Check out this answer from Consensus:
The disruption of gut flora caused by antibiotic use in early childhood is strongly associated with an increased risk of developing various allergic diseases later in life. This relationship is likely mediated through the negative impact on gut microbiota diversity and composition, leading to immune system dysregulation. Therefore, cautious use of antibiotics in early childhood is recommended to mitigate the risk of future allergic conditions.
The potential link between antibiotic use in early childhood and the development of allergies later in life has been a topic of significant research interest. Antibiotics can disrupt the gut microbiome, which plays a crucial role in immune system development. This disruption may predispose individuals to allergic diseases.
Key Insights
- Antibiotic Use and Allergic Diseases:
- Gut Microbiota Dysbiosis:
- Antibiotic-induced gut microbiota dysbiosis increases the susceptibility and severity of food allergies due to increased intestinal permeability and inflammatory response2.
- Disruption of beneficial intestinal bacteria by antibiotics allows yeast to flourish, leading to more potent allergic reactions in mouse models3.
- Microbiome Diversity and Composition:
- Antibiotic administration negatively impacts the microbiome by decreasing bacterial diversity, which correlates with allergic diseases4 7 8.
- Significant reductions in beneficial bacteria such as Bifidobacteria and Lactobacillus, and increases in Proteobacteria like E. coli, are observed following antibiotic exposure8.
- Dose-Dependent Relationship:
- Exposure to multiple classes of antibiotics in infancy may amplify the impact on the gut biome and increase the likelihood of developing allergies, suggesting a dose-dependent relationship4.
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Mirco Schmolke has answered Likely
An expert from University of Geneva in Virology, Microbiome, Immunology
In a nut shell, allergic responses are overreactions to certain substances (e.g. in food, animal saliva, pollen etc.). This overreaction is partially based on a dysregulated T cell balance. Clinical data from human patients (e.g. [1,2]) correlate early life antibiotics use and the consequent loss of some “good” bacterial flora with an increased risk of allergies and asthma. Experimental data obtained in mouse models confirm this observation (e.g. [3-7]). It is believed that a balanced T cell response requires the presence of certain “good” bacteria. The identity of bacteria preventing allergic responses in humans is still matter of debate. Nevertheless, judging the benefits and risks of antibiotics therapy clearly depends on the medical circumstances.
1 Ann Allergy Asthma Immunol. 2017 Jul;119(1):54-58.
2 Pediatr Allergy Immunol. 2018 Aug;29(5):490-495
3 EMBO Rep. 2012 May 1; 13(5):440-7.
4 Gut Microbes. 2013 Mar 1; 4(2): 158–164.
5 J Immunol May 1, 2016, 196 (1 Supplement) 191.20
6 Pediatr Res. 2018 Sep;84(3):426-434.
7 Nat Med. 2016 Jul 7;22(7):713-22.
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Milena Sokolowska has answered Uncertain
An expert from University of Zurich in Asthma, Allergology, Immunology, Molecular Biology
There are epidemiological and mechanistic data (mainly in animal models) linking many factors (including disruption of the gut flora by frequent antimicrobial treatment) early in life with the increases in the frequencies of allergies later in life. However, much more research is needed in this field to determine the clear answer to this question. Antibiotics should be used when necessary during bacterial infections and should not be withhold, as this might lead to the life-threatening situations. However unnecessary treatment with antibiotics in case e.g. viral infections should be restrained.
Many recent data on this subject are summarised in the following publications:
Sokolowska M, Frei R, Lunjani N, Akdis CA, O’Mahony L.
Asthma Res Pract. 2018 Jan 5;4:1. doi: 10.1186/s40733-017-0037-y. eCollection 2018. Review.
PMID: 29318023
Recent developments and highlights in mechanisms of allergic diseases: Microbiome.
Lunjani N, Satitsuksanoa P, Lukasik Z, Sokolowska M, Eiwegger T, O’Mahony L.
Allergy. 2018 Dec;73(12):2314-2327. doi: 10.1111/all.13634. Epub 2018 Nov 13. Review.
PMID: 30325537
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Rebecca Dewey has answered Likely
An expert from The University of Nottingham in Neuroimaging, Neuroscience
Composition of the gut microbiota is influenced by numerous factors including antibiotic use. Antibiotic use alters reproductive success/failure of the gut flora and through this mechanism can alter the gut microbiome.
This paper [Early-life exposures associated with antibiotic use and risk of subsequent Crohn’s disease. Hildebrand H, Malmborg P, Askling J, Ekbom A, Montgomery SM Scand J Gastroenterol. 2008 Aug; 43(8):961-6] has shown a possible link between paediatric antibiotic use and adult-onset Crohn’s disease.
Another study found that individuals diagnosed with IBD were more likely to have been prescribed antibiotics 2-5 years before their diagnosis [Association between the use of antibiotics and new diagnoses of Crohn’s disease and ulcerative colitis. Shaw SY, Blanchard JF, Bernstein CN Am J Gastroenterol. 2011 Dec; 106(12):2133-42].
Conversely, inflammatory bowel disease typically affects intestinal regions with the highest concentration of bacteria and the use of antibiotics can be effective in the management of inflammatory bowel disease.
So the jury’s still out, but it seems likely that there is an association.
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Sylvia Brugman has answered Uncertain
An expert from Wageningen University and Research Centre in Immunology, Microbiology, Gastroenterology
A very interesting question indeed!
Indeed antibiotics can disturb the microbial composition and this can have an influence on the immune system of the host. However, it is still not clear how this eventually links to allergies.
During development, we all are colonized by different microbes, most of which are good for us. They inhabit our intestinal tract for example, or the mucosal surfaces of the mouth and throat (and even in the lungs). In the intestines these microbes help us digest food and at other surfaces such as in the respiratory tract they take up space (their niche) preventing pathogenic bacteria to colonize.
As soon as the microbes are colonizing us our immune system develops. Cells of the immune system get instructed not to react to these bacteria, since they are ‘good’. At the same time the immune cells learn to react against ‘bad’ bacteria, usually because these bacteria invade our tissues (and are present at the wrong side of the barrier, e.g. not in the gut lumen, but invading into the host). If this education takes place properly during development we are mainly tolerant to the microbes and food that are present in our intestines, and only react to pathogens. We have so-called Regulatory T cells that prevent or turn off inflammatory reactions specifically. These cells are long lived and once instructed do not ‘forget’.
Antibiotics are used to combat infections, however, a nasty side effect is indeed that they also might attack the ‘good’ bacteria. It really depends on what type of antibiotic is used. Broad spectrum antibiotics (those that react to many species) tend to have more collateral damage than specific antibiotics. Depending on the age at which the antibiotics are used (infancy, childhood) this might have different effects. Theoretically, it might interfere with the education of the immune system (good vs bad) because not all good species are present at the moment of education (during antibiotic treatment). However, although it might be that antibiotic treatment disturbes the microbiota in the intestines, we cannot claim that that results in allergies to food since it still might be that the immune system is properly instructed. Once educated the adaptive immune system does not forget, you will have memory cells and regulatory cells that will know what to do. Furthermore, there are regulatory T cells that do not need to be instructed first (so-called natural T regulatory cells) that are there to keep the peace in the intestines.
So, to conclude as with most answers from scientists, I have to answer that we need more research to address this issue!
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Timothy W Hand has answered Likely
An expert from University of Pittsburgh in Immunology, Microbiome
Evidence from animal models (‘germ-free’ mice that have no microbes and antibiotic-treated mice) indicate that disruption of the microbiota early in life shapes which immune cells populate barrier sites (gut, lung, skin) and increase the predisposition to allergy. Specifically, removal of the microbial flora seems to favor immune cells that then drive T and B cell responses to make IgE in response to environmental molecules.
Immunological ‘memory’ of the microbiota may well be affected by antibiotic use, but this has not been directly linked to the development of allergies. Memory lymphocytes do not generally depend upon one another, so ‘forgetting’ the the microbiome would not make you more prone to make responses against allergens.
Could the disruption of the gut flora caused by the use of antibiotics in childhood, be triggering allergies in later years?
Maria C Jenmalm has answered Likely
An expert from Linköping University in Allergology, Microbiome, Immunology
A recent systematic review and meta-analysis found that early‐life exposure to antibiotics appears to be related to an increased risk of allergic symptoms of hay fever, eczema, and food allergy later in life.
It is important to note that the underlying studies (including 340 428 patients in 34 different studies) are association studies, making the evidence less certain. More solid evidence for the association between antibiotics exposure and clinical manifestations of allergies would require a randomized control study, which is not feasible to perform due to ethical reasons.
Ahmadizar F, Vijverberg SJH, Arets HGM, et al. Early-life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta-analysis. Allergy. 2018;73(5):971–86.