PT  - JOURNAL ARTICLE
AU  - Elise M.A. Slob
AU  - Bronwyn K. Brew
AU  - Susanne J.H. Vijverberg
AU  - Chantal J.A.R. Kats
AU  - Cristina Longo
AU  - Mariëlle W. Pijnenburg
AU  - Toos C.E.M. van Beijsterveldt
AU  - Conor V. Dolan
AU  - Meike Bartels
AU  - Patrick Magnusson
AU  - Paul Lichtenstein
AU  - Tong Gong
AU  - Gerard H. Koppelman
AU  - Catarina Almqvist
AU  - Dorret I. Boomsma
AU  - Anke H. Maitland-van der Zee
TI  - Early-life antibiotic use and risk of asthma and eczema: results of a discordant twin study
AID  - 10.1183/13993003.02021-2019
DP  - 2020 Apr 01
TA  - European Respiratory Journal
PG  - 1902021
VI  - 55
IP  - 4
4099  - http://erj.ersjournals.com/content/55/4/1902021.short
4100  - http://erj.ersjournals.com/content/55/4/1902021.full
SO  - Eur Respir J2020 Apr 01; 55
AB  - Rationale Early-life antibiotic use has been associated with the development of atopic diseases, but the aetiology remains unclear. To elucidate the aetiology, we used a discordant twin design to control for genetic and environmental confounding.Methods We conducted a retrospective cohort study in twins aged 3–10 years from the Netherlands Twin Register (NTR, n=35 365) and a replication study in twins aged 9 years from the Childhood and Adolescent Twin Study in Sweden (CATSS, n=7916). Antibiotic use was recorded at age 0–2 years. Doctor-diagnosed asthma and eczema were reported by parents when children were aged 3–12 years in both cohorts. Individuals were included in unmatched analyses and in co-twin control analyses with disease discordant twin pairs.Results Early-life antibiotic use was associated with increased risk of asthma (NTR OR 1.34, 95% CI 1.28–1.41; CATSS OR 1.45, 95% CI 1.34–1.56) and eczema (NTR OR 1.08, 95% CI 1.03–1.13; CATSS OR 1.07, 95% CI 1.01–1.14) in unmatched analyses. Co-twin analyses in monozygotic and dizygotic twin pairs showed similar results for asthma (NTR OR 1.54, 95% CI 1.20–1.98; CATSS OR 2.00, 95% CI 1.28–3.13), but opposing results for eczema in the NTR (OR 0.99, 95% CI 0.80–1.25) and the CATSS (OR 1.67, 95% CI 1.12–2.49). The risk of asthma increased for antibiotics prescribed for respiratory infections (CATSS OR 1.45, 95% CI 1.34–1.56), but not for antibiotics commonly used for urinary tract/skin infections (CATSS OR 1.02, 95% CI 0.88–1.17).Conclusion Children exposed to early-life antibiotic use, particularly prescribed for respiratory infections, may be at higher risk of asthma. This risk can still be observed when correcting for genetic and environmental factors. Our results could not elucidate whether the relationship between early-life antibiotic use and eczema is confounded by familial and genetic factors.Large twin studies show that antibiotics in early life are associated with risk of asthma, regardless of familial environment and genetics, and possibly due to early infections. Risks and benefits of antibiotics use in infants should be considered. http://bit.ly/372Qu5A