ASTHMA

Early prescriptions of antibiotics and the risk of allergic disease in adults: a cohort study

P Cullinan, J Harris, P Mills, S Moffat, C White, J Figg, A Moon, A J Newman Taylor

Department of Occupational and Environmental Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK

Correspondence to:
Correspondence to:
Dr P Cullinan
Department of Occupational and Environmental Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, Manresa Road, London SW3 6LR, UK; p.cullinan{at}ic.ac.uk

Background: It is frequently asserted that antibiotic prescriptions in childhood are associated with the development of allergic disease, especially asthma. A study was undertaken to establish the direction of this relationship.

Methods: A retrospective cohort study of 746 adults was performed in three general practices. Antibiotic prescriptions in the first 5years of life, collected from contemporary medical records, were related to self-reports of asthma and hay fever and the results of skin prick testing with common aeroallergens.

Results: There was no relationship between early antibiotic prescription and atopy, either for all antibiotic use (OR 1.01) or for antibiotics prescribed at different ages. The significant associations between prescriptions at ages 4 and 5 and hay fever (OR 1.23 and 1.16, respectively) were explained by coexisting asthma. Relationships between antibiotic use and asthma (allergic or otherwise) were statistically significant and strengthened with increasing age of prescription, but were largely confined to antibiotics prescribed for lower respiratory symptoms.

Conclusions: The reported associations between childhood antibiotic use and asthma are most plausibly explained by "reverse causation"—the tendency for prescriptions to be written for the early manifestations of pre-existing asthma.

Keywords: asthma; atopy; hay fever; antibiotics

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This article has been cited by other articles:

• Harris, J. M, Mills, P., White, C., Moffat, S., Newman Taylor, A. J, Cullinan, P. (2007). Recorded infections and antibiotics in early life: associations with allergy in UK children and their parents. Thorax 62: 631-637 [Abstract] [Full Text]  
• Marra, F., Lynd, L., Coombes, M., Richardson, K., Legal, M., FitzGerald, J. M., Marra, C. A. (2006). Does Antibiotic Exposure During Infancy Lead to Development of Asthma?: A Systematic Review and Metaanalysis. Chest 129: 610-618 [Abstract] [Full Text]  
• Cullinan, P (2006). Childhood allergies, birth order and family size. Thorax 61: 3-5 [Full Text]  
• Muir, M. (2005). Hygieia. J. Epidemiol. Community Health 59: 532-532 [Full Text]  
• (2004). Lucina. Arch. Dis. Child. 89: 798-798 [Full Text]  
• Thomas, M (2004). Early life antibiotics and asthma. Thorax 59: 541-541 [Full Text]  
• Pekkanen, J. (2004). Commentary: Use of antibiotics and risk of asthma. Int J Epidemiol 33: 564-565 [Full Text]  

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Early-life antibiotics and asthma

Mike Thomas

Thorax Online, 23 Jan 2004 [Full text]