Prenatal, postnatal antibiotics show varying risks for allergic symptoms in infants
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Key takeaways:
- Prenatal antibiotic exposure showed a borderline association with the development of wheeze in infants.
- Risk for the development of wheeze, asthma and eczema was linked to postnatal antibiotic exposure.
- Prenatal and postnatal antibiotics showed “conflicting” associations with food sensitization, according to the study researchers.
Exposure to prenatal and postnatal antibiotics appeared associated with risks for development of allergic diseases in infants, according to a study published in Pediatric Allergy and Immunology.
However, risk for food sensitization differed between the two types of antibiotic exposures, according to researchers.
“This was an observational study, which means that we cannot prove a causal link between antibiotic treatment and the development of allergic diseases,” Christina West, MD, PhD, professor, senior consultant and chair of pediatric allergy and immunology at Umeå University in Sweden, told Healio. “Antibiotics should of course be prescribed to children when there is indication, such as in the treatment of bacterial infections including blood stream infections, bacterial pneumonia and urinary tract infection. However, as a general rule, antibiotics should not be prescribed for viral infections, such as the common cold or the flu.”
West and colleagues examined data from 1,387 mother-child pairs from the NorthPop birth cohort study conducted in Sweden. They sought to observe the relationship between prenatal and postnatal antibiotics and allergic manifestations in infants through age 18 months.
Parents reported allergic symptoms (n = 1,219) and physician-diagnosed food allergy (n = 1,025) their infants experienced up to age 18 months. Researchers then tested serum immunoglobulin E levels to inhalant (birch, timothy, mugwort, cat, dog, horse, Cladosporium herbarum, Dermatophagoides pteronyssinus and farinae) and food (cow's milk, egg white, wheat, codfish, peanut and soybean) allergens once the infant turned 18 months old.
According to researchers, parents reported wheeze in 252 (18.2%) infants and “any adverse reaction to food and drinks” in 255 (22.7%) infants, with 69 (5%) infants having
physician-diagnosed asthma and 44 (3.9%) diagnosed with food allergy. Eczema was reported in 424 (30.6%) infants.
Through questionnaires given at 4, 9 and 18 months, researchers found 114 (9.2%) women took antibiotics during their pregnancy, and 252 (20.2%) infants received antibiotics in the first 18 months.
Despite a positive association in the crude data between prenatal antibiotic exposure and food sensitization, this relationship did not persist in the adjusted analysis (adjusted OR = 1.58; 95% CI, 0.82-3.05).
Additionally, in the adjusted analysis, prenatal antibiotic exposure showed an association of borderline significance with wheeze (aOR = 1.56; 95% CI, 0.95-2.57).
Exposure to postnatal antibiotics was found to have a decreased risk for food sensitization (aOR = 0.46; 95% CI, 0.25-0.83), which West said was “an unexpected finding.” However, this decreased risk was not found for food allergy or sensitization to inhalants.
Researchers also observed that exposure to postnatal antibiotics was significantly linked to risk for wheeze (aOR 2.14; 95% CI, 1.47-3.11), asthma (aOR = 2.35; 95% CI, 1.32-4.19) and eczema (aOR = 1.49; 95% CI, 1.07-2.06).
When researchers excluded infants treated with antibiotics because of a respiratory tract infection, the estimates remained mostly unchanged for wheeze (aOR = 2.03; 95% CI 1.57-3.07) and asthma (aOR = 2; 95% CI 1.07-3.74), indicating that antibiotic treatment for other indications increased the risks for wheeze and asthma. When they excluded children treated with antibiotics due to skin infection, the association did not remain (aOR =1.32; 95% CI 0.94-1.86).
“Future studies should assess the association between perinatal antibiotics and allergic diseases and IgE-sensitization at a later age,” West told Healio. “The mechanisms underlying the association between antibiotic exposure in early life and allergic diseases also need to be demonstrated. Although we know from animal models that broad-spectrum antibiotics in the perinatal period impact gut microbiota, increase IgE production and reduce regulatory T-cell populations that suppress overly active immune responses, we need further mechanistic studies in the human setting.”
For more information:
Christina West, MD, PhD, can be reached at christina.west@umu.se.
Photo credit: Mattias Pettersson