Ofri Mai, Kristal Eyal, Cohen Braha, Beigelman Avraham, Hazan Guy
The School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
The Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Eur J Pediatr. 2025 Apr 21;184(5):304. doi: 10.1007/s00431-025-06136-2.
Food allergies (FAs) in children have become increasingly prevalent. While early life factors such as gut microbiome disruptions have been implicated, the association between neonatal antibiotic exposure and subsequent FAs remains a topic of ongoing debate. This nationwide cohort study aimed to investigate the impact of neonatal antibiotic exposure on the development of childhood FA. This population-based retrospective cohort study analyzed data from Clalit-Healthcare-Services, Israel's largest state-mandated healthcare provider. The cohort included neonates (aged 0-60 days) admitted with fever between 2011 and 2018. Patients with confirmed infectious etiologies were excluded. The cohort was divided into two groups: those who received systemic antibiotics (Antibiotic ( +)) and those who did not (Antibiotic ( -)). FA cases were identified using ICD-9 codes up to age 6. Multivariate logistic regression and survival analysis models were utilized and adjusted for inflammatory markers, maternal atopy, and socioeconomic status. Among 2780 neonates, 1220 received antibiotics, while 1560 did not. The incidence of FAs was significantly higher in the Antibiotic ( +) group compared to the Antibiotic ( -) group (2.5% vs. 1.3%, P = 0.02). Adjusted analysis revealed that systemic antibiotic exposure during the neonatal period was associated with a threefold increased risk of FA up to age 6 (OR = 2.89, 95% CI = 1.34-6.92, P = 0.01). Conclusions: This study provides strong evidence linking neonatal antibiotic exposure to an increased risk of childhood FAs, particularly in the first 2 years of life. The findings highlight the importance of judicious antibiotic use in young infants.
儿童食物过敏（FA）日益普遍。虽然诸如肠道微生物群破坏等早期生活因素与之相关，但新生儿期抗生素暴露与随后发生的食物过敏之间的关联仍是一个持续争论的话题。这项全国性队列研究旨在调查新生儿期抗生素暴露对儿童食物过敏发展的影响。这项基于人群的回顾性队列研究分析了以色列最大的国家法定医疗服务机构——克拉利特医疗服务公司的数据。该队列包括2011年至2018年期间因发热入院的新生儿（年龄0至60天）。确诊有感染病因的患者被排除。该队列分为两组：接受全身用抗生素的（抗生素（+）组）和未接受的（抗生素（-）组）。使用国际疾病分类第九版（ICD - 9）编码确定6岁以下的食物过敏病例。采用多变量逻辑回归和生存分析模型，并针对炎症标志物、母亲特应性和社会经济状况进行了调整。在2780名新生儿中，1220名接受了抗生素治疗，而1560名未接受。抗生素（+）组的食物过敏发生率显著高于抗生素（-）组（2.5%对1.3%，P = 0.02）。调整分析显示，新生儿期全身用抗生素暴露与6岁前食物过敏风险增加两倍相关（比值比（OR）= 2.89，95%置信区间（CI）= 1.34 - 6.92，P = 0.01）。结论：本研究提供了有力证据，表明新生儿期抗生素暴露与儿童食物过敏风险增加有关，尤其是在生命的头两年。研究结果凸显了在幼儿中明智使用抗生素的重要性。
