title: Early exposure to infections and antibiotics and the incidence of allergic disease: a birth cohort study with the West Midlands General Practice Research Database.
abstract: BACKGROUND
  It has been suggested that the rise in prevalence of allergic disease in westernized countries is due in part to a decrease in exposure to infections and an increase in the use of antibiotics early in life.
  
  
  OBJECTIVE
  The purpose of this investigation was to quantify the relationships between (1) exposure to personal infections, infections in siblings, and use of antibiotics in early life and (2) the incidence of allergic disease.
  
  
  METHODS
  Using the West Midlands section of the UK General Practice Research Database, we established a historical birth cohort of children (N = 29,238). For each child, we identified all personal infections and infections in siblings and determined the use of antibiotics in early life; we also noted incident diagnoses of asthma, eczema, and hay fever. The data were analyzed through use of Cox regression.
  
  
  RESULTS
  There was no clear protective effect of exposure to either personal infections or infections in siblings with respect to the incidence of allergic disease. Antibiotic exposure was associated with an increased risk of developing allergic disease in a dose-related manner: having 4 or more courses of antibiotics in the first year of life was associated with an increased incidence of asthma (hazard ratio [HR], 3.13; 95% CI, 2.75-3.57), eczema (HR, 1.48; 95% CI, 1.31-1.68), and hay fever (HR, 2.12; 95% CI, 1.68-2.66). However, adjusting for consulting behavior reduced these effects (adjusted HR [95% CI]: asthma, 1.99 [1.72-2.31]; eczema, 1.01 [0.88-1.17]; hay fever, 1.14 [0.88-1.47]).
  
  
  CONCLUSIONS
  We found no evidence that exposure to infections reduced the incidence of allergic disease, and infections did not explain the previous findings of a strong birth order effect in this cohort. The use of antibiotics might be associated with early diagnoses of allergic disease.
authors.affiliation: Division of Respiratory Medicine, University of Nottingham, United Kingdom.
authors.forename: Tricia M
authors.initials: TM
authors.lastname: McKeever
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Lewis
authors.forename: Chris
authors.initials: C
authors.lastname: Smith
authors.forename: Juliet
authors.initials: J
authors.lastname: Collins
authors.forename: Heath
authors.initials: H
authors.lastname: Heatlie
authors.forename: Martin
authors.initials: M
authors.lastname: Frischer
authors.forename: Richard
authors.initials: R
authors.lastname: Hubbard
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019992:Databases as Topic; D005194:Family Practice; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007239:Infections / Q000276:immunology*; D008297:Male; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents