Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease?

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Abstract
One of the mechanisms evoked to explain the increasing prevalences of asthma and allergy, in particular among children, is the ‘Western lifestyle’ or ‘hygiene’ hypothesis. As early childhood infections are assumed to hold a protective effect on the development of asthma and allergies, the use of antibiotics at that sensitive age may lead to an increased risk of asthma and allergy. The aim of this study is to investigate the association between the use of antibiotics in the first year of life and the subsequent development of asthma and allergic disorders. In a population-based sample of 7-and-8-year-old children questionnaire and skin prick test data were collected from 1206 and 675 subjects, respectively. Prevalence rates of asthma, allergic disorders and skin test positivity were compared between children with and without early life use of antibiotics, taking into account other possible risk factors including early respiratory infections. The effect of genetic predisposition was investigated by stratified analyses of children with and without parental hay fever. The use of antibiotics during the first year of life was significantly associated with asthma (OR = 1.7, 95% CI 1.0–3.1), hay fever (OR = 2.3, 95% CI 1.3–3.8) and eczema (OR = 1.3, 95% CI 1.0–1.8). No significant relationship was found with skin test positivity (OR = 1.1, 95% CI 0.7–1.7). After stratification for the presence of parental hay fever, children without parental hay fever did not show any significant associations between antibiotics use and asthma or allergy, whereas in children with parental hay fever the use of antibiotics was significantly related with asthma (OR = 2.3, 95% CI 1.1–5.1), hay fever (OR = 2.8, 95% CI 1.5–5.1) and eczema (OR = 1.6, 95% CI 1.0–2.6), and of borderline statistical significance with skin test positivity (OR = 1.6, 95% CI 0.9–3.0). Early childhood use of antibiotics is associated with an increased risk of developing asthma and allergic disorders in children who are predisposed to atopic immune responses. These findings support recent immunological understanding of the maturation of the immune system.