Early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in the first 2 years of life: The KOALA Birth Cohort Study
Early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in the first 2 years of life: The KOALA Birth Cohort Study
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DOI：
10.1542/peds.2006-0896
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发表时间：
2007-01-01
期刊：
影响因子：
8
通讯作者：
van den Brandt, Piet A.
中科院分区：
文献类型：
--
作者：
Kummeling, Ischa;Stelma, Foekje F.;van den Brandt, Piet A.
目标。生命早期接触抗生素可能通过干扰细菌共生菌群或改变细菌感染的过程与特应性疾病的发展有关。我们评估了生命早期接触抗生素的情况以及婴儿期湿疹、喘息和过敏性过敏的后续发展。方法。通过对参加荷兰 KOALA（儿童、父母和健康：生活方式和遗传构成[荷兰语]）出生队列研究的 2764 个家庭进行重复问卷调查，收集了有关头 6 个月内抗生素使用以及 2 岁之前湿疹和喘息的信息。抗生素摄入量根据母乳喂养期间母亲抗生素的使用情况和婴儿口服药物进行评估。使用放射性过敏吸附剂测试，分析了 815 名 2 岁婴儿的静脉血样本中针对常见食物和吸入过敏原的总免疫球蛋白 E 和特异性免疫球蛋白 E。使用多变量逻辑回归分析来调整混杂因素。结果。在头 2 年内，32% 的婴儿患有湿疹，11% 的婴儿患有反复喘息，5% 的婴儿患有长期喘息。 2 岁时，27% 的儿童对 >= 1 种过敏原过敏。 6 个月大时，11% 的孩子通过母乳接触过抗生素，20% 的孩子直接通过药物接触抗生素。在通过药物直接接触抗生素的婴儿中，反复喘息和长时间喘息的风险较高，而且在从分析中排除与使用抗生素同一时期出现喘息的儿童之后（避免反向因果关系）。母乳喂养期间使用抗生素与反复喘息有关，但长时间喘息则不然。湿疹和过敏与抗生素暴露无关。结论。我们证明，在生命的头两年内，早期抗生素的使用先于喘息的表现，而不是湿疹或过敏性过敏的表现。与湿疹或过敏相比，喘息的病因可能有不同的生物学机制。母乳喂养期间接触抗生素会增加反复喘息的风险，但这需要进一步证实。
OBJECTIVES. Antibiotic exposure in early life may be associated with atopic disease development either by interfering with bacterial commensal flora or by modifying the course of bacterial infections. We evaluated early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in infancy.METHODS. Information on antibiotic use in the first 6 months and eczema and wheeze until age 2 was collected by repeated questionnaires in 2764 families participating in the KOALA (Child, Parent and Health: Lifestyle and Genetic Constitution [in Dutch]) Birth Cohort Study in the Netherlands. Antibiotic intake was evaluated both as maternal antibiotic use during breastfeeding and infant oral medication. Venous blood samples taken from 815 infants at 2 years of age were analyzed for total and specific immunoglobulin E against common food and inhalant allergens using a radioallergosorbent test. Multivariate logistic regression analysis was used to adjust for confounding factors.RESULTS. During the first 2 years, eczema was present in 32% of all infants, recurrent wheeze in 11%, and prolonged wheezing in 5%. At 2 years old, 27% of children were sensitized against >= 1 allergen. At 6 months old, 11% had been exposed to antibiotics through breast milk and 20% directly through medication. The risk for recurrent wheeze, and prolonged wheeze was higher in infants directly exposed to antibiotics through medication, also after excluding from the analyses children who wheezed in the same period as an antibiotic had been used (avoiding reverse causation). Antibiotic use through breastfeeding was associated with recurrent wheeze, but prolonged wheeze was not. Eczema and sensitization were not associated with antibiotic exposure.CONCLUSIONS. We demonstrated that early antibiotic use preceded the manifestation of wheeze but not eczema or allergic sensitization during the first 2 years of life. Different biological mechanisms may underlie the etiology of wheeze compared with eczema or sensitization. Antibiotic exposure through breastfeeding enhanced the risk for recurrent wheeze, but this needs further confirmation.