{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:42:34Z","timestamp":1761864154901,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T00:00:00Z","timestamp":1596758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research start-up fund for new faculty of Chongqing University of science and Technology","award":["182001002"],"award-info":[{"award-number":["182001002"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2017YFC0702700"],"award-info":[{"award-number":["2017YFC0702700"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Special Foundation for Postdoctoral Fellow in Chongqing","award":["13201907"],"award-info":[{"award-number":["13201907"]}]},{"name":"Shanghai Sailing Program","award":["17YF1412800"],"award-info":[{"award-number":["17YF1412800"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011\u20132012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child\u2019s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95\u20132.37), croup (1.46, 1.24\u20131.73), wheeze (1.44, 1.30\u20131.60), asthma (1.38, 1.19\u20131.61), food allergy (1.29, 1.13\u20131.46), and allergic rhinitis (1.23, 1.07\u20131.41), and as well as current (one year before the survey) common cold (\u22653 times) (1.38, 1.25\u20131.52), dry cough (1.27, 1.13\u20131.42), atopic dermatitis (1.25, 1.09\u20131.43), wheeze (1.23, 1.10\u20131.38), and rhinitis symptoms (1.15, 1.04\u20131.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.<\/jats:p>","DOI":"10.3390\/ijerph17165700","type":"journal-article","created":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T09:30:54Z","timestamp":1596792654000},"page":"5700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses"],"prefix":"10.3390","volume":"17","author":[{"given":"Zhijun","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9863-4332","authenticated-orcid":false,"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing 401331, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanjuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jialing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2147\/TCRM.S203719","article-title":"Antibiotic overuse and allergy-related diseases: An epidemiological cross-sectional study in the grasslands of northern China","volume":"15","author":"Chen","year":"2019","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhang, K., Xin, R., Zhao, Z., Ma, Y., Zhang, Y., and Niu, Z. (2019). Antibiotic resistance genes in drinking water of China: Occurrence, distribution and influencing factors. Ecotoxicol. Environ. Saf., 188.","DOI":"10.1016\/j.ecoenv.2019.109837"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Zhou, L.J., Li, J., Zhang, Y., Kong, L., Jin, M., Yang, X., and Wu, Q.L. (2019). Trends in the occurrence and risk assessment of antibiotics in shallow lakes in the lower-middle reaches of the Yangtze river basin, China. Ecotoxicol. Environ. Saf., 183.","DOI":"10.1016\/j.ecoenv.2019.109511"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1111\/all.13332","article-title":"Early-life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta-analysis","volume":"73","author":"Ahmadizar","year":"2018","journal-title":"Allergy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/j.1365-2222.2011.03850.x","article-title":"Antibiotics and asthma medication in a large register-based cohort study-confounding, cause and effect","volume":"42","author":"Almqvist","year":"2012","journal-title":"Clin. Exp. Allergy"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Baan, E.J., Janssens, H.M., Kerckaert, T., Bindels, P.J., de Jongste, J.C., Sturkenboom, M.C., and Verhamme, K.M. (2018). Antibiotic use in children with asthma: Cohort study in UK and Dutch primary care databases. BMJ Open, 8.","DOI":"10.1136\/bmjopen-2018-022979"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1164\/rccm.2109074","article-title":"Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years","volume":"166","author":"Celedon","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1111\/apa.14332","article-title":"Antibiotics in the first week of life were associated with atopic asthma at 12 years of age","volume":"107","author":"Celind","year":"2018","journal-title":"Acta Paediatr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cvejoska-Cholakovska, V., Vlashki, E., Kimovska, M., Seckova, L., and Micevska, V. (2018). Antibiotics use in relation to asthma in schoolchildren. Allergy, 73.","DOI":"10.26226\/morressier.5acc8ad4d462b8028d89b397"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/cea.12424","article-title":"Antibiotics and risk of asthma: A debate that is set to continue","volume":"45","author":"Dharmage","year":"2015","journal-title":"Clin. Exp. Allergy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1093\/ije\/dyh031","article-title":"Antibiotic sales and the prevalence of symptoms of asthma, rhinitis, and eczema: The international study of asthma and allergies in childhood (ISAAC)","volume":"33","author":"Foliaki","year":"2004","journal-title":"Int. J. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.jaci.2009.08.017","article-title":"Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III","volume":"124","author":"Foliaki","year":"2009","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/pai.12153","article-title":"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","volume":"24","author":"Teyhan","year":"2013","journal-title":"Pediatric Allergy Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1016\/j.jaci.2005.04.020","article-title":"Antibiotic exposure in early infancy and risk for childhood atopy","volume":"115","author":"Johnson","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1378\/chest.06-3008","article-title":"Increased risk of childhood asthma from antibiotic use in early life","volume":"131","author":"Kozyrskyj","year":"2007","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1111\/j.1365-2222.2010.03532.x","article-title":"Antibiotic use in early life and development of allergic diseases: Respiratory infection as the explanation","volume":"40","author":"Mai","year":"2010","journal-title":"Clin. Exp. Allergy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1378\/chest.129.3.610","article-title":"Does antibiotic exposure during infancy lead to development of asthma? A systematic review and meta-analysis","volume":"129","author":"Marra","year":"2006","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/cea.12356","article-title":"Prenatal and post-natal exposure to antibiotics and risk of asthma in childhood","volume":"45","author":"Metsala","year":"2015","journal-title":"Clin. Exp. Allergy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1542\/peds.2010-2092","article-title":"Prenatal or early-life exposure to antibiotics and risk of childhood asthma: A systematic review","volume":"127","author":"Murk","year":"2011","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.envint.2019.01.036","article-title":"Sources of indoor particulate matter (PM) and outdoor air pollution in china in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke","volume":"125","author":"Lu","year":"2019","journal-title":"Environ. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.chest.2019.10.004","article-title":"Early-life exposure to oral antibiotics and lung function into early adulthood","volume":"157","author":"Lodge","year":"2020","journal-title":"Chest"},{"key":"ref_22","unstructured":"Shrikant Kulkarni, N. (2019). More evidence against antibiotics for acute asthma exacerbations. Am. Fam. Physician, 100."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Testa, D., Bari, M.D., Nunziata, M., Cristofaro, G.D., Massaro, G., Marcuccio, G., and Motta, G. (2019). Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int. J. Pediatric Otorhinolaryngol., 129.","DOI":"10.1016\/j.ijporl.2019.109759"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.anai.2017.11.015","article-title":"Allergic asthma is associated with increased risk of infections requiring antibiotics","volume":"120","author":"Woehlk","year":"2018","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/pai.13039","article-title":"Association between antibiotic treatment during pregnancy and infancy and the development of allergic diseases","volume":"30","author":"Metzler","year":"2019","journal-title":"Pediatric Allergy Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1542\/peds.2008-1146","article-title":"Antibiotic use in children is associated with increased risk of asthma","volume":"123","author":"Marra","year":"2009","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.anai.2014.01.022","article-title":"Consequences of antibiotics and infections in infancy: Bugs, drugs, and wheezing","volume":"112","author":"Ong","year":"2014","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_28","first-page":"169","article-title":"Antibiotics in fetal and early life and subsequent childhood asthma: Nationwide population-based study with sibling analysis","volume":"70","author":"Lundholm","year":"2015","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annepidem.2018.10.003","article-title":"Trimester-specific association between antibiotics exposure during pregnancy and childhood asthma or wheeze: The role of confounding","volume":"30","author":"Bai","year":"2019","journal-title":"Ann. Epidemiol."},{"key":"ref_30","first-page":"1","article-title":"Effect of antibiotic use for acute bronchiolitis on new-onset asthma in children","volume":"8","author":"Chen","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_31","unstructured":"Lin, Y.C., Chen, Y.C., Kuo, C.H., Chang, Y.H., Huang, H.Y., Yeh, W.J., Wu, T.Y., Huang, M.Y., and Hung, C.H. (2019). Antibiotic exposure and asthma development in children with allergic rhinitis. J. Microbiol. Immunol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Huang, C., Liu, W., Hu, Y., Zou, Z., Zhao, Z., Shen, L., Weschler, L.B., and Sundell, J. (2015). Updated prevalences of asthma, allergy, and airway symptoms, and a systematic review of trends over time for childhood asthma in Shanghai, China. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121577"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1111\/all.12874","article-title":"An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011","volume":"71","author":"Wang","year":"2016","journal-title":"Allergy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4182","DOI":"10.1007\/s11434-013-5914-z","article-title":"Ten cities cross-sectional questionnaire survey of children asthma and other allergies in China","volume":"58","author":"Zhang","year":"2013","journal-title":"Chin. Sci. Bull."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4168\/aair.2019.11.2.156","article-title":"Increasing prevalence of allergic rhinitis in China","volume":"11","author":"Zhang","year":"2019","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1093\/jac\/dkt223","article-title":"A systematic review of antibiotic utilization in China","volume":"68","author":"Yin","year":"2013","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.envint.2019.03.013","article-title":"Household dampness-related exposures in relation to childhood asthma and rhinitis in China: A multicentre observational study","volume":"126","author":"Cai","year":"2019","journal-title":"Environ. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1183\/09031936.95.08030483","article-title":"International study of asthma and allergies in childhood (ISAAC): Rationale and methods","volume":"8","author":"Asher","year":"1995","journal-title":"Eur. Respir. J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Cai, J., Li, B., Yu, W., Yao, Y., Wang, L., Li, B., Wang, Y., Du, C., and Xiong, J. (2020). Associations of household dampness with asthma, allergies, and airway diseases among preschoolers in two cross-sectional studies in Chongqing, China: Repeated surveys in 2010 and 2019. Environ. Int., 140.","DOI":"10.1016\/j.envint.2020.105752"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1289\/ehp.1103780","article-title":"Improving the linkages between air pollution epidemiology and quantitative risk assessment","volume":"119","author":"Fann","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1080\/02770903.2016.1231203","article-title":"Breastfeeding and timing of first dietary introduction in relation to childhood asthma, allergies, and airway diseases: A cross-sectional study","volume":"54","author":"Huang","year":"2017","journal-title":"J. Asthma"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1164\/rccm.200802-309OC","article-title":"Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children","volume":"178","author":"Jackson","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1183\/09031936.00105010","article-title":"Infant antibiotic use and wheeze and asthma risk: A systematic review and meta-analysis","volume":"38","author":"Penders","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s10654-015-0038-1","article-title":"Antibiotic exposure in the first year of life and later treated asthma, a population-based birth cohort study of 143,000 children","volume":"31","author":"Pitter","year":"2016","journal-title":"Eur. J. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/pai.12725","article-title":"Early life antibiotic use and the risk of asthma and asthma exacerbations in children","volume":"28","author":"Ahmadizar","year":"2017","journal-title":"Pediatric Allergy Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1183\/09031936.00002108","article-title":"Definition, assessment and treatment of wheezing disorders in preschool children: An evidence-based approach","volume":"32","author":"Brand","year":"2008","journal-title":"Eur. Respir. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jmii.2013.04.005","article-title":"Early life exposure to antibiotics and the risk of childhood allergic diseases: An update from the perspective of the hygiene hypothesis","volume":"46","author":"Kuo","year":"2013","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/bjd.13497","article-title":"T helper cell 2 immune skewing in pregnancy\/early life: Chemical exposure and the development of atopic disease and allergy","volume":"172","author":"McFadden","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4161\/gmic.23567","article-title":"Perinatal antibiotic treatment affects murine microbiota, immune responses and allergic asthma","volume":"4","author":"Russell","year":"2013","journal-title":"Gut microbes"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1046\/j.1365-2222.1999.00536.x","article-title":"Antibiotic use in early childhood and the development of asthma","volume":"29","author":"Wickens","year":"1999","journal-title":"Clin. Exp. Allergy."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1111\/j.1365-2222.2008.03024.x","article-title":"The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: Confounding or causality?","volume":"38","author":"Wickens","year":"2008","journal-title":"Clin. Exp. Allergy."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Liu, W., Cai, J., Fu, Q., Zou, Z., Sun, C., and Huang, C. (2020). Associations of ambient air pollutants with airway and allergic symptoms in 13,335 preschoolers in Shanghai, China. Chemosphere, 252.","DOI":"10.1016\/j.chemosphere.2020.126600"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1093\/ije\/25.3.609","article-title":"Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma","volume":"25","author":"Jenkins","year":"1996","journal-title":"Int. J. Epidemiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/16\/5700\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:57:30Z","timestamp":1760176650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/16\/5700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,7]]},"references-count":53,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["ijerph17165700"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17165700","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2020,8,7]]}}}