TY - JOUR
T1 - Antibiotic exposures and the development of pediatric autoimmune diseases
T2 - a register-based case–control study
AU - Räisänen, Laura K.
AU - Kääriäinen, Sohvi E.
AU - Sund, Reijo
AU - Engberg, Elina
AU - Viljakainen, Heli T.
AU - Kolho, Kaija Leena
N1 - Funding Information:
The project has received financial support from the Swedish Cultural Foundation in Finland, Folkhälsan Research Foundation governed by HV. L.K.R. received a research grant from Tampere University Hospital, Department of Pediatrics. K.-L.K. received a Helsinki University Grant. There were no other specific grants from any public, commercial, or non-profit sectors relevant to this article to disclose. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Open Access funding provided by University of Helsinki including Helsinki University Central Hospital.
Publisher Copyright:
© 2022, The Author(s).
PY - 2023
Y1 - 2023
N2 - Background: Antibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general. Methods: From a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or inflammatory bowel diseases) by a median age of 16 years. Antibiotic purchases from birth until the date of diagnosis (or respective date in the matched controls n = 708) were traced from national registers. Results: Total number of antibiotic purchases was not related to the onset of ADs when studied as a group. Of specific diagnoses, JIA was associated with the total number of antibiotics throughout the childhood and with broad-spectrum antibiotics before the age of 3 years. Intriguingly, recent and frequent antibiotic use (within 2 years before diagnosis and ≥3 purchases) was associated with the onset of ADs (OR 1.72, 95% CI 1.08–2.74). Regardless of frequent use in childhood (40% of all antibiotics), penicillin group antibiotics were not related to any ADs. Conclusions: Use of antibiotics was relatively safe regarding the overall development of ADs. However, broad-spectrum antibiotics should be used considerately as they may associate with an increased likelihood of JIA. Impact: Increasing numbers of antibiotic purchases before the age of 3 years or throughout childhood were not associated with the development of pediatric autoimmune diseases.Broad-spectrum antibiotics were related to the development of autoimmune diseases, especially juvenile idiopathic arthritis in children, while penicillin group antibiotics were not.The use of broad-spectrum antibiotics in children should be cautious as they may carry along a risk for autoimmune disease development.
AB - Background: Antibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general. Methods: From a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or inflammatory bowel diseases) by a median age of 16 years. Antibiotic purchases from birth until the date of diagnosis (or respective date in the matched controls n = 708) were traced from national registers. Results: Total number of antibiotic purchases was not related to the onset of ADs when studied as a group. Of specific diagnoses, JIA was associated with the total number of antibiotics throughout the childhood and with broad-spectrum antibiotics before the age of 3 years. Intriguingly, recent and frequent antibiotic use (within 2 years before diagnosis and ≥3 purchases) was associated with the onset of ADs (OR 1.72, 95% CI 1.08–2.74). Regardless of frequent use in childhood (40% of all antibiotics), penicillin group antibiotics were not related to any ADs. Conclusions: Use of antibiotics was relatively safe regarding the overall development of ADs. However, broad-spectrum antibiotics should be used considerately as they may associate with an increased likelihood of JIA. Impact: Increasing numbers of antibiotic purchases before the age of 3 years or throughout childhood were not associated with the development of pediatric autoimmune diseases.Broad-spectrum antibiotics were related to the development of autoimmune diseases, especially juvenile idiopathic arthritis in children, while penicillin group antibiotics were not.The use of broad-spectrum antibiotics in children should be cautious as they may carry along a risk for autoimmune disease development.
U2 - 10.1038/s41390-022-02188-4
DO - 10.1038/s41390-022-02188-4
M3 - Article
AN - SCOPUS:85134543050
SN - 0031-3998
VL - 93
SP - 1096
EP - 1104
JO - Pediatric Research
JF - Pediatric Research
IS - 4
ER -
