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. 2024 Jun 20;191(1):58-64.
doi: 10.1093/bjd/ljad428.

In utero or early-in-life exposure to antibiotics and the risk of childhood atopic dermatitis, a population-based cohort study

Zelma Chiesa Fuxench  1 , Nandita Mitra  2 , Domenica Del Pozo  3 , Ole Hoffstad  1 , Daniel B Shin  1 , Sinéad M Langan  4 , Irene Petersen  5   6 , Ketaki Bhate  4 , David J Margolis  1   2
Affiliations

In utero or early-in-life exposure to antibiotics and the risk of childhood atopic dermatitis, a population-based cohort study

Zelma Chiesa Fuxench et al. Br J Dermatol. .

Abstract

Background: Atopic dermatitis (AD) is a common inflammatory disease of the skin that begins early in life and can be lifelong. The purpose of our study was to evaluate whether fetal exposure and/or early-life exposure of a child to antibiotics increases the risk of early-onset AD.

Objectives: We hypothesize that antibiotic exposure in utero or early in life (e.g. first 90 days) increases the likelihood that children develop AD.

Methods: Utilizing a large, prospectively collected electronic medical records database, we studied the association of antibiotic exposure received in utero or very early in life and the relative risk of onset of AD in a population-based cohort study. Associations were estimated using proportional hazards models as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: The risk of AD in childhood was increased after in utero or early-life antibiotic exposure. For any in utero antibiotic exposure the HR (CI) was 1.38 (1.36-1.39). However, penicillin demonstrated the strongest association with AD for both in utero exposure [1.43 (1.41-1.44)] and for childhood exposure [1.81 (1.79-1.82)]. HRs were higher in children born to mothers without AD than in those with AD pointing to effect modification by maternal AD status.

Conclusions: Children born to mothers exposed to antibiotics while in utero had, depending on the mother's history of AD, approximately a 20-40% increased risk of developing AD. Depending on the antibiotic, children who received antibiotics early in life had a 40-80% increased risk of developing AD. Our study supports and refines the association between incident AD and antibiotic administration. It also adds population-based support to therapeutic attempts to treat AD by modifying the skin microbiome.

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Conflict of interest statement

Conflicts of interest Z.C.F. has received research grants from LEO Pharma, Lilly, Regeneron, Sanofi, Tioga and Vanda for work related to atopic dermatitis and from Galderma and Menlo Therapeutics for work related to prurigo nodularis. She has also served as a consultant for AbbVie, the Asthma and Allergy Foundation of America, Incyte Corporation, the National Eczema Association and Pfizer; received honoraria for Continuing Medical Education work in Atopic Dermatitis sponsored by education grants from Pfizer and Regeneron/Sanofi, and from Beirsdorf for work related to skin cancer and sun protection. D.J.M. is or recently has been a consultant for LEO, Pfizer and Sanofi with respect to studies of atopic dermatitis and served on an advisory board for the National Eczema Association. N.M., D.D.P., O.H., D.B.S., S.M.L., I.P. and K.B. report no conflicts of interest with respect to the materials in this manuscript.

Comment in

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