Antibiotic Exposure and the Risk of Food Allergy: Evidence in the U.S. Medicaid Pediatric Population

Publication date: Available online 20 November 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Minghui Li, Kevin Lu, David J. Amrol, Joshua R. Mann, James W. Hardin, Jing Yuan, Christina L. Cox, Bryan L. Love

Abstract

Background

Food allergy is a significant public health concern in the United States, especially in the pediatric population. It places substantial clinical and economic burdens on the healthcare system. Exposure to antibiotics in early childhood is thought to increase the risk of subsequent food allergy.

Objective

The objective of the study was to examine the impact of exposure to antibiotics early in life on time to development of food allergy.

Methods

We conducted a population-based matched cohort study using Medicaid data from 28 states. Antibiotic non-users were matched 1:1 to antibiotic users on date of birth, sex, race, and state. A Cox proportional hazards regression model was used to evaluate the effect of antibiotic exposure on time to development of food allergy. Sensitivity analyses were performed to assess the robustness of study findings.

Results

We matched 500,647 antibiotic non-users to 500,647 antibiotic users in the Medicaid pediatric population. In the adjusted Cox proportional hazards regression analysis, antibiotic exposure was significantly associated with faster development of food allergy (HR: 1.40; 95% CI: 1.34-1.45). The magnitude and significance of the association between antibiotic exposure and food allergy did not change in the sensitivity analyses. A significant association between antibiotic exposure and faster development of food allergy was found in 17 of 28 states.

Conclusion

Compared to antibiotic non-users, children with antibiotic prescription had an increased risk of food allergy.

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