Additive effect between IL-13 polymorphism and cesarean section delivery/prenatal antibiotics use on atopic dermatitis: a birth cohort study (COCOA).

Abstract

BACKGROUND: Although cesarean delivery and prenatal exposure to antibiotics are

likely to affect the gut microbiome in infancy, their effect on the development

of atopic dermatitis (AD) in infancy is unclear. The influence of individual

genotypes on these relationships is also unclear. To evaluate with a prospective

birth cohort study whether cesarean section, prenatal exposure to antibiotics,

and susceptible genotypes act additively to promote the development of AD in

infancy. METHODS: The Cohort for Childhood of Asthma and Allergic Diseases

(COCOA) was selected from the general Korean population. A pediatric allergist

assessed 412 infants for the presence of AD at 1 year of age. Their cord blood

DNA was subjected to interleukin (IL)-13 (rs20541) and cluster-of-differentiation

(CD)14 (rs2569190) genotype analysis. RESULTS: The combination of cesarean

delivery and prenatal exposure to antibiotics associated significantly and

positively with AD (adjusted odds ratio, 5.70; 95% CI, 1.19-27.3). The

association between cesarean delivery and AD was significantly modified by

parental history of allergic diseases or risk-associated IL-13 (rs20541) and CD14

(rs2569190) genotypes. There was a trend of interaction between IL-13 (rs20541)

and delivery mode with respect to the subsequent risk of AD. (P for interaction =

0.039) Infants who were exposed prenatally to antibiotics and were born by

cesarean delivery had a lower total microbiota diversity in stool samples at 6

months of age than the control group. As the number of these risk factors

increased, the AD risk rose (trend p<0.05). CONCLUSION: Cesarean delivery and

prenatal antibiotic exposure may affect the gut microbiota, which may in turn

influence the risk of AD in infants. These relationships may be shaped by the

genetic predisposition.