Recorded infections and antibiotics in early life: associations with allergy in UK children and their parents

Abstract

Background: It is suggested that the inverse relationship between allergic disease and family size reflects reduced exposure to early life infections, and that antibiotic treatment in childhood diminishes any protective effect of such infection. Methods: A birth cohort study was undertaken in 642 children recruited before birth and seen annually until the age of 8 years. Reported infections and prescribed antibiotics by the age of 5 years were counted from GP records and comparisons were made with a previous study of their parents. Results: At the age of 8 years, 104 children (19%) were atopic, 79 (13%) were currently wheezy and 124 (21%) had seasonal rhinitis. 577 children (97%) had at least three infections recorded by age 5, a figure much higher than that of their parents (69%). By the age of 5 only 11 children (2%) had never received a prescription for antibiotics; the corresponding figure for the parents was 24%. Higher numbers of infections were recorded for firstborn children. After adjusting for parental atopy and birth order, there was no association between infection counts and atopy (OR 1.01 (95% CI 0.99 to 1.03) per infection). Significant positive associations were found for wheeze and seasonal rhinitis. An increased risk of current wheeze was found for each antibiotic prescription (adjusted OR 1.07 (95% CI 1.03 to 1.10)) but not for atopy. This was primarily explained by prescriptions for respiratory infections. Similar patterns were observed for seasonal rhinitis. Conclusions: Despite very high rates of recorded early life infections and antibiotic prescriptions, no plausibly causative relationships were found with subsequent respiratory allergies.

Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

“…Taken together, this results in two studies with doubtful results [38,39], three studies in which the association disappeared after correcting for RC [3,40,42], and eight that found a positive association that could not be explained by RC [41,[43][44][45][46][47][48][49].…”

“…Four other studies [3,[40][41][42] corrected for RC by means of excluding children who had already developed symptoms at the time of antibiotic use from the analyses. In three of these studies [3,40,42], initially positive associations between antibiotic use and wheeze or asthma disappeared after correction, whereas in the fourth study [41] the association between antibiotic use and wheeze remained after correcting for RC. RC as an explanation was unlikely in six studies that had ensured that exposure (antibiotic use) and follow-up periods took place subsequently and were not overlapping [43][44][45][46][47][48].…”

“…Although several studies had a follow-up beyond pre-school age [36,42,44,45,47,48,50], several of them did not distinguish between age periods of diagnosis, thus still resulting in many cases already being diagnosed at pre-school ages [36,44,45,48]. The studies by MARTEL et al [45] and PONSONBY et al [36] did conduct subgroup analysis based on age of asthma onset, but with a cut-off of 3 and 4 yrs, respectively.…”

Early‐life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta‐analysis

“…However, it should be noted that there is no clear relationship between allergic sensitization and allergic symptoms. 17,[51][52][53] Although allergic sensitization often overlaps with the occurrence of allergic symptoms, there are also many children without allergen-specific serum IgE/positive SPT that do develop allergic symptoms 17,19,21,22,26,31 and vice versa. 43 There might be a different …”

“…Only 11 of 34 studies included explicitly reported that the use of antibiotics preceded the diagnosis of allergies. 10,12,16,18,21,[25][26][27]37,38,43 In our meta-analysis, we tested the association between antibiotics and risk of hay fever and eczema only in these 11 studies to infer causality and the results still showed a significant association.…”