Early Antibiotic Exposure Shapes Childhood Food Allergy Risk
New Dutch follow-up data suggest antibiotics in the first week of life may be linked to higher food allergy rates in later childhood, without the same signal for asthma or inhalant allergies.
A long-term follow-up of the Dutch INCA birth cohort found that infants treated with antibiotics during their first week of life had higher odds of developing food allergies by ages 9 to 12, while rates of asthma, eczema, and inhalant allergies were not increased. The findings point toward early-life microbiome disruption as a possible contributor.
Study Details
Food allergies affect a growing number of children, and researchers have long suspected that very early exposures could shape immune development. Prior work from the INCA study showed that antibiotics in the first week of life were associated with wheezing in infancy and food allergies by early childhood.
The new analysis, published in the European Journal of Pediatrics, extends those observations into late childhood. Led by Nora C. Carpay, MD, the study asked whether early antibiotic exposure continued to matter years later and whether it was also linked to other allergic conditions.
The cohort included term-born infants delivered at four Dutch hospitals between 2012 and 2015. Some newborns received intravenous antibiotics in the first week of life for suspected sepsis, while others did not receive antibiotics.
Methodology
Researchers followed the original INCA cohort prospectively and re-contacted families when children were aged 9 to 12 years.
Key elements included:
Antibiotic exposure limited to the first week of life
Parent questionnaires on allergies and general health
Review of general practitioner diagnoses for most participants
Adjustment for potential confounders, including later antibiotic use
Of the original 436 infants, 314 children were included in this follow-up analysis.
Key Findings
Children exposed to antibiotics in the first week of life had higher odds of food allergy in late childhood.
Reported food allergy odds were about 3.5 times higher in the antibiotic group.
Test-confirmed food allergies showed an even stronger association.
No significant association was found with asthma, inhalant allergies, or eczema.
Any allergy diagnosis recorded by a general practitioner was more common among children who received early antibiotics.
Implications for Practice
For families, these findings may help explain why some children develop food allergies despite otherwise typical childhood exposures. The results do not suggest avoiding necessary antibiotics in newborns, which can be lifesaving, but they do reinforce the idea that the earliest days of life are a sensitive window for immune development.
For clinicians, the study strengthens the case for thoughtful antibiotic stewardship in neonates and highlights the importance of early introduction of allergenic foods in infants who may be at higher risk. As pediatric allergists note, this is one of the few interventions shown to reduce food allergy risk and may be especially relevant for children exposed to antibiotics shortly after birth.
More broadly, the work supports the concept that food allergies may follow a different developmental pathway than asthma or inhalant allergies, with stronger ties to the gut and skin rather than the airways.