Antibiotics in the first week of life and the association with atopic diseases at ages 9-12: a prospective cohort study.

Dysbiosis in early life has been associated with the development of atopic diseases. In the INCA study, antibiotic treatment in the first week of life was associated with wheezing at 1 year and food allergies at 4-6 years. This follow-up study investigates whether these associations persist at age 9-12, and whether new associations with other atopic diseases have developed. The INCA cohort consisted of 436 children included in 2012-2015 to investigate the long-term effects of antibiotic treatment in the first week of life. Term-born infants from four Dutch hospitals were included, of which 151 received intravenous antibiotics in their first week of life due to suspected early-onset sepsis (AB+), and 285 were unexposed infants (AB-). In the 9-12-year follow-up study, parents and children filled out questionnaires on atopic diseases. Furthermore, general practitioners' diagnoses were collected. The follow-up questionnaire was completed by 314 participants. Parental-reported and test-confirmed food allergies were more prevalent in AB+ children compared to AB- (unadjusted odds ratio (OR) 3.52, 95% confidence interval (CI) 1.50-8.25 and OR 6.6, 95% CI 1.3-32, respectively). However, no significant differences existed between AB+ and AB- in the incidence of asthma (OR 0.73, 95% CI 0.25-2.1) or inhalant allergies (OR 1.03, 95% CI 0.554-1.91). The "any allergy" diagnosis by general practitioners was more prevalent in AB+ than AB- (OR 3.0, 95% CI 1.2-7.6).

conclusionsAntibiotic treatment in the first week of life is associated with food allergies at ages 9-12, but not with asthma, inhalant allergies, or eczema. WHAT IS KNOWN: • Correlations have been observed between early life antibiotics exposure (< 2 years of age) and the development of atopic diseases such as asthma, eczema, and allergies. • Antibiotics exposure specifically in the first week of life has been associated with an increased risk of wheezing at age 1 and food allergies at ages 4-6. WHAT IS NEW: • Antibiotics in the first week of life are still associated with food allergies at ages 9-12, but not with airway atopy (asthma, hay fever, or inhalant allergies). • The results of this study suggest that there may be different mechanisms involved in the development of food vs. inhalant allergies, and further research is needed to determine how these diseases develop and how to prevent this.