The association between early life antibiotic use and allergic disease in young children: recent insights and their implications

Abstract

Greater prescribing of antibiotics to infants has coincided with an epidemic of allergic disease. Through meta-analytic synthesis, accumulating evidence from prospective or database cohorts suggests a link between infant antibiotic treatment and the development of atopy. Stronger associations seen with multiple course and broad-spectrum antibiotic treatment add to biological plausibility. A major bias, confounding by indication, has been addressed in studies on antibiotic treatment of conditions which do not precede allergic disease. Areas covered: Our review provides an up-to-date synthesis of the current literature on associations between infant antibiotic exposure and future allergic disease. We discuss methods that assist in reducing study bias and look at new insights from studies of the infant gut microbiome. Expert commentary: Large-scale profiling of the gut microbiome provides a new tool for disentangling biases found in observational studies of infant antibiotic use. To date, microbial dysbiosis of the infant gut has been reported to predict allergic disease independent of antibiotic exposure up to 3 months after birth. However, these studies have not accounted for antibiotic treatment in later infancy. Continued study of the infant gut microbiome, mycobiome, or resistome will provide a closer link to antibiotic treatment or refute it as a cause of allergic disease.

Dysbiosis of the gut and lung microbiome has a role in asthma

“…Generally, it is well accepted that changes of the intestinal microbiota, and of their metabolites, has a systemic impact and determines the severity of atopic dermatitis and the susceptibility to asthma [110], especially when occurring in early life [111], up to 1 year after birth [54,112]. This was demonstrated in a mouse model where an antibiotic mix reduced T-regulatory cell (Treg) abundance in the lung and supported house dust mite-specific asthma [100].…”

The Relationship between the Infant Gut Microbiota and Allergy. The Role of Bifidobacterium breve and Prebiotic Oligosaccharides in the Activation of Anti-Allergic Mechanisms in Early Life

“…In the short term, antibiotic-induced changes in the intestinal microbiota may contribute to the pathogenesis of necrotizing enterocolitis (NEC) and antibiotic-associated diarrhea [27,28]. In the long term, antibiotic therapy in infants and young children may have a significant impact on the process of microbiota development and on microbial programming of anti-allergic mechanisms later in life [29,30]. Table 1 presents a summary of studies showing the effect of antibiotic exposure in perinatal and early post-natal periods on the composition of intestinal microbiota [26,[31][32][33][34][35][36][37][38].…”

Perspective of Caesarean section delivery and its health risks on children among Indonesian pediatricians

“…It impacts on early immune developing that will increase the risk of immunologic problem like an allergy. 8,9,21 There are number studies examined the antibiotic exposure increased the risk of pediatric atopic or asthma. 9,21 Current medical care promotes the use of antibiotics have to change the pattern of infectious disease and bacterial exposure in infancy that the use of antibiotics should be reduced.…”