Antibiotic exposure in early life causes asthma and allergic disease.
Original statement
No Arabic original wording available.
Translation
Antibiotic exposure in early life causes asthma and allergic disease.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors (eltayebat.com)
- Origin
- https://eltayebat.com/rule/antibiotic-overuse/
- Attribution uncertainty
- Archive summary ('linked to ... asthma') and bibliography (A-ABX-04, A-ABX-05, A-ABX-06); no direct Elawady quote found on asthma.
- Claimed mechanism
Microbiome disruption during immune development.
- Claimed health effect
Asthma, eczema, hay fever.
- Population concerned
Children
- Geographic restriction by Elawady
none found
Scientific assessment
Unclear / insufficient evidence – The data do not allow an assessment either way.
Certainty of evidence: low – Further research is likely to change the assessment considerably.
1. What was claimed?
Antibiotics cause asthma.
2. What is demonstrably correct?
Associations: ALSPAC OR 1.75 (1.40-2.17) with dose-response (A-ABX-04); US cohort aOR 1.52 (1.07-2.16) (A-ABX-05); Canadian cohort small risk increasing with courses (A-ABX-06).
3. What is wrong or exaggerated?
Örtqvist et al. (n=493,785; sibling analysis): fetal exposure HR 1.28 in cohort but 0.99 (0.92-1.07) in sibling analysis; antibiotics for urinary/skin infections HR 0.85 (0.47-1.55) in siblings; when analyses were restricted to first-year exposure and asthma from age 2, the sibling associations disappeared for all antibiotic groups; 'previous positive associations ... could have been caused by confounding' (I-ABX-03). Early asthma symptoms are often treated as respiratory infections with antibiotics (protopathic bias, discussed by A-ABX-05).
4. What remains unclear?
Residual effect for respiratory-infection antibiotics in sibling analysis (HR 2.36) may still reflect confounding by indication.
5. Which studies support it?
6. Which studies contradict it?
7. What applies to Germany and Europe?
The decisive sibling analysis is Swedish (I-ABX-03) and ALSPAC is British (A-ABX-04); both are directly relevant to Europe.
8. What is known about Egypt?
No Egyptian data were reviewed.
9. What practical conclusion is appropriate?
The asthma link is not good evidence against necessary antibiotic use.
Assessment details
- Rationale for certainty of evidence
Dose-dependent associations exist, but a large Swedish sibling analysis showed the association with prenatal antibiotics disappeared and childhood associations were strongly attenuated, consistent with confounding by familial factors and respiratory infections (confounding by indication / protopathic bias).
- Source quality
Archive cites three cohort studies, all observational.
- Regional transferability
Moderate.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 25 October 2026 provisional
In plain language
Children who received antibiotics as babies have asthma more often. But children who later develop asthma often have chest symptoms early and get antibiotics for them. A large Swedish study compared siblings and found that much of the link disappeared. So it is not clear whether antibiotics cause asthma.
Studies on this claim
Studies supporting the claim (3)
-
Infant antibiotics and asthma (UK)
Hoskin-Parr L et al.. Pediatr Allergy Immunol 2013 · PMID 24299467 · DOI 10.1111/pai.12153Cohort studycited by the Tayebat archiveabstract only checkedMore antibiotic courses were linked to more asthma at age 7.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link to asthma.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
4952.
- What was actually found?
Dose-response.
- How large was the observed effect?
OR 2.82 (4+).
- What do the results mean in everyday life?
May be confounded.
- What are the study's limitations?
Reverse causation.
- What does it say about Elawady's specific claim?
Association.
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
Causation.
-
Early antibiotics and asthma (US)
Risnes KR et al.. Am J Epidemiol 2011 · PMID 21190986 · DOI 10.1093/aje/kwq400Cohort studycited by the Tayebat archiveabstract only checkedAntibiotics before 6 months were linked to asthma at age 6.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
1401.
- What was actually found?
Association.
- How large was the observed effect?
OR 1.52.
- What do the results mean in everyday life?
Uncertain.
- What are the study's limitations?
Small.
- What does it say about Elawady's specific claim?
Association.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Causation.
-
Antibiotics and asthma (Canada)
Marra F et al.. Pediatrics 2009 · PMID 19255032 · DOI 10.1542/peds.2008-1146Cohort studycited by the Tayebat archiveabstract only checkedInfant antibiotics were linked to a small increased asthma risk.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Link.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
251,817.
- What was actually found?
Small risk.
- What do the results mean in everyday life?
Small.
- What are the study's limitations?
Confounding.
- What does it say about Elawady's specific claim?
Association.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Causation.
No study in this group is marked as key.
Studies contradicting or limiting the claim (1)
-
Antibiotics and asthma: sibling comparison (Sweden)
Örtqvist AK et al.. BMJ 2014 · PMID 25432937 · DOI 10.1136/bmj.g6979Cohort studyindependent cross-checkfull text checked★ key studyWhen siblings were compared, most of the antibiotic-asthma link disappeared.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test confounding.
- How was the study done?
Sibling analysis.
- How many people, animals or samples were studied?
493,785 children.
- What was actually found?
Fetal antibiotic exposure: HR 1.28 in the whole cohort, 0.99 when comparing siblings. Antibiotics for urinary/skin infections: 1.54 vs 0.85 in siblings. Antibiotics for respiratory infections remained linked (2.36 in siblings), likely because of the infections themselves.
- How large was the observed effect?
Fetal HR 0.99 in siblings.
- What do the results mean in everyday life?
Antibiotics probably not the main cause.
- What are the study's limitations?
Reason for prescriptions not recorded; short follow-up (to about age 6); fewer informative sibling pairs for some comparisons.
- What does it say about Elawady's specific claim?
Contradicts causal claim.
- Do the results apply to Germany and Europe?
High.
- What can explicitly not be concluded from this study?
That antibiotics cause asthma; a small effect cannot be fully excluded.
No study in this group is marked as key.
Studies with mixed or unclear results (0)
No studies in this group.
Regional context
Germany / EU
The decisive sibling analysis is Swedish (I-ABX-03) and ALSPAC is British (A-ABX-04); both are directly relevant to Europe.
Egypt
No Egyptian data were reviewed.
What applies in my country?
General scientific assessment
Unclear / insufficient evidence Association exists, but sibling studies suggest much of it is confounding; causation unclear.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Antibiotic exposure in the first two years of life and development of asthma and other allergic diseases by 7.5 yr: a dose-dependent relationship.. Hoskin-Parr L et al.. Pediatr Allergy Immunol 2013 · PMID 24299467 · DOI 10.1111/pai.12153
- Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children.. Risnes KR et al.. Am J Epidemiol 2011 · PMID 21190986 · DOI 10.1093/aje/kwq400
- Antibiotic use in children is associated with increased risk of asthma.. Marra F et al.. Pediatrics 2009 · PMID 19255032 · DOI 10.1542/peds.2008-1146
- Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis.. Örtqvist AK et al.. BMJ 2014 · PMID 25432937 · DOI 10.1136/bmj.g6979