Early life exposures and development of allergic disease in infants with familial risk: Results from ongoing probiotic intervention trials

Abstract

Aim We search revision of risk determinants of the ongoing allergy epidemic. Methods Children numbering 433 born to mothers with allergic disease or sensitisation were selected from the three ongoing probiotic intervention trials for this case–control study. Children who developed atopic eczema or food allergy, had positive skinprick test results or had been prescribed inhaled corticosteroids by the age of 2 years were identified as cases (n = 231), while children without allergic manifestations were the healthy controls (n = 202). The data on early environmental exposures were collected from prospectively documented study records. The statistical analyses were adjusted for potential confounders. Results Determinants associated with the increased risk of atopic eczema were lower maternal prepregnancy BMI (aOR 0.15, 95% CI: 0.037–0.54) and maternal intrapartum antibiotic treatment (aOR 2.21, 95% CI 1.20–4.10), the latter also linked to obstructive respiratory symptoms (aOR 3.87, 95% CI 1.07–14.06). The risk of allergic sensitisation was associated with lower maternal prepegnancy BMI (aOR 0.18, 95% CI 0.43–0.79) and intrapartum antibiotic treatment (aOR 2.13, 95% CI 1.07–4.22). Conclusion Based on our demonstrations, interventions such as personalised diets, can be optimised for specific subgroups and definite risk periods.

Linking antibiotic treatment in early life with childhood allergic disease

“…Reassuringly, Puisto et al 3 found that giving probiotics to pregnant women decreased the risk of atopic eczema in offspring up to 2 years of age, similarly to previous reports from the trials, 3 but not allergic sensitisation or inhaled corticosteroids. The new results showed that low maternal prepregnancy body mass index was associated with an increased risk of atopic eczema and allergic sensitisation.…”

“…In this issue of Acta Paediatrica , Puisto et al 3 report the findings of a nested case‐control design that used data from ongoing Finnish probiotic intervention trials to investigate early life risk factors for developing childhood allergic diseases. They studied 433 children with a genetic predisposition to allergic disease, who were born to mothers with atopic eczema, hay fever, asthma or food allergies.…”

“…In contrast, using antibiotics during the first 6 months of life was associated with a decreased risk of atopic eczema and allergic sensitisation. Exposure to pets prenatally and in early childhood was also linked with a decreased risk of allergic sensitisation 3 …”

“…Puisto et al observed an increased risk of atopic eczema when there was in utero exposure to antibiotics and a decreased risk for both atopic eczema and allergic sensitisation if the child was exposed to antibiotic treatment in the first 6 months of life 3 . These findings contrast with those of a large meta‐analysis from 2018 that reported an increased risk of atopic eczema after antibiotic treatment in the first 2 years of life, but no association between antibiotic use and allergic sensitisation, defined as positive skin prick test 9 .…”

“…Puisto et al's finding that antibiotics during the first 6 months were associated with a decreased risk of atopic eczema and allergic sensitisation of approximately 50% is intriguing but should be interpreted with caution. We do not know what antibiotics were prescribed, the exact timing, or the indications for prescribing 3 . Associations with antibiotic use may also suffer from reverse causation or confounding by indication, as immunologically incompetent children may need antibiotics early in life and have a concomitant vulnerability to later develop allergic disease 9 .…”