BackgroundThere are only preliminary studies examining the associations of postnatal antibiotic exposure with food allergy in childhood, and the effect of antibiotic exposure in utero has not been resolved. Thus, we aimed to investigate the effect of prenatal and postnatal antibiotic exposure on the risk of food allergy in childhood.MethodsUsing the nationwide birth cohort in South Korea, all 3,163,206 infants (pairing mother; n = 2,322,735) born in South Korea between 2010 and 2017 were included in the analysis. The primary outcome was the diagnosis of food allergy, and the observation period was between January 1, 2009, and December 31, 2020. We implemented four different designs for the study, which consisted of a full unmatched cohort, 1:1 propensity‐matched cohort, sibling comparison cohort, and health screening cohort along with multiple subgroup analyses.ResultsDuring the follow‐up period (median 6.92 years [IQR, 4.72–9.00]) of the 3,161,858 infants (52.6% male) in the birth cohort, 29,973 (1.9%) were diagnosed with food allergies. After a 1:1 propensity score matching, the use of antibiotics increased the risk of overall food allergy (prenatal [HR, 1.05; 95% CI, 1.04–1.09] and postnatal [HR, 1.05; 95% CI, 1.01–1.10] periods). The association was more significantly accentuated when antibiotic exposure was used in the short term, and the children were born preterm or with low birthweight; however, a trimester‐specific effect was not observed. We observed more pronounced risks of food allergy in the health screening cohort (prenatal, 17%; postnatal, 15%), thus addressing the adverse effects of critical factors including maternal BMI, smoking status, and type of infant feeding. Similar trends were observed across all four differnt cohorts.ConclusionThis study reported a moderate association between early‐life antibiotic use and subsequent food allergy during childhood throughout four different designs of analyses. This study suggests that clinicians need to consider the risks and benefits of antibiotics when administering antibiotics to individuals in the prenatal and postnatal periods.

中文翻译：

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产前和产后接触抗生素以及后代食物过敏的风险：韩国的一项全国性出生队列研究

背景只有初步研究探讨了产后抗生素暴露与儿童食物过敏之间的关系，并且子宫内抗生素暴露的影响尚未得到解决。因此，我们的目的是调查产前和产后抗生素暴露对儿童食物过敏风险的影响。方法使用韩国全国出生队列，所有 3,163,206 名婴儿（配对母亲；n= 2,322,735）2010年至2017年出生于韩国的人被纳入分析。主要结局是食物过敏的诊断，观察期为2009年1月1日至2020年12月31日。我们为该研究实施了四种不同的设计，其中包括完全不匹配的队列、1:1倾向匹配结果在出生队列中 3,161,858 名婴儿（52.6% 男性）的随访期间（中位时间 6.92 年 [IQR，4.72-9.00]），29,973 名婴儿（52.6% 为男性） 1.9%）被诊断出患有食物过敏。经过 1:1 倾向评分匹配后，抗生素的使用增加了总体食物过敏的风险（产前 [HR，1.05；95% CI，1.04–1.09] 和产后 [HR，1.05；95% CI，1.01–1.10]期）。当短期使用抗生素且儿童早产或出生体重低时，这种关联更为显着。然而，没有观察到妊娠期特异性的影响。我们在健康筛查队列中观察到更明显的食物过敏风险（产前，17%；产后，15%），从而解决了包括母亲体重指数、吸烟状况和婴儿喂养方式等关键因素的不利影响。在所有四个不同的队列中都观察到了类似的趋势。结论这项研究通过四种不同的分析设计报告了生命早期抗生素的使用与随后的儿童时期食物过敏之间存在中等关联。这项研究表明，临床医生在对产前和产后时期的个体使用抗生素时需要考虑抗生素的风险和益处。