Infant antibiotic exposure and food allergy development

Description

A Northwestern University Capstone Project. This paper is submitted in fulfillment of the requirements for the Master of Public Health degree in the Spring of 2017.

Abstract

Background: Food allergy prevalence is steadily increasing in the developed world, for reasons that are still being investigated. Epidemiological evidence suggests that insufficient microbial exposure early in life may increase the risk of developing allergic diseases. Antibiotics, which are a significant source of microbial deprivation, may be a risk factor for developing food allergies. Objective: The objective of this study was to characterize the association between antibiotic exposure in the first year of life and the subsequent development of food allergies by age five. Methods: A cohort of 18,088 patients born between 01/01/2006 and 12/31/2010 was analyzed retrospectively. Poisson regression was used to analyze the time-weighted association between antibiotic prescriptions and food allergy diagnosis, while adjusting for sex and race/ethnicity. Results: In both the unadjusted and adjusted analyses, the risk of developing a food allergy for the group exposed to antibiotics in the first year of life was more than double that of the unexposed group. In the unadjusted Poisson regression model, the relative risk was 2.53 [1.96, 3.26]. In the model adjusted for sex and race/ethnicity, the relative risk was 2.33 [1.19, 4.56]. Neither sex nor race/ethnicity was found to be significantly associated with the likelihood of a food allergy diagnosis. Conclusion: There is a significant association between antibiotic exposure in the first year of life and food allergy development by age five. While the results of this study support an existing hypothesis that posits an antibiotic-allergy association mediated by reduced microbial exposure, they do not provide direct evidence of mediation. In order to more accurately characterize this association, additional studies will need to directly analyze the quantity and variety of intestinal microbiota in relation to food allergy prevalence.

Files

Additional details