Antibiotics in the first week of life is a risk factor for allergic rhinitis at school age

Background: Heredity as well as external factors influences the development of allergic rhinitis. The aim of this study was to analyse early risk factors and protective factors for allergic rhinitis at school age. Methods: This is a prospective, longitudinal study of children born in western Sweden in 2003 where 50% of the birth cohort was randomly selected. The parents answered questionnaires at 6 months, 12 months, 4.5 yr and 8 yr. At 8 yr, 5044 questionnaires were distributed. Of these, 4051 responded, that is, 80.3%. Current allergic rhinitis was defined as symptoms and use of medication during the past 12 months. Results: Current allergic rhinitis at 8 yr was reported by 10.9%. Mean onset age was 5.7 yr, and 61.9% were boys. In a multivariate analysis, antibiotics in the first week of life increased the risk of allergic rhinitis (adjusted odds ratio 1.75, 95% confidence interval (1.03, 2.97)). Increased risk was also seen with parental allergic rhinitis (aOR 2.73 (2.12, 3.52)), food allergy first year (aOR 2.45 (1.61, 3.73)), eczema first year (aOR 1.97 (1.50, 2.59)) and male gender (aOR 1.35 (1.05, 1.74)). Living on a farm at 4.5 yr reduced the risk (aOR 0.31 (0.13, 0.78)). Conclusion: Antibiotics in the first week of life increased the risk of allergic rhinitis at school age, while living on a farm at preschool age reduced the risk. Both findings are compatible with the hygiene hypothesis.