Antibiotic Exposure And Atopic Dermatitis Risk in Infants - EMJ

Antibiotic Exposure Increases Atopic Dermatitis Risk in Infants

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ATOPIC dermatitis (AD) is one of the most common inflammatory dermatological diseases in both paediatric and adult populations. Though antibiotic exposure, and resultant dysbiosis, have been linked to AD, there has not yet been sufficient evidence to conclusively identify antibiotics as direct contributors.

Recent research identified antibiotic usage in infancy as a risk factor for the development of AD, specifically on account of dysbiosis of the gut microbiome. The longitudinal, prospective, general population birth cohort study comprised 7,076 participants, including 3,621 prospective mothers and 3,455 eligible infants (who did not have congenital abnormalities and were born at ≥34 weeks gestation). Analysis of infant stool samples was conducted to assess for the concurrence of dysbiosis and AD, and various statistical analyses were conducted to balance the treatment and control groups, and mediate between antibiotics, the gut microbiome, and the presence of AD.

Where previous data indicated a link between lower respiratory tract infection before 18 months and AD, the more recent data demonstrate that the relationship between these two maladies is fundamentally based on the use of systemic antibiotics: broad-spectrum drugs lacking specificity and thus negatively impacting microbiota. This was confirmed in the standardisation of numerous AD-associated risk factors where, even in the exclusion of their influence, a significant link is discernible.

To add to these findings, the authors identified the timing of antibiotic exposure as a highly influential factor in the risk of AD. Adjusting for key demographic characteristics and risk factors among participants, it was found that children who were prescribed systemic antibiotics in the first year of life, regardless of the related illness, were at significantly higher risk of being diagnosed with AD by the age of 5 years (adjusted odds ratio: 1.81; 95% confidence interval: 1.28–2.57; p<0.001). Interestingly, the link became non-significant when antibiotic exposure occurred after 1 year, indicating that infants in the first year of life may require additional consideration compared to older children when prescribing systemic antibiotics.

Of this crucial influence, the authors wrote: “Infancy is a period of pronounced development for a number of biological systems within the human body, and this coincides with dramatic shifts and expansion within the microbiome as it matures. Emphasising the sensitivity of this time, microbiota perturbations early in life are often associated with long-term health consequences that extend beyond infancy.”


Hoskinson C et al. Antibiotics within first year are linked to infant gut microbiome disruption and elevated atopic dermatitis risk. J Allergy Clin Immunol. 2024;DOI:10.1016/j.jaci.2024.03.025.

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