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The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: confounding or causality?
Clin Exp Allergy. 2008 Aug; 38(8):1318-24.CE

Abstract

BACKGROUND

In general, studies reporting positive associations between antibiotic exposure and respiratory and allergic disease have been unable to determine the nature of this association.

OBJECTIVE

To examine the association between antibiotic exposure in infancy and the development of asthma, eczema and atopy in early childhood.

METHODS

In a birth cohort study, we collected reported antibiotic exposure before 3 months and before 15 months along with outcomes (wheeze, asthma, eczema, rash, inhaler use) at 15 months (n=1011) and 4 years (n=986). Atopy was measured using skin prick tests at 15 months.

RESULTS

We found significant univariate associations of antibiotic exposure before 3 months with asthma developing between birth and 15 months [OR 2.32 (95% CI 1.45-3.69)]. After adjustment for chest infections, this association reduced (OR=1.58, 95% CI 0.96-2.60) becoming marginally significant (P=0.07). A marginally significant association of antibiotics with atopy (OR=1.44, 95% CI 0.96-2.14) in the univariate analysis also reduced after adjustment for chest infections (OR=1.36, 95% CI 0.91-2.05). There was no effect of antibiotic exposure before 15 months on asthma developing after 15 months and present between 3 and 4 years (OR=1.35 95% CI 0.85-2.14). Antibiotic exposure before 3 months was not associated with eczema and rash developing between birth and 15 months but exposure before 15 months was related to eczema [OR 1.83 (95% CI 1.10-3.05)] and rash [OR 1.61 (95% CI 1.02-2.53)] developing after 15 months and remaining present at 4 years. These effects reduced in the multivariate analysis.

CONCLUSIONS

Our findings suggest that the effect of antibiotics on respiratory disease may be due to confounding by chest infections at an early age when asthma may be indistinguishable from infection.

Authors+Show Affiliations

Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand. kristin.wickens@otago.ac.nzNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18727794

Citation

Wickens, K, et al. "The Association of Early Life Exposure to Antibiotics and the Development of Asthma, Eczema and Atopy in a Birth Cohort: Confounding or Causality?" Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 38, no. 8, 2008, pp. 1318-24.
Wickens K, Ingham T, Epton M, et al. The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: confounding or causality? Clin Exp Allergy. 2008;38(8):1318-24.
Wickens, K., Ingham, T., Epton, M., Pattemore, P., Town, I., Fishwick, D., & Crane, J. (2008). The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: confounding or causality? Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 38(8), 1318-24. https://doi.org/10.1111/j.1365-2222.2008.03024.x
Wickens K, et al. The Association of Early Life Exposure to Antibiotics and the Development of Asthma, Eczema and Atopy in a Birth Cohort: Confounding or Causality. Clin Exp Allergy. 2008;38(8):1318-24. PubMed PMID: 18727794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: confounding or causality? AU - Wickens,K, AU - Ingham,T, AU - Epton,M, AU - Pattemore,P, AU - Town,I, AU - Fishwick,D, AU - Crane,J, AU - ,, PY - 2008/8/30/pubmed PY - 2008/10/23/medline PY - 2008/8/30/entrez SP - 1318 EP - 24 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 38 IS - 8 N2 - BACKGROUND: In general, studies reporting positive associations between antibiotic exposure and respiratory and allergic disease have been unable to determine the nature of this association. OBJECTIVE: To examine the association between antibiotic exposure in infancy and the development of asthma, eczema and atopy in early childhood. METHODS: In a birth cohort study, we collected reported antibiotic exposure before 3 months and before 15 months along with outcomes (wheeze, asthma, eczema, rash, inhaler use) at 15 months (n=1011) and 4 years (n=986). Atopy was measured using skin prick tests at 15 months. RESULTS: We found significant univariate associations of antibiotic exposure before 3 months with asthma developing between birth and 15 months [OR 2.32 (95% CI 1.45-3.69)]. After adjustment for chest infections, this association reduced (OR=1.58, 95% CI 0.96-2.60) becoming marginally significant (P=0.07). A marginally significant association of antibiotics with atopy (OR=1.44, 95% CI 0.96-2.14) in the univariate analysis also reduced after adjustment for chest infections (OR=1.36, 95% CI 0.91-2.05). There was no effect of antibiotic exposure before 15 months on asthma developing after 15 months and present between 3 and 4 years (OR=1.35 95% CI 0.85-2.14). Antibiotic exposure before 3 months was not associated with eczema and rash developing between birth and 15 months but exposure before 15 months was related to eczema [OR 1.83 (95% CI 1.10-3.05)] and rash [OR 1.61 (95% CI 1.02-2.53)] developing after 15 months and remaining present at 4 years. These effects reduced in the multivariate analysis. CONCLUSIONS: Our findings suggest that the effect of antibiotics on respiratory disease may be due to confounding by chest infections at an early age when asthma may be indistinguishable from infection. SN - 1365-2222 UR - https://www.unboundmedicine.com/medline/citation/18727794/The_association_of_early_life_exposure_to_antibiotics_and_the_development_of_asthma_eczema_and_atopy_in_a_birth_cohort:_confounding_or_causality L2 - https://doi.org/10.1111/j.1365-2222.2008.03024.x DB - PRIME DP - Unbound Medicine ER -