Association between early life antibiotic exposure and development of early childhood atopic dermatitis

Background: Atopic dermatitis (AD) is a chronic, inflammatory skin disease commonly onset during infancy. Objective: We examine the association between pre -and postnatal antibiotic exposure and the development of AD. Methods: A retrospective, observational study analyzed 4106 infants at the University of Florida from June 2011 to April 2017. Results: Antibiotic exposure during the first year of life was associated with a lower risk of AD. The association was strongest for exposure during the first month of life. There were no significant differences in the rates of AD in infants with or without exposure to antibiotics in months 2 through 12, when examined by month. Antibiotic exposure during week 2 of life was associated with lower risk of AD, with weeks 1, 3, and 4 demonstrating a similar trend. Limitations: Retrospective data collection from a single center, use of electronic medical record, patient compliance with prescribed medication, and variable follow-up. Conclusions: Early life exposures, such as antibiotics, may lead to long-term changes in immunity. Murine models of atopic dermatitis demonstrate a "critical window"for the development of immune tolerance to cutaneous microbes. Our findings suggest that there may also be a "critical window"for immune tolerance in human infants, influenced by antibiotic exposure. ( JAAD Int 2023;10:68-74.)