Early life exposure to antibiotics and laxatives in relation to infantile atopic eczema

Allergy-associated biomarkers in early life identified by Omics techniques

“…A study found that caesarean section delivery predisposed to the development of FA but not AD in early childhood (125). In turn, epidemiological studies have linked perinatal (pre-and post-) antibiotic use to the appearance of AD and cow's milk allergy in infants (126)(127)(128). Whether early disruption of the microbiota directly affects future risk of allergic diseases remains elusive.…”

Comment on El‐Heis et al.

“…by the investigator to help them understand, explain, and communicate potential causal relationships between important outcome variables (e.g., atopic dermatitis (AD) in children) and important exposure variables (e.g., maternal exposure to laxatives and/or antibiotics). 2 These potential relationships are displayed in figure 1 of El-Heis et al 1 The DAG was generated by the investigators' understanding of these relationships. However, the use of a DAG can be problematic if the prior knowledge used to generate the DAG is incomplete.…”

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To the editor, We read with great interest a recent letter to the editor entitled El-Heis et al Early life exposures to antibiotics and laxatives in relation to infantile atopic eczema. 1 We have several questions about the study design and analysis. Central to the analysis plan was the use of directed acyclic graphs (DAGs).

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Reply to Fuxench et al

“…To the Editor, We thank Fuxench et al 1 for sharing their comments and for the opportunity to expand on findings reported in our letter "Early life exposure to antibiotics and laxatives in relation to infantile atopic eczema." 2 Our a priori hypothesis was that medicines that alter the maternal microbiome could impact infant risk of atopic eczema. Such medicines include antibiotics and laxatives, and we considered these as one entity (the main exposure) in the directed acyclic graph (DAG), with a common relationship to other exposure variables and infant risk of atopic eczema (the outcome).…”

“…The aim of the DAG approach is to reduce the risk of confounding in an observational context where selection bias is likely to be relevant. It is not necessary to adjust for all variables entered into a DAG 2,6 ; instead, the DAG software (DAGitty in this case) guides the variables to adjust for, in order to remove confounding (the minimal adjustment set) and these are supplemented as necessary with competing exposures to improve precision.…”