# The impact of neonatal antibiotic exposure on the development of childhood food allergies

## TL;DR

Neonatal antibiotic use is linked to a higher risk of childhood food allergies, suggesting the need for cautious antibiotic use in infants.

## Contribution

This study shows neonatal antibiotic exposure triples the risk of food allergies by age six in a large cohort.

## Key findings

- Neonates receiving antibiotics had a 2.5% FA incidence compared to 1.3% in non-exposed infants.
- Adjusted analysis showed a threefold increased FA risk with neonatal antibiotic exposure (OR = 2.89).

## Abstract

Food allergies (FAs) in children have become increasingly prevalent. While early life factors such as gut microbiome disruptions have been implicated, the association between neonatal antibiotic exposure and subsequent FAs remains a topic of ongoing debate. This nationwide cohort study aimed to investigate the impact of neonatal antibiotic exposure on the development of childhood FA. This population-based retrospective cohort study analyzed data from Clalit-Healthcare-Services, Israel’s largest state-mandated healthcare provider. The cohort included neonates (aged 0–60 days) admitted with fever between 2011 and 2018. Patients with confirmed infectious etiologies were excluded. The cohort was divided into two groups: those who received systemic antibiotics (Antibiotic ( +)) and those who did not (Antibiotic ( −)). FA cases were identified using ICD-9 codes up to age 6. Multivariate logistic regression and survival analysis models were utilized and adjusted for inflammatory markers, maternal atopy, and socioeconomic status. Among 2780 neonates, 1220 received antibiotics, while 1560 did not. The incidence of FAs was significantly higher in the Antibiotic ( +) group compared to the Antibiotic ( −) group (2.5% vs. 1.3%, P = 0.02). Adjusted analysis revealed that systemic antibiotic exposure during the neonatal period was associated with a threefold increased risk of FA up to age 6 (OR = 2.89, 95% CI = 1.34–6.92, P = 0.01).

Conclusions: This study provides strong evidence linking neonatal antibiotic exposure to an increased risk of childhood FAs, particularly in the first 2 years of life. The findings highlight the importance of judicious antibiotic use in young infants.

What is Known:

• Early-life gut microbiome disruption is linked to an increased risk of food allergies (FA).

• Antibiotic use in infancy may contribute to FA, but the impact of neonatal antibiotics remains unclear.

What is New:

• In this large nationwide cohort, neonatal antibiotic exposure was associated with a nearly threefold increased risk of FA by age six, highlighting the need for careful antibiotic use in young infants.

The online version contains supplementary material available at 10.1007/s00431-025-06136-2.