Epub ahead of print]
                            
Dehlink E, et al. Clin Exp Allergy. 2008 Dec 9. [Epub ahead of print]
First evidence of a possible association between gastric acid suppression during pregnancy and childhood asthma: a population-based register study.

Summary Background Recent data in mice suggest that acid suppression during pregnancy yields offspring with type 2 T helper-dominant immunity, suggesting a predisposition for allergy. Objective To determine the association of in utero exposure to acid-suppressive medications and the subsequent development of allergic diseases in children. Methods We studied a population-based observational cohort formed by linking data from three Swedish national healthcare registers: the Medical Birth Register, the Hospital Discharge Register, and the Swedish Prescribed Drug Register. Main outcome measures included a hospital discharge diagnosis of an allergic disease or prescription for asthma medications, epinephrine auto-injectors, antihistamines or steroid ointments in children. Data were analysed using the Mantel-Haenszel procedure. Results Twenty-nine thousand four hundred and ninety (5.03%) children had a discharge diagnosis of allergy or prescriptions for allergy medications. Five thousand six hundred and forty-five (0.96%) children had been exposed to acid suppression therapy during pregnancy; of these, 405 (0.07%) were treated for allergic diseases. Exposure to acid-suppressive medications in utero was associated with an increased odds ratio (OR) for developing allergy (OR 1.43, 95% confidence interval (95% CI) 1.29-1.59). We observed this association irrespective of the type of drug, time of exposure during pregnancy, and maternal history of allergy. The use of maternal acid-suppressive medication was associated with an increased OR for the development of childhood asthma (3.7% in the population at large vs. 5.6% in exposed children, OR 1.51, 95% CI 1.35-1.69), but not for other allergic diseases. Conclusion These data provide first evidence of a significant association between in utero exposure to acid-suppressive drugs and the risk of developing childhood asthma.