Hi Rick,

I have found articles on "Hygiene Hypothesis" quite intriguing. The fact that antibiotics, vaccinations and a pristine clean environment can lead to increased allergic sensitivity (and possibly more allergic asthma) has some scientific support based on the study of white blood cell subtypes. Yet,  we have to be careful to not go too far in the other direction (no antibiotics, live in unclean environments avoid all or most vaccines etc.).

I recommend parents discuss with their doctors  whether "waiting a little longer" before starting antibiotics, is a reasonable alternative, in the setting of upper respiratory tract infections (URIs). For many years doctors felt pressured to treat URIs with antibiotics more often than not because parents were so intent that their child needed it. I know that's not a good excuse but I believe it is true. I think this has changed in recent years, for many doctors, because of studies on emerging  drug resistance (but perhaps not enough...).

A joint understanding between doctor and patient/parents is key to reducing the overuse of antibiotics. Your posting should help parents to accept the wait and see measure, or perhaps bring it up to the doctor.

I don't think there is enough evidence, to date to conclude that asthma is caused by use of antibiotics early in life. The Yale article was retrospective (as you know, not as reliable in drawing conclusions as prospective studies). It could be that children that were given more than one or two doses of antibiotic were sicker because of their allergic or asthmatic problem (which we know is evident, genetically, at birth). It's kind of a "chicken vs. egg" thing when it comes to this type of study and analysis.

I appreciate your address of these very important issues concerning asthma and allergy. It makes a great forum for discussion.

J. Thompson, M.D.