To the Editor The study by Mitre et al1 is concerning given incomplete acknowledgment of limitations and questionable accuracy of associations between antireflux and antibiotic use independently increasing the risk of developing allergic diseases.1 Using International Classification of Diseases, Ninth Revision codes to indicate a diagnosis of allergic conditions is often inaccurate without additional encounter-level details verifying a history consistent with the condition and confirmatory testing. These diagnoses were not linked to allergist referral and confirmatory coding, evidence of allergen sensitization, abnormal pulmonary function testing, or treatment of the diagnosis.2 This raises concerns of misspecified associations with risk.
Greenhawt M, Stukus D, Chan ES. Antibiotics and Acid-Suppressing Medications in Early Life and Allergic Disorders. JAMA Pediatr. 2018;172(10):987–988. doi:10.1001/jamapediatrics.2018.2510
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