730 - Early life Antibiotic Exposure and the Risk of Allergic Diseases at age five: Evidence from a Nationwide Cohort Study

Publication Number: 2712.730

Hung-Chih Lin, China Medical University Children's Hospital, Taichung, Taichung, Taiwan (Republic of China); Yi-Shiuan(Keira) Lin, China Medical University Children's Hospital, Taichung, Taichung, Taiwan (Republic of China); Ming-Luen Tsai, China Medical University Children’s Hospital, Taichung City, Taichung, Taiwan (Republic of China); Cheyenne HsiangYu. Lin, China Medical University Children's Hospital, Beitun, Taichung, Taiwan (Republic of China)

Background: Early-life antibiotic exposure may alter the developing gut–allergic axis, increasing susceptibility to allergic diseases. However, comprehensive studies incorporating perinatal and parental factors alongside antibiotic exposure remain limited.

Objective: To investigate the association between early-life antibiotic exposure and allergic diseases at school age in a nationwide cohort study.

Design/Methods: We analyzed data from 14,572 Taiwanese children born between 2004 and 2017. Outcomes included physician-diagnosed atopic dermatitis (AD), asthma, allergic rhinitis (AR), and frequency of pediatric visits (FPV) up to age five. Cox regression models estimated adjusted hazard ratios (aHRs) for antibiotic exposure during the first year of life, accounting for parental factors, neonatal characteristics, and pregnancy-related conditions.

Results: Asthma was significantly associated with male sex (aHR 1.30), higher family income (1.28), parental allergic disease (mother 1.25; father 1.16), and antibiotic exposure (1.23). Nearly all commonly used antibiotics were associated with asthma, with azithromycin (1.26) and ampicillin (1.23) showing the highest risks. Lower urbanization and advanced paternal age were protective (0.82; 0.99).AR was associated with parental allergic disease (mother 1.31; father 1.28), higher family income (1.26), male sex (1.25), antibiotic exposure (1.21), and parental anxiety (1.10). Azithromycin showed the strongest association (1.23), while cefotaxime reduced AR risk (0.89).AD was associated with parental allergic disease (mother 1.22; father 1.16), higher family income (1.18), antibiotic exposure (1.15), maternal diabetes (1.05), and male sex (1.04). Clarithromycin (1.26) and cephalexin (1.21) showed the strongest associations. Antibiotic exposure also increased FPV (aHR 1.23).

Conclusion(s): Early-life antibiotic exposure was associated with increased risks of asthma, AR, and AD. Male sex, parental allergic and psychiatric disorders, delivery mode, socioeconomic status, and urbanization level were significant contributors to allergic disease susceptibility.