Early-life antibiotics and childhood allergy: a multi-center cohort.

Hattab, M., Sarrees, Y., Sous, M. et al.  Allergy Asthma Clin Immunol (2026). https://doi.org/10.1186/s13223-026-01013-5

Abstract

Background

Antibiotic use in infants is hypothesized to alter the gut microbiota, influencing immune system dysregulation and increasing allergy risk. We aim to assess the prevalence of allergic diseases in children treated with different classes of antibiotics in early life.

Methods

A retrospective cohort study was conducted from April 2024 to January 2025 in three main hospitals in the West Bank in Palestine. Records of pediatric admissions of children who received antibiotic treatment within their first six months of life were reviewed, followed by parents’ interview regarding the development of allergies.

Results

A total of 423 medical records were included. The average age of children was 7.33 ± 1.38 years (mean ± SD), and 62.41% of them were males. The total prevalence of allergic diseases was 29.55%. Common manifestations of allergies were skin reactions (70.4%), wheezing (16.8%), and respiratory symptoms (10.4%). Among the most common reported triggers were food (10.17%) and dust (7.33%). The most commonly prescribed antibiotics were Beta-lactams; cefotaxime (78.49%), and ampicillin (63.59%). No statistically significant association was found between the number of antibiotics used and the development of allergies (p = 0.45). Similarly, different classes of antibiotics did not show an impact on developing allergies except for Trimethoprim/Sulfamethoxazole (p = 0.05). A significant decrease in allergy was observed with increasing age (p = 0.011).

Conclusion

Allergic conditions affect about one third of children treated with antibiotics in early life. While allergic conditions tended to decrease with age, no association was observed between antibiotic number/class and later allergy, except for a hypothesis-generating signal toward lower odds with TMP-SMX.

Highlights

• What is already known about this topic?

  Early-life antibiotic use is suspected to disrupt the gut microbiota, potentially increasing the risk of developing allergic diseases in childhood.

• What does this article add to our knowledge?

  In this first Palestinian cohort, ≈30% of children exposed to antibiotics in early life developed allergies; no class-specific link was found except a hypothesis-generating potential protective effect of TMP-SMX.

• How does this study impact current management guidelines?

  It supports antibiotic stewardship in infancy by discouraging unnecessary use, without implicating specific antibiotic classes as allergy triggers; highlights need for further research on TMP-SMX’s potential immunomodulatory effects.

Key message

In this multi-hospital cohort of 423 children exposed to antibiotics in the first six months of life, ~ 30% developed allergic disease, with no association between number/class of antibiotics and later allergy; TMP-SMX showed a signal toward lower odds of allergy. Findings support antibiotic stewardship without implicating specific classes in increased allergy risk and highlight the need for prospective controlled trials.

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