Effect of early-life antibiotic exposure and IL-13 polymorphism on atopic dermatitis phenotype

Pediatr Allergy Immunol. 2021 Oct;32(7):1445-1454. doi: 10.1111/pai.13531. Epub 2021 May 21.


Background: Although atopic dermatitis (AD) is associated with certain gene variants, the rapidly increasing incidence of AD suggests that environmental factors contribute to disease development. In this study, we investigated the association of AD incidence and phenotype with antibiotic exposure within 6 months of age, considering the dose administered and genetic risk.

Methods: This study included 1637 children from the COCOA cohort. Pediatric allergists assessed the presence of AD at each visit and obtained information about antibiotic exposure for more than 3 days. IL-13 (rs20541) polymorphism was genotyped by the TaqMan method. We stratified the AD phenotypes into four groups and used multinomial logistic regression models for analysis.

Results: Antibiotic exposure within 6 months of age was found to increase the risk of AD within 3 years of life (aOR = 1.40; 95% CI, 1.09-1.81) in dose-dependent manner. Antibiotic exposure more than twice increased the risk of the early-persistent AD phenotype (aOR = 2.50; 95% CI, 1.35-4.63). There was a weak interaction between genetic polymorphisms and environmental factors on the development of AD (p for interaction = 0.06). Children with the IL-13 (rs20541) GA + AA genotype have a higher risk of the early-persistent AD phenotype when exposed to antibiotics more than twice than those with the IL-13 (rs20541) GG genotype and without exposure to antibiotics (aOR = 4.73; 95% CI, 2.01-11.14).

Conclusion: Antibiotic exposure within 6 months was related to the incidence of early-persistent AD and a dose-dependent increase in the incidence of AD in childhood, whose effect was modified by the IL-13 (rs20541) genotype.

Keywords: interleukin-13; antibacterial agents; atopic; dermatitis; phenotype; polymorphism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Child
  • Child, Preschool
  • Dermatitis, Atopic* / drug therapy
  • Dermatitis, Atopic* / epidemiology
  • Dermatitis, Atopic* / genetics
  • Genetic Predisposition to Disease
  • Humans
  • Interleukin-13* / genetics
  • Phenotype
  • Polymorphism, Genetic


  • Anti-Bacterial Agents
  • Interleukin-13