The Journal of Allergy and Clinical Immunology
Volume 124, Issue 5 , Pages 982-989, November 2009

Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III

  • Sunia Foliaki, MBBS, MPH, PhD

      Affiliations

    • Center for Public Health Research, Massey University, Wellington, New Zealand
    • ,
  • Neil Pearce, PhD, DSc

      Affiliations

    • Center for Public Health Research, Massey University, Wellington, New Zealand
    • Corresponding Author InformationReprint requests: Neil Pearce, PhD, DSc, Centre for Public Health Research, Massey University, Wellington Campus, Private Box 756, Wellington, New Zealand.
    • ,
  • Bengt Björkstén, MD, PhD

      Affiliations

    • Center for Allergy Research, Karolinska Institute, Stockholm, Sweden
    • ,
  • Javier Mallol, MD

      Affiliations

    • Department of Pediatric and Respiratory Medicine, University of Santiago de Chile, Santiago, Chile
    • ,
  • Stephen Montefort, MD, PhD

      Affiliations

    • Department of Medicine, University of Malta, Malta, Germany
    • ,
  • Erika von Mutius, MD, MSc

      Affiliations

    • Dr von Haunersches University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
    • ,
  • International Study of Asthma and Allergies in Childhood Phase III Study Group

Received 23 April 2009; received in revised form 1 August 2009; accepted 6 August 2009.

Background

Phase III of the International Study of Asthma and Allergies in Childhood measured the global prevalence of symptoms of asthma, rhinoconjunctivitis, and eczema in children.

Objective

To investigate the associations between the use of antibiotics in the first year of life and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old.

Methods

Parents or guardians of children 6 and 7 years old completed written questionnaires on current symptoms and possible risk factors. Prevalence odds ratios (ORs) were estimated by using logistic regression.

Results

A total of 193,412 children from 71 centers in 29 countries participated. Reported use of antibiotics in the first year of life was associated with an increased risk of current asthma symptoms (wheezing in the previous 12 months) with an OR (adjusted for sex, region of the world, language, and per capita gross national income) of 1.96 (95% CI, 1.85-2.07); this fell to 1.70 (1.60-1.80) when adjusted for other risk factors for asthma. Similar associations were observed for severe asthma symptoms (OR, 1.82; 95% CI, 1.67-1.98), and asthma ever (OR, 1.94; 95% CI, 1.83-2.06). Use of antibiotics in the first year of life was also associated, but less strongly, with increased risks of current symptoms of rhinoconjunctivitis (OR, 1.56; 95% CI, 1.46-1.66) and eczema (OR, 1.58; 95% CI, 1.33-1.51).

Conclusion

There is an association between antibiotic use in the first year of life and current symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old. Further research is required to determine whether the observed associations are causal or are a result of confounding by indication or reverse causation.

Key words: Antibiotics, ISAAC, asthma, rhinoconjunctivitis, eczema

Abbreviations used: ISAAC, International Study of Asthma and Allergies in Childhood, OR, Odds ratio

 

 Disclosure of potential conflict of interest: S. Foliaki has received research support from the New Zealand Health Research Council and the Center for Public Health Research, Massey University. E. von Mutius has consulted for GlaxoSmithKline, UCB, and ProtectImmun and has received research support from Airsonett. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)01253-6

doi:10.1016/j.jaci.2009.08.017

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 5 , Pages 982-989, November 2009

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