Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
Pediatr Allergy Immunol. 2024 Mar;35(3):e14114. doi: 10.1111/pai.14114.
There are only preliminary studies examining the associations of postnatal antibiotic exposure with food allergy in childhood, and the effect of antibiotic exposure in utero has not been resolved. Thus, we aimed to investigate the effect of prenatal and postnatal antibiotic exposure on the risk of food allergy in childhood.
Using the nationwide birth cohort in South Korea, all 3,163,206 infants (pairing mother; n = 2,322,735) born in South Korea between 2010 and 2017 were included in the analysis. The primary outcome was the diagnosis of food allergy, and the observation period was between January 1, 2009, and December 31, 2020. We implemented four different designs for the study, which consisted of a full unmatched cohort, 1:1 propensity-matched cohort, sibling comparison cohort, and health screening cohort along with multiple subgroup analyses.
During the follow-up period (median 6.92 years [IQR, 4.72-9.00]) of the 3,161,858 infants (52.6% male) in the birth cohort, 29,973 (1.9%) were diagnosed with food allergies. After a 1:1 propensity score matching, the use of antibiotics increased the risk of overall food allergy (prenatal [HR, 1.05; 95% CI, 1.04-1.09] and postnatal [HR, 1.05; 95% CI, 1.01-1.10] periods). The association was more significantly accentuated when antibiotic exposure was used in the short term, and the children were born preterm or with low birthweight; however, a trimester-specific effect was not observed. We observed more pronounced risks of food allergy in the health screening cohort (prenatal, 17%; postnatal, 15%), thus addressing the adverse effects of critical factors including maternal BMI, smoking status, and type of infant feeding. Similar trends were observed across all four differnt cohorts.
This study reported a moderate association between early-life antibiotic use and subsequent food allergy during childhood throughout four different designs of analyses. This study suggests that clinicians need to consider the risks and benefits of antibiotics when administering antibiotics to individuals in the prenatal and postnatal periods.
仅有初步研究探讨了产后抗生素暴露与儿童期食物过敏的关联，而产前抗生素暴露的影响尚未得到解决。因此，我们旨在调查产前和产后抗生素暴露对儿童期食物过敏风险的影响。
利用韩国全国性出生队列，纳入 2010 年至 2017 年间在韩国出生的所有 3163206 名婴儿（配对母亲；n=2322735）。主要结局为食物过敏诊断，观察期为 2009 年 1 月 1 日至 2020 年 12 月 31 日。我们实施了四项不同的研究设计，包括全未匹配队列、1:1 倾向评分匹配队列、兄弟姐妹比较队列和健康筛查队列，并进行了多项亚组分析。
在 3161858 名婴儿（52.6%为男性）的出生队列中，中位随访时间为 6.92 年（IQR，4.72-9.00），其中 29973 名（1.9%）被诊断为食物过敏。在 1:1 倾向评分匹配后，抗生素的使用增加了总体食物过敏的风险（产前[HR，1.05；95%CI，1.04-1.09]和产后[HR，1.05；95%CI，1.01-1.10]）。当抗生素短期使用，儿童早产或低出生体重时，这种关联更为显著；然而，并未观察到特定孕期的影响。我们在健康筛查队列中观察到更明显的食物过敏风险（产前，17%；产后，15%），从而解决了包括母亲 BMI、吸烟状况和婴儿喂养类型等关键因素的不利影响。在所有四个不同的队列中都观察到了相似的趋势。
本研究在四项不同的分析设计中报告了儿童期早期抗生素使用与随后食物过敏之间的中度关联。本研究提示临床医生在产前和产后期间给个体使用抗生素时需要考虑风险和益处。
