September 6, 2016

expert reaction to conference talk (unpublished work) on early life antibiotic use and development of allergies

A presentation of unpublished work at the European Respiratory Society (ERS) International Congress has examined the effects of exposure to antibiotics early in life and reports a relationship with increased risk of eczema and hayfever.

Prof. Chris Butler, Director of the Institute of Primary Care and Public Health, University of Oxford, said:

“Most discussions between patients and doctors, and campaigns directed at the general public about using antibiotics less often, usually focus on the potential benefits to society and future generations. Assuming that scrutiny of the full report of this systematic confirms these findings are robust, then the review adds to the growing body of evidence that antibiotics, although life-saving and incredibly beneficial in the right circumstances, carry important potential ‘down sides’ for the individuals who take them.

“Unnecessary antibiotics put individuals at risk for a wide range of poorer outcomes, not only eczema and hay fever as found in this review, but also subsequent infections that are more likely to be antibiotic resistant, which means that those individuals will be sicker for longer and consume more health care resources.  So these findings will of interest to both clinicians and patients, when together they weigh up the potential benefits and harms of antibiotics, especially for probable self-limiting illnesses.”

Prof. Adam Finn, Professor of Paediatrics, University of Bristol, said:

“The authors in this study have reviewed a number of published studies and calculated from them the overall association between use of antibiotics in early childhood and likelihood of getting eczema and hay fever later, finding that the rates are higher. There is not much in the abstract to enable one to judge how systematic their review is both in terms of selection of studies or meta-analysis, but these findings add weight to the evidence that there is a downside long term to antibiotic use.

“These drugs are extremely useful and important, saving lives and alleviating suffering from serious infections.

“But they should not be used unless they are really needed. Once people – both the doctors prescribing them and the patients who ask for them – begin to understand this, we may see an important change in behaviour which may not only reduce any risks of allergic disease or other long term problems but also help reduce the rate of emergence of antibiotic resistance which results from their overuse.”

Dr Sheena Cruickshank, British Society for Immunology spokesperson, and Senior Lecturer in Immunology, University of Manchester, said:

“In recent years, there have been many studies looking at whether there is a link between early life exposure to antibiotics and an individual’s subsequent risk of developing allergies. The results of these individual studies have been contradictory, but what they have shown is that there are probably many factors at play in determining this relationship. The finding presented here of an increased risk of hay fever or eczema with early life antibiotic exposure is an interesting observation, based on an analysis of 22 previously published studies for each condition. However, without knowing more about how this work was carried out and how the studies were selected, it is hard to judge the robustness of this finding. Confounding factors such as how cases were selected, what the antibiotics were for, how long they were taken for and what types of antibiotics were used could have a big influence of effect size. The effect size reported is quite modest given the stated confidence intervals and this would support more research being carried out to help us fully understand the relationship between early life exposure to antibiotics and subsequent allergy risk.

“When considering work in this area, it’s also imperative to remember that antibiotics are one of the most important tools we have to fight bacterial infections and have saved millions of lives. If a doctor gives your child antibiotics, it’s important for the child’s health that they are taken as prescribed.”

‘Abstract title: ‘Early life antibiotic exposure is associated with an increased risk of allergy’ by Fariba Ahmadizar  et al. This is a conference talk that will be discussed at the European Respiratory Society (ERS) International Congress and is under embargo until 00:01 UK time on Tuesday 6 September 2016.  There is no paper as this is not published work but an abstract is available. 

Declared interests

Prof Chris Butler: “I have no interests to declare.”

Prof. Adam Finn: “None.”

Dr Sheena Cruickshank: “No interests to declare.”