Pre- and Post-natal Exposure to Antibiotics and the Development of Eczema, Recurrent Wheezing, and Atopic Sensitization in Children Up to the Age of 4 Years

Karla L. Davis

doi:10.1542/peds.2011-2107F

S Dom, JH Droste, MA Sariachvili. Clin Exp Allergy. 2010;40(9):1378–1387

PURPOSE OF THE STUDY.

To investigate the relationship of indirect prenatal and postnatal antibiotic exposure and the subsequent development of eczema, recurrent wheeze, and atopic sensitization in early childhood.

STUDY POPULATION.

The study population of 773 children was obtained from a prospective project regarding the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies (PIPO cohort) in Belgium. Of 2006 women recruited at 20 weeks of pregnancy, 1072 agreed to participate (total cohort population: 1128 children).

METHODS.

Children were included in the current study if information on antibiotic exposure and at least 1 health outcome was available. History of maternal antibiotic use during pregnancy and breastfeeding was queried at home visits during pregnancy and after delivery. Postal questionnaires queried patient antibiotic exposure at 1 year and subsequently every 6 months until the age of 4 years. Biannual questionnaires also queried the diagnoses of eczema or recurrent wheeze in children. Atopic sensitization was assessed via Dermatophagoides pteronyssinus–, cat-, dog-, egg-, and cow's milk–specific immunoglobulin E (IgE) at 1 and 4 years and birch- and timothy grass–specific IgE at 4 years. Atopic sensitization was defined as at least 1 positive specific IgE result. Parental D pteronyssinus–, cat-, dog-, birch-, timothy-, mugwort-, and Cladosporium herbarum–specific IgE were quantified. Gender, parental allergic history, parental educational level, pet exposure, tobacco use during pregnancy, birth weight, maternal age at birth, breastfeeding history, number of older siblings, day care attendance, environmental tobacco exposure, and lower respiratory tract infection history were also queried. Chronology of exposures and outcomes were considered independently.

RESULTS.

Prenatal antibiotic exposure was significantly positively associated with eczema but not associated with recurrent wheeze or atopic sensitization. Antibiotic exposure through breastfeeding had a positive, but not statistically significant, association with recurrent wheeze. Neither eczema nor atopic sensitization was significantly associated with antibiotic exposure through breastfeeding. There was a negative association between patient use of antibiotics in the first year of life and eczema and atopic sensitization and between patient use of antibiotics after the first year of life and recurrent wheeze, eczema, and atopic sensitization.

CONCLUSIONS.

Indirect exposure to antibiotics during pregnancy or through breast milk increases the risk for allergic symptoms in children, whereas direct exposure is protective.

REVIEWER COMMENTS.

The authors acknowledged potential study limitations to include selection bias, selective attrition, and misclassification of the chronology of antibiotic exposure and outcomes. Future studies on both outcomes associated with indirect antibiotic exposure in children and associations between the chronology of antibiotic exposure and atopic disease outcomes in childhood are needed.