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Early-life antibiotic use is associated with wheezing among children with high atopic risk: a prospective European
Wenjie Sun1, Erik R Svendsen, Wilfried J J Karmaus
1a School of Food Science, Guangdong Pharmaceutical University , Zhongshan , China .
Insights
Early macrolide antibiotic use in infants with allergy risk is linked to increased wheezing. This association persists even without respiratory infections, highlighting potential long-term respiratory health impacts.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Pharmacology
Background:
- Limited understanding of antibiotic impact on childhood asthma development in high-risk infants.
- Investigating the link between early-life antibiotic exposure and allergic sensitization in children.
Purpose of the Study:
- To examine the association between specific antibiotic use in the first year of life and wheezing by 36 months.
- Focusing on children with a high risk for allergic sensitization.
Main Methods:
- Multi-center prospective cohort study of 606 European children at high risk for allergic sensitization.
- Validated questionnaires collected data on antibiotic use and wheezing risk factors at multiple time points.
- Multivariate regression models adjusted for confounders to assess antibiotic-wheezing association.
Main Results:
- Macrolide antibiotic use in the first year was associated with increased wheezing risk by 36 months (RR=1.09).
- This association remained significant after adjusting for multiple risk factors including respiratory infection.
- Analysis of children without respiratory infection confirmed the association with macrolide use.
Conclusions:
- Macrolide exposure in infancy is linked to wheezing in European children with familial allergy risk.
- The observed association is independent of respiratory infection, suggesting a direct effect.
- Findings emphasize the need to consider early antibiotic use in pediatric respiratory health and allergy development.
Background:
Little is known about the relationship between antibiotic use and asthma in the children with a higher risk of allergic sensitization. We examine the association between the use of specific therapeutic antibiotics in the first year of life and development of wheezing by 36 months among children with a higher risk of allergic sensitization.
Methods:
A multi-center prospective cohort study was conducted among children at high risk for allergic sensitization. A validated questionnaire was used to prospectively collect information on antibiotic use and potential risk factors for wheezing from parents or guardians of 606 children from three European countries at 6, 12, 24 and 36 months of age. Multivariate linear and logistic regression models were used to adjust for potential confounders and effect modifiers and to estimate the association of antibiotic use with the development of early childhood wheezing.
Results:
Of the antibiotics assessed, only macrolide use in the first year of life was associated with increasing risk for wheezing by 36 months, after adjusting for gender, socioeconomic status, breast feeding >6 months, tobacco smoke exposure, family history of asthma, and respiratory infection (RR = 1.09; 95% CI 1.05-1.13). To avoid a bias by indication, we analyzed children with and without respiratory infection separately. Similar associations were observed for macrolides use in children who had no respiratory infection.
Conclusions:
In European children with a familial risk for allergic sensitization, we found a positive association between macrolide use in the first year of life and wheezing until 36 months old which was independent of the effect of respiratory infection.
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