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Antibiotics in the first week of life is a risk factor for allergic rhinitis at school age
Bernt Alm1, Emma Goksör, Rolf Pettersson
1Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
Insights
Early antibiotic exposure increases school-age allergic rhinitis risk, while farm living may be protective. These findings align with the hygiene hypothesis, suggesting environmental factors play a key role in allergy development.
Area of Science:
- Pediatrics
- Allergology
- Epidemiology
Background:
- Allergic rhinitis development is influenced by both genetic predisposition and environmental exposures.
- Identifying early-life risk and protective factors is crucial for understanding and potentially preventing allergic rhinitis in school-aged children.
Purpose of the Study:
- To investigate early-life risk and protective factors associated with the development of allergic rhinitis by school age.
- To analyze the impact of various early-life exposures on the incidence of allergic rhinitis.
Main Methods:
- A prospective, longitudinal study followed a randomly selected birth cohort from western Sweden, born in 2003.
- Parental questionnaires were administered at multiple time points (6 months, 1, 4.5, and 8 years), with 80.3% response rate at 8 years (n=4051).
- Allergic rhinitis was defined as current symptoms and medication use in the past 12 months at 8 years of age.
Main Results:
- 10.9% of children had allergic rhinitis at 8 years, with a mean onset age of 5.7 years. Boys constituted 61.9% of cases.
- Early-life antibiotic use (first week of life) significantly increased allergic rhinitis risk (aOR 1.75).
- Risk factors included parental allergic rhinitis (aOR 2.73), early food allergy (aOR 2.45), early eczema (aOR 1.97), and male gender (aOR 1.35). Living on a farm at 4.5 years was protective (aOR 0.31).
Conclusions:
- Antibiotic use in the first week of life is a significant risk factor for developing allergic rhinitis by school age.
- Exposure to a farm environment during preschool years appears to reduce the risk of allergic rhinitis.
- These findings support the hygiene hypothesis, highlighting the interplay between early-life exposures and immune system development in the context of allergic diseases.
Background:
Heredity as well as external factors influences the development of allergic rhinitis. The aim of this study was to analyse early risk factors and protective factors for allergic rhinitis at school age.
Methods:
This is a prospective, longitudinal study of children born in western Sweden in 2003 where 50% of the birth cohort was randomly selected. The parents answered questionnaires at 6 months, 12 months, 4.5 yr and 8 yr. At 8 yr, 5044 questionnaires were distributed. Of these, 4051 responded, that is, 80.3%. Current allergic rhinitis was defined as symptoms and use of medication during the past 12 months.
Results:
Current allergic rhinitis at 8 yr was reported by 10.9%. Mean onset age was 5.7 yr, and 61.9% were boys. In a multivariate analysis, antibiotics in the first week of life increased the risk of allergic rhinitis (adjusted odds ratio 1.75, 95% confidence interval (1.03, 2.97)). Increased risk was also seen with parental allergic rhinitis (aOR 2.73 (2.12, 3.52)), food allergy first year (aOR 2.45 (1.61, 3.73)), eczema first year (aOR 1.97 (1.50, 2.59)) and male gender (aOR 1.35 (1.05, 1.74)). Living on a farm at 4.5 yr reduced the risk (aOR 0.31 (0.13, 0.78)).
Conclusion:
Antibiotics in the first week of life increased the risk of allergic rhinitis at school age, while living on a farm at preschool age reduced the risk. Both findings are compatible with the hygiene hypothesis.
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