Antibiotic use, rural environment, and childhood allergic diseases

Published online: February 4, 2017

Both antibiotic use and the prevalence of allergic diseases have increased worldwide, becoming major public health issues in developing countries over the last decade. Antibiotics disturb the normal gut microbiome, thus potentially altering immune programming and predisposing to allergic diseases in children. Studies of antibiotic use in early life and allergic diseases have yielded inconsistent results, which may be partly due to the effects of concurrent environmental exposures.

In an article published in The Journal of Allergy and Clinical Immunology: In Practice, Han et. al. report the results of a cross-sectional study of antibiotic use in early life, rural residence and allergic diseases among 1,517 children (ages 6-7 years) living in urban and rural areas of San Francisco (Córdoba, Argentina). Current asthma, current wheeze, and current allergic rhino-conjunctivitis were defined on the basis of responses to a validated questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC). Information on use of antibiotics and paracetamol, bronchiolitis, and environmental exposures in the first year of life was also obtained from this questionnaire. Multivariable logistic regression was used for the analysis of antibiotic use and allergic diseases.

In an analysis adjusting for paracetamol use and bronchiolitis in the first year of life, antibiotic use in the first year of life was significantly associated with 1.8 and 1.9 times increased odds of current wheeze and current allergic rhino-conjunctivitis, respectively. After stratification by area of residence in the first year of life, antibiotic use in the first year of life was significantly associated with increased odds of current wheeze and current allergic rhino-conjunctivitis among children who lived in an urban area in early life. In contrast, antibiotic use was not significantly associated with current wheeze or current allergic rhino-conjunctivitis among children who lived in a rural area in early life.

Our findings suggest that rural residence in early life may protect against detrimental effects of antibiotic use on allergic diseases, perhaps through immune modulation by a more robust and diverse gut microbiome. Clinicians should adhere to current guidelines for prescribing antibiotics, while educating patients about adverse effects of inadequate antibiotic use in children, including treatment resistance and alterations of the gut microbiome.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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