Study Finds 3-Fold Increase in Food Allergy Risk Following Neonatal Antibiotic Treatment

A recent Dutch study published in the European Journal of Pediatrics has identified a significant link between antibiotic use during the first week of life and the development of food allergies in children ages 9 to 12. Although early exposure was strongly associated with food-related sensitivities, the study found no corresponding association with other atopic conditions, such as asthma, eczema, or inhalant allergies.

The research, led by Nora C Carpay, MD, built on the 2012 INCA (Impact of Nutrition on Children with ADHD) cohort. This original cohort comprised 436 full-term infants across four Dutch hospitals, some of whom received intravenous antibiotics such as penicillin or gentamicin for suspected sepsis shortly after birth. For this follow-up, researchers interviewed parents and reviewed general practitioner records for a subset of the original cohort to track long-term health outcomes.

The findings were striking: children who received antibiotics as neonates were more than three times as likely to have a reported food allergy as those who did not. Among test-confirmed allergies, the odds ratio was even higher. The study noted that an “any allergy” diagnosis by a general practitioner was significantly more common in the antibiotic-exposed group, reinforcing the idea that early medical interventions can have lasting immunological consequences.

Researchers suggested that the timing of the treatment — the first week of life — is critical because it coincides with the most rapid phase of microbiome development. Carpay and her colleagues noted, “The most rapid microbiome development occurs in the weeks after birth, and antibiotic treatment later in childhood… introduces a risk of bias due to reverse causation and confounding by indication.”

The study also addressed why food allergies were affected while respiratory-related allergies were not. The authors theorized that different sensitization pathways might be at play. They wrote, “One explanation could be that food allergies follow a different route of sensitization, via the skin and gastrointestinal tract, while inhalant allergies and asthma typically develop via the respiratory system.”

Additionally, the team hypothesized that the timing of disease onset is a factor. They suggested “that food allergies develop earlier in life during the period of dysbiosis associated with antibiotics, while asthma and inhalant allergies develop later in life and may be less related to this early antibiotics-associated dysbiosis.” This suggests a specific window of vulnerability for the gut microbiome that dictates food-related immune responses.

The medical community has welcomed the data as a prompt for proactive care. Jessica Hui, MD, a pediatric allergist at National Jewish Health, noted that while larger studies are needed, these results allow doctors to refine their advice to parents. She stated, “pediatricians and allergists can reinforce early introduction of allergenic foods so the infants at risk for food allergy can hopefully prevent its development through methods that we know work.”