Antibiotics in Early Childhood: The Road to Asthma and Allergy

When my son was just 36 hours old, he was re-hospitalized with a fever and put onto 5 days of IV antibiotics.  (You can read more about his history here.)  He was given more oral antibiotics right before his first birthday. Once I learned about the gut-brain-immune connection, several years later, I began to wonder what effect those antibiotics had had on him, especially in light of his diagnoses with both autism and then, several years later, with inflammatory bowel disease.

As you can imagine, I’ve always followed research into the effects of early introduction of antibiotics closely.  I remember, when Alex was very young, I found myself sitting in a psychiatrist’s waiting room reading an article in a lay publication about the burgeoning realization that there is a relationship between early use of these medications and the development of allergy. And 20 years later, I’m still reading more of the same.  There is a massive amount of evidence at this point.  I’ve addressed this issue several times before on this blog, for example, here – but it’s such an incredibly important topic that I want to keep you up-to-date as the evidence accumulates.

Last night I read a study done at Loyola University’s Medical Center that used a retrospective look at children’s medical charts, between the years of 2007 and 2016, to further delve into this association.[i]  Before I go into their results though, I want to tell you a couple of astounding statistics the paper provides.  Firstly, in spite of the fact that the overuse of antibiotics is known to be detrimental to health, and that there is a relationship between “…early antibiotic exposure and dysbiosis of the gut microbiota [which] may have significant implications for the health of children now and as they grow into adults,”  the use of these medicines continues to grow in hospitals. They are also the “…most frequently dispensed outpatient prescription medication, accounting for approximately 25% of all pediatric medication prescriptions.”  A recent large study showed that 30% of the antibiotics prescribed for respiratory tract infections are unnecessary.  11.5 million antibiotics are prescribed annually for illnesses without a bacterial component.

Unbelievable, right?

The article goes on to state that the first year of life is crucial in the development of a normal bacterial microbiome, and that by 3 years of age, it is fully mature.  Early disruption of the microbiome has been definitively linked with disruptions of the immune system and to the development of atopic (allergic) and inflammatory respiratory diseases, like asthma and allergic rhinitis.  This particular study is meant to add data to the investigation into the question of the timing of the antibiotics and its relationship to these illnesses: “…we hypothesize that children exposed to antibiotics during the first year of life will be more likely to be diagnosed with asthma or allergic rhinitis later in childhood, compared to children not receiving antibiotics during their first year of life.”

The researchers analyzed the data from 7224 children born at the hospital and  once they narrowed it down to those who had at least 2 subsequent visits there, were left with 2398 of them.  Believe it or not, a whopping 44.2% of these children were exposed to antibiotics in their first year!  And in the course of the 9 years covered by this study, the children averaged about 4 rounds of antibiotics.  Exposure to these medicines in their first year was significantly correlated with the development of asthma, but not with allergic rhinitis.  However, there was a significant association of lifetime antibiotics to the development of both diseases.  This, the authors suggest that this may mean that the early developing gut flora “… may still be sensitive to insult as the child grows, or that the insults may be cumulative and irreversible.”  That is, the more antibiotics a child is exposed to in those first early years, the worse the permanent damage, and the greater their chances for developing these diseases during the course of their lives.

In my son’s case, his antibiotic exposure, which of course is just one factor in his medical history that was likely detrimental, did not lead to allergy or asthma, which are the only two illnesses looked at in this research.  I’d bet money though that more such studies, looking at other diseases, will be conducted in the near future.  I’ll read them, of course, and report to you. But…I’m not looking forward to it.

p.s.  Don’t you wonder why the physicians prescribing the antibiotics didn’t have the parents put the babies on infant probiotics or synbiotics (i.e. a combination of pro- and prebiotics)?  Or…if they did, did it have a protective effect at all?  I also wonder how many of these babies were breast fed…???

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[i] Ni, J, Friedman, H, Boyd, BC, McGurn, A, Babinski, P, Markossian, T, Dugas, LR.  Early antibiotic exposure and development of asthma and allergic rhinitis in childhood.  BMC Pediatrics. 2019. 19:225.  https://doi.org/10.1186/s12887-019-1594-4