Tome V, 2 vols. The results were unchanged from the original model for both unadjusted and adjusted models aOR 1.
Berlin, Cari Hevmann, Schriften der Gesellschaft fiir Soziale Reform, Heft Vergleick der deutschen und der englischen Arbeitslosigkeit nach dem Weltkriege. Leipzig, Robert Noske, Vierteljahrshefte zur Konjunkturforschung, 2.
Museo social Argentino, Boletin del. Australie — Australia — Australien Clementson, a. One of Labour's Greatest Problems: Westralian Worker, 24 April-1 May Quarterly Summary of Australian Statistics. Census of the Commonwealth of Australia taken for the Night hetween 3 and 4 April Development and Migration Commission.
Report on Unemployment and Business Stability in Australia. Labour Mobility in Australian Industry. The Economie Record Melbourne , May , pp. Ministry for Home and Territories. Bureau of Census and Sta- tistics. New South Wales Industrial Gazette. Queensland Industrial Gazette, Brisbane. A B C of Queensland Statistics. Royal Commission on National Insurance. Melbourne, Government Printer, Office of the Government Statistician.
Western Australian Industrial Gazette. Wien , , Nr. Statistisches Handbuch fUr die Republik Oesterreieh. Bureau der statistischen Zentralkommission. Oester- reichische Statistik, Absatzmangel und Arbeitslosigkeit als Dauerzustand.
Die Arbeitslosigkeit als Dauererscheinung. Kammer fur Arbeiter und Angestellte in Wien. Wien, Verlag Arbeit und Wirtschaft. Die Krise in der Glasindustrie. Arbeit und Wirtschaft, , Heft 3. Die Arbeitsiosigkeit in Oesterreich.
Report presented to the Council of the League of Nations. Arbeit und Wirtschaft, , Heft 2. Die Arbeitsiosigkeit in Oesterreich Arbeit und Wirt- schaft, 1. Die Arbeitsiosigkeit in Oesterreich im Jahre Der gesetzliche Arbeiterschutz in Oesterreich. Die Bekampfung der Arbeitsiosigkeit im Mittelpunkt des Wirt- schaftsprogrammes. Financial Reconstitution of Austria.
Report of the Financial Com- mittee to the Council. Kampf gegen die Arbeitsiosigkeit. La crise dans l'industrie du cuir. Bulletin d'Information et de Documentation Banque nationale de Belgique , 25 janv. Mouvement syndical belge, 20 oct. Commission de la production industrielle. Constitution, pro- gramme, rapport final et conclusions.
Bruxelles, , pp. Bruxelles, , 56 pp. Annuaire statistique de la Belgique et du Congo belge. La crise industrielle en Belgique. Bulgarie — Bulgaria — Bulgarien Bermann, L. Die wirtschaftUchen Ergebnisse der bulgarischen Arbeits- pflicht. Informations sociales, 23 nov, , pp. Industriel and Labour Information, 23 Nov.
Le service obligatoire de travail en Bulgarie. Bezrabotitsata v Balgaria kam L'Internationale syndicale rouge, juillet , pp. Die Rote Gewerkschafts- internationale. Canada — Kanada Alberta. Labour Gazette of Canada, March , pp. Government Action on Unemployment in the Dominion of Canada.
Bureau of Labour Statistics, No. Canada's Programme for Meeting Unemployment. Labour Gazette of Canada, Jan. The Labour Gazette of Canada.
La Gazette du Travail. The Canada Year Book. Department of Trade and Commerce. Annual Report of the Dominion Statistician. Rapport annuel du Statisticien du Dominion. Employment Bulletin of the Employ- ment Service of Canada.
Journal of the American Statistical Association, March , pp. The Man Out of Work. The Survey of Unemployment in Canada. International Association of Public Employment Services. Eighth Annual Meeting, pp.
Department of Public Works, Bureau of Labour. Report of the Ontario Commission on Unemployment. Summarised in Labour Gazette of Canada, March , pp. The Labour Gazette of Canada, Vol. Bureau of Labour and Industries. The Public Service Monthly. Trades and Labour Congress. Unemployment Statistics in Canada. Labour Gazette of Canada, Aug. Danemark — Denmark — Danemark Anbaek, p.
Med et Forslag til Arbejdsleshedens Beksempelse. Arbejdslesheden i Aarene K0benhavn, Bianco Luno, Oekonomi og Politik, , Nr. Arbejdslesheden, dens Aarsag og dens Beksempelse. Bureau international du Travail. Revue internationale du Travail, mars , p. Unemployment in Denmark from to International Labour Review, March , pp. An Enquiry into the Conditions of the Unemployed in Denmark. Socialt Tids- skrift, Feb. Undersogelse vedr0rende de arbejdsloses Forhold pr.
Har Arbejdsl0sheden forandret Karakter? Socialt Tidsskrift, , Nr. Om Arbejdsl0sheden i Aarene Socialt Tidsskrift , Nr. Socialt Tidsskrift, Juni , pp. Tidsskrift for Industri, , Nr. Tidskrift for social Forsikring og Forsorgelse samt Arbejder- heskyttelse. Betsenkning angaaende Foranstalt- ninger til Imodegaaelse af Arbejdslesheden i Statistiske Ejterretninger, 5 Mai , pp.
Undersogelse vedrorende de Arbejdsloses Forhold pr. Danish Foreign Office Journal. Danish Commercial Review mensuel. Revue commerciale danoise trimestriel. Nationalekonomisk Tidsskrijt, , Nr. Dantzig — Danzig Danziger Statistische Mitteilungen.
Danziger Statistische Mitteilungen, 7. Espagne — Spain — Spanien Baeza, a. El problema del paro en Espana. Estonie — Estonia — Estland Bach, M. Die Rote Gewerk- schajtsinternationale , Juli , pp. Bureau central de statistique. Eesti Statistika ilmub kord kuus. Recueil mensuel du Bureau central de statistique de l'Estonie. Revue internationale du Travail, janv. Social Aspects of Land Reform in Estonia.
International Labour Review, Jan. Eesti Statistika, 15 janv. Eesti Statistika, aprillist The Record of the Government's Failure. The Pioneer, April , March The Survey, 15 June, , pp. Supplemental Biblio- graphy on Unemployment. Unemployment; a Problem of Industry. Unemployment Survey, , with Standard Recommendations.
Unemployment and the Unions. Unemployment in Trade Unions. American Federationist, April , p. American Trade Unions and the Problem of Unemployment. Monihly Labor Review, March , pp. Why Are We Idle? The Survey, 15 March , pp. L'Avenir du Travail, sept. Bureau of Labor and Statistics. Little Rock, State Printer.
Chapters on Machinery and Labor. Cambridge, Harvard University Press, La stabilisation de Vemploi aux Etats-Unis. Stabilisation of Employment in the United States. Quarterly Journal of Economies, May , pp.
Cycles of Employment and Unemployment in the United States, The Remedy for Overproduction and Unemployment. New York, Vanguard Press, Factory Labor Turnover in Michigan.
University of Michigan, The Coal Miners' Insecurity. New York, Russell Sage Founda- tion, Methods Used in Measuring Unemployment. Journal of the American Statistical Association, Dec. A Statistical Study of its Extent and Causes.
Bulletin of the U. Bureau of Labor Statistics, No. Labor Turnover in Industry. New York, Macmillan, City Committee on Unemployment. How to Meet Unemployment. The Victims of Progress. The New Leader, 24 Feb. Some Uses of Employment Statistics. The Employment Bulletin, Jan. Bureau of Labor Statistics. California Labor Market Bulletin. The History and Problems of Organized Labor. Boston, New York, Heath and Co. The Tragedy of Waste. Skilled Work and No Work. Revue internationale du Travail, mars , pp.
An American Labor Policy. New York, Macmillan Co. Committee on Unemployment and Relief. Denver, State Printers, Trade Unionism and Labor Problems. New York, Harpers, Committee on Naval Affairs. Subcommittee and Yards and Docks.
A Hearing on Bill H. Report for the Period ending 30 June. Keeping the Worker in Work. The Nation's Business, April , pp. Unemployment in Colombus, Ohio, Depart- ment of Labor, Bureau of Labor Statistics. Review of Economie Statistics, , Suppl. Unemployment as a Resuit of Over-Development of Industry. Monthly Labor Review, Oct. The Problem of the Worker Displaced by Machinery. Monthly Labor Review, Sept. Science and the Worker.
Monthly Labor Review, Feb. Labor-Saving Machinery and Unemployment. Regularization of Industry against Unemployment. Dennison Manufacturing Company, Personnel Division. Surcey of Carrent Business. Annual Report of the Secretary of Labor. Employment in Select Industries. Character and Value of Employment Statistics.
Monthly Labor Review, Jan. Comparison of Employment and Productivity in Manufactur- ing Industries, to Monthly Labor Review, May , pp.
Monthly Labor Review, March , pp. Monthly Labor Review, June , pp. Monthly Labor Review, June , p. Monthly Labor Review, July , pp. Stabihty of Employment in the Men's Clothing Industry. Survey of Unemployment in Baltimore, February Unemployment Conditions and Relief. Monthly Labor Review, June Industrial Employment Information Bulletin. Industrial, Agricultural, and General Employment Prospects for Douglas, Hitchcock, and Atkins.
The Worker in Modem Economie Society. Chicago, University of Chicago Press, Scotching That Unemployment Bogie. American Industries, April , pp. Depart- ment OF Research and Education. New York, East 22nd Street. Federated American Engineering Societies. The Regularization of Employment. New York, Harper Bros. The Causes of the Industrial Unrest.
A Way Oui of the Dilemma of Thrift. Do Workers Gain by Labor Turnover? Department of Commerce and Labor. New York, Century Co. What Puts Men Out of Work? Nation's Business, April , pp. The Outlook for Wages and Employment. Pre-War Unemployment Statistics; a Critique. Journal of the American Statistical Association, Sept. Harvard University Committee on Economic Research. Bureau of Labor Statistics, Report. Court of Industrial Relations. Department of Labor and Industry.
When Mass Production Stalls. The Survey, 1 March, , pp. Safeguarding Industry by Stabilizing Employment. Bulletin of the Taylor Society, June The Psychology of Vocational Adjustment. Employment Statistics and T rade Unions. Reprinted from the American Federationist, April The Burden of Unemploynient. New York, Russell Sage Foundation, Business Fluctuations and the American Labor Movement, New York, Columbia University, The Woman's Press, March Irregularity of Employment in the Anthracite Industry, Irregularity of Employment of Railroad Workers.
Geographical Aspects of Statistics of Employment and Earnings. Journal of the American Statistical Association, June , pp. Can Business Precent Unemployment? New York, Knopf, , pp. New York, American Management Association, The Absorption of the Unemployed by American Industry.
I, 1 July, , No. Board of Labor and Statistics. Department of Labor and Industries. Annual Report for the Year ending 30 November. Annual Report on the Public Employment Offices. Superseding the Quarterly Report on Employment in Massachusetts.
Statistics of Labor Organization in Massachusetts Boston, State Printer, Department of Agriculture, Labor and Industry. The Management Review, June , pp. Unemployment in the Coal Industry. National Bureau of Economic Research. Bureau of Industrial Statistics. The Labor Market Bulletin. Course of Employment in New York State from Department of Agriculture and Labor. Biennial Report of the Commissioner. Council on Women and Children in Industry.
Ohio and Unemployment in The Oklahoma Labor Market. Annual Report of the Commissioner. Philadelphia Society for Organizing Charity. The Aftermath of Unemployment. Annual Report of the Governor- General. Report of the Philippine Bureau of Labor included therein. Modem Economic Tendencies, pp. Report of the Committee on the Measurement of Employment.
Unemployment; a Selected Bibliography. The Statistical Work of the National Government. Institute for Government Research. Senate Committee on Education and Labor. Unemployment in the United States. Hearings before the Senate Committee on Education and Labour. Seventieth Congress, Second Session, pursuant to S. The Wastage of Men. Ultimate Effects of Automatic Machine Production.
Monthly Labour Revieiv, March , pp. Can the Worker be Guaranteed Continuous Employment: A Survey of Employment Statistics. The Price of Industrial Progress. The New Republic, 8 Feb. Tennessee, Bureau of Labor, Statistics and Mines. Held in Philadelphia, Pa. Reprinted from American Federationist, June Unemployment and the Ways Out. Graphie, April , p. American Federationist, March , pp. Chicago University Press, Problems in Business Economies.
Bureau of Labor and Industry. Report for Period ending 30 June. An Introduction to the Study of Labor Problems. New York, Crowel Co. The Wisconsin Labor Market. The Survey, 1 March , pp. Johns H opkins University Studies. Finlande — Finland — Finniand Bank of Finland. Ekonomisk Tidskrijt , nr. U Internationale syndicale rouge, juillet , pp. Die Arbeitslosigkeit in Finnland. Die Rote Gewerkschaftsinter- nationale, Juli , pp.
Sosiulincn Aikukauskirja, Social Tidskrijt. Les Documents du Travail. Les Documents du Travail, avril-mai Informations Sociales, 17 janv. Development of Unemployment in France. Industrial and Labour Information, 17 Jan. Publications de la Dotation Carnegie pour la paix inter- nationale. Paris, les Presses universitaires de France. L' Effort de la France. Paris, Les Presses universitaires de France, Revue d'Economie politique, janv.
Paris, Berger- Levrault, A Contribution to the Discussion. With a Foreword by Lord Askwith. London, Hodder and Stough- ton, London, Philip Allan, The Lesson of South Wales. National Economies for Britain' s Day of Need.
The Solution of the Unemployment Problem. A Reply to Sir William Beveridge. Sta- tionery Office, Output and Employment in Coal Mines. Output and Employment at Metalliferous Mines, Quarries, etc. British Library of Political Science. Bibliography of Unemployment since Ses aspects nationaux et inter- nationaux. Unemployment in its National and International Aspects. Bureau of Social Research for Tyneside. Employment and Unemployment at the Shipyards. The Tragedy of Unemployment.
Labour Magazine, June , pp. The Export Trades and Unemployment. The Manchester Guardian Commercial, 19 April , pp. The Immobility of Labour. The Manchester Guardian Commercial, 17 Nov. The Post-War Unemployment Problem. An Introduction to the Study of Unemploy- ment. London, Labour Publishing Co.
Survcy on Industrial Relations. Further Factors in Industrial Efficiency. With an Introduction by the Committee. Survey of Industrial Relations. Trade Recovery and Relief of Unemployment. London, Heath Cranton, The Surplus Labour in the Industry. The Commercial, 22 Aug. With an Introduction by G. Roberts and a Section on Emigration by H. London, Economie Publishing Co.
Old Policies and New. The Workman' s Charter. Its Cause and Cure. London, Independent Labour Party, Unemployment and Public Health. Journal of the Royal Sanitary Institute, Feb. Land Tenure and Unemployment.
The Labour Year Book. London, Labour Publications Department. Meihods of Relieving Unemploy- ment. Glasgow Chamber of Commerce. Journal of Institute of Bankers, Dec. The Unemployed and the Labour Party. Journal of the Royal Statisti- cal Society, March , pp.
Britain's Economie Outlook on Europe. Journal of Political Economy, Aug. London, Labour Publica- tions Co. The Industrial Year Book. London, , 18 pp. Co-operative Printing Society, Ltd.
International Labour Office — Bureau international du Travail. International Labour Review, Oct. Revue internationale du Travail, oct. The Situation in Great Britain: Industrial and Labour Information, 23 Nov. Informa- tions sociales, 23 nov.
An Analysis and a Forecast. A continuation of the investigations embodied in The Third Winter of Unemployment. Some Dangers of Rationalisation. London, Gee and Co. The Mobihty of Labour in the Cotton Industry. The Economie Journal, March , pp. Nation and Athenaeum, 18 May , pp. CanLloyd George do it? London, Nation and Athenaeum, Labour and the Nation. Labour's Reply to Lloyd George. How to Conquer Unemployment.
London, Labour Party, Port Sunlight, Lever Bros. We Can Conquer Unemployment. London and Cambridge Economic Service. A Practical Policy for Unemployment. Financial Aspects of Unemployment in England. Contemporary Review, May , pp. British Aspects of Unemployment. Journal of Political Economy, Dec. The Problem of Unemployment. The Problem of the Unemployed. Ministry of Labour Gazette. Provision of Work for Relief of Unemployment.
Analysis of the Course of Unemployment from July to October Ministry of Labour Gazette, Dec. Ministry of Labour Gazette, Nov. Memoranda on Certain Proposais relating to Unemployment. The Remedy for Unemployment. Llanelly, South Wales Press, The Incidence of Unemployment by Age and Sex. The Gateway to a New Life. London, Longmans Green and Co. Committee of In quiry into Production. The Waste of Capitalism. London, Labour Joint Publications Dept. The General Problem of Unemployment.
International Aspect of Unemployment. Emigration and Colonization as a Remedy for Unemployment. Types of Unemployment Insurance. The Financial Control of the Trade Cycle.
Social Significance of the Trade Cycle. Trade Cycle and Business Policy. The Ethics of Industry. The Riddle of Unemployment and its Solution. The Diseuse of Unemployment and the Cure. Wage Policy and Unemployment. L'' Internationale Syndicale Rouge, mars , pp. The Nation's Responsibility for Relief. The Clarion, 21 Jan. The Mobility of Labour in Liverpool Industry. The Sociological Review, July , pp.
The Human Factor in Business. London, New York, Longmans Green, Unemployment benefit scheme, Rowntree and Co. Unemployment and its AUeviations.
Political Science Quarterly, June , pp. Some Practical Steps towards ils Solution. Royal Commission on the Coal Industry Unemployment, a Suggested Policy. Sections on relief of unemployed. The British Trade Board System. The Engineering Industry and the Crisis of The Limits of Industrial Employment with Discussion.
Labour and the New World. London, New York, Cassell, Labour Monthly, April , pp. The Crisis in the World's Textile Industry. European Finance, 24 May , pp. The Third Winter of Unemployment. The results of a study of the Unemployment problem undertaken by A. Bowley, Henry Clay, J.
Pybus, Robert Grant, and W. Is there a Cure for Unemployment? London, Chapman and Hall, The Contribution of the Ministers. An examination of the Government's White Paper on Unemployment. English Poor Law History. The Last Hundred Years. The Inwardness of Unemployment. London, Elkin Matthews, Social Aspects of Industrial Problems. V Internationale syndi- cale rouge, juillet , pp. Die Rote Gaverk- schaftsinter nationale, Juli , pp. Arbeitsvermittlung, Arbeitslosigkeit in Ungarn.
Zeitschrift fiir Kommunalwirtschajt, Social Problems of Hungary. Ungarisches Wirtschafts-Jahrbuch, , L'Internationale syndicale rouge, juin , pp. Die Arbeitslosigkeit in Ungarn. Die Rote Gewerkschaftsinterna- tionale, Juni , pp. Office royal hongrois de statistique.
Bulletin statistique mensuel hongrois. Revue internationale du Travail, sept. Its Causes and Cure. International Labour Review, Sept. Ihre Ursachen und Bekampfung. Inde — India — Indien Bombay, Governmewt of. Labour in Indian Industries. The Mysore Economie Journal, July Receipt of antibiotic prescription in the first year of life is associated with FA diagnosis code in young children after controlling for common covariates.
Multiple antibiotic prescriptions are more strongly associated with increases in the odds of FA diagnosis. Food allergy contributes significantly to healthcare utilization with an estimated average of , ambulatory visits per year to emergency departments or physician offices [ 3 ].
A threefold increase in overall hospitalizations related to food allergy has been reported from to through — [ 1 , 3 ]. Newborn children need exposure to immunogenic material to develop a healthy, functional immune system. Changes in the composition, richness, and abundance of microbiota that colonize the human gut during infancy has been theorized to play a role in development in atopic disease, including food allergen sensitization [ 4 ].
Commensal bacteria have been shown to protect against food allergen sensitization in mice [ 5 ]. Attempts to translate these findings to early infancy in one study revealed that infants with low gut microbiota richness and elevated proportion of Enterobacteriaceae relative to Bacteroides spp. In this study, we sought to explore the association between antibiotic prescription in the first year of life and the presence of any food allergy diagnosis code in young children.
We performed a matched case—control study using Medicaid billing data for children from birth to age 3 in were obtained from the South Carolina Office of Research and Statistics, a clearinghouse for administrative and vital records data in South Carolina SC. Controls were selected from among children from birth to age 3 who were enrolled in SC Medicaid in and never had a diagnosis of food allergy documented in Medicaid billing records since their birth.
Both cases and controls were limited to children who were enrolled in SC Medicaid for the entirety of their first year of life. The primary exposure of interest was systemic antibiotic prescription in the first year of life. Information about all antibiotic and epinephrine prescriptions in the first year of life was obtained, along with the timing of the purchase since birth, from pharmacy billing records submitted to Medicaid. Additional analyses categorized antibiotics by class using the American Hospital Formulary System classification.
Prior to estimating any regression models, antibiotic exposure for cases was limited to prescriptions that were filled prior to the first diagnosis of food allergy. Significant variables were then used to examine the association between any antibiotic prescription and case status using multivariable, conditional logistic regression models.
We performed several sensitivity analyses. We repeated unadjusted and adjusted conditional logistic regression models only when the FA diagnosis code was submitted by an allergy or immunology provider. Additionally, we developed a model where only cases with epinephrine prescription and corresponding matching controls were considered.
Finally, we considered a model that excluded diagnoses that were felt to have lower sensitivity or specificity, dermatitis, rhinitis, and urticaria. Hypothesis tests were 2-sided with a type I error of 0. Data utilized for this study was obtained via the South Carolina Revenue and Fiscal Affairs Office, and information on obtaining data is available through their website http: The Data Oversight Council reviews and approves applications for the release of health care data at the encounter level.
The authors are not permitted to share the raw data through a data use agreement. The final study sample included controls and cases with at least one food allergy related diagnosis code. Vaginal birth was the preferred delivery approach in the control group, and breastfeeding upon hospital discharge was more common in the case group. A total of antibiotic prescriptions were dispensed in cases and controls. The overall proportion of patients receiving antibiotics by class were as follows: These antibiotic classes represented nearly all antibiotics prescribed.
The mean number of antibiotic prescriptions received was 1. Significantly more controls did not receive any antibiotic course during the first year of life compared to cases with food allergy, We also modeled specific types of food allergy based on available diagnostic coding; however, only peanut allergy diagnosis aOR 2. Children receiving three aOR 1. Unadjusted conditional logistic regression analyses assessing the association between antibiotic exposure and food allergy diagnosis.
Two controls also received epinephrine prescription for unknown reasons. Unadjusted and adjusted conditional logistic regression analyses assessing the association between antibiotic drug classification and food allergy diagnosis.
The odds of antibiotic exposure were not significant when limiting the analysis to FA cases with diagnosis by allergy or immunology provider aOR 1. The results were unchanged from the original model for both unadjusted and adjusted models aOR 1. The odds of antibiotic exposure were significantly increased relative to the original model when only cases with epinephrine prescription were considered aOR 2. In our sample of children enrolled in the South Carolina Medicaid Program, we identified an association between antibiotic prescription and presence of food allergy diagnosis code in young children.
Children with diagnosis of food allergy received significantly more antibiotics than controls even though we censored further antibiotics after the initial FA diagnosis in the case group. Our approach could have reduced the observed association between antibiotics and food allergy, since controls had an unlimited number of antibiotic exposures up to the end of month 12, while for cases the potential for exposure continued only until the initial food allergy diagnosis.
However, we felt it was important to enforce this restriction since considering antibiotic prescriptions filled after the initial food allergy diagnosis as potential risk factors would have been nonsensical. In our study, increasing quantity of antibiotic prescriptions was associated with a higher incidence of food allergy. We theorize that this could affect the likelihood of food allergen sensitization in several ways. Multiple courses of antibiotics increase the likelihood that children are on an antibiotic while introducing a new food.
Secondly, there are more opportunities for microbiota dysbiosis with more frequent antibiotic administration. Commensal gut flora serves an important role in both immune system development and immune tolerance. Studies with germ free animals show impaired humoral and cell mediated immune function [ 7 , 8 ]. Also, the interaction with normal gut flora is important in the development of regulatory T-cells and IgA antibody, both of which are important in developing tolerance to foreign proteins such as food [ 9 , 10 ].
Emerging evidence suggests that alterations in commensal flora due to early antimicrobial use may increase the risk of obesity, inflammatory bowel disease, and allergic diseases [ 11 — 18 ]. Recent articles suggest that even antimicrobial food additives or antimicrobials in health care products may be associated with increased allergic disease [ 19 , 20 ].
Conflicting findings are available for the few studies which have examined the association between antibiotic exposure and diagnosis of food allergy. Another study was designed to look at several allergic diseases and was not powered to identify food allergy specifically.
Of the children studied, had food allergy at age 4, and had food allergy at age 8. While antibiotic use was associated with food allergy, the association was not significant in adjusted models [ 24 ]. Most of these prescriptions are for otitis media, although most cases are caused by viral infection. Additionally, some studies have suggested high rates of antimicrobial prescribing for viral infections such as bronchitis and upper respiratory infection.
Data suggests that this pattern continues despite educational efforts and increasing reports of bacterial resistance [ 29 — 31 ]. Antibiotics are not devoid of adverse effects: Nausea, vomiting, diarrhea, and rash are common and well known short-term side effects reported in children receiving antimicrobial agents. Antibiotics are known to affect the GI flora, with the potential to cause antibiotic—induced diarrhea or Clostridium difficile associated disease [ 32 — 35 ].
Antibiotics with broader spectrum of activity are more likely to have an impact on commensal flora than narrower spectrum agents. We are just beginning to understand the potential long-term effects of microbiotia dysbiosis due to antibiotic exposure. Strengths of our study include matching on demographic variables including month and year of birth, multivariate analysis that controlled for variables previously associated with food allergen sensitization in other studies, and a large sample of FA children; however, our study has several limitations.
First, we defined food allergy using ICD-9 codes; thus, we cannot determine whether patients had food allergy versus food intolerance. The only definitive diagnostic test for food allergy is a double-blind, placebo-controlled challenge [ 36 ], but this is not frequently done in clinical practice. Additionally, there is not one single diagnostic code for food allergy, but rather several codes exist which define the allergen or clinical presentation of allergy. In clinical practice, inconsistent or varied use of diagnosis codes between providers could lead to under or over reporting of true food allergy.
On the other hand, we chose FA diagnosis codes for our study based upon prior retrospective analyses of administrative records, and we conducted sensitivity analyses comparing diagnosis by provider type, receipt of epinephrine, and exclusion of diagnoses to examine this. Second, children at risk for food allergy often have other associated allergic diseases; therefore, such children may receive more antibiotics simply because of these illnesses.
Atopic dermatitis predisposes to recurrent skin infections such as impetigo and Staphylococcal abscesses, and asthma exacerbations or wheezing episodes are often treated with antibiotics.
We controlled for asthma, wheezing and atopic dermatitis in all logistic regression models to account for this. Finally, our study population consisted of patients receiving Medicaid benefits, thus our study may be more representative of a lower socioeconomic group than the general population.
Lower socioeconomic status has been associated with higher rates of asthma and allergic rhinitis [ 37 ], but recent data cite higher rates of peanut sensitization among higher socioeconomic families [ 38 — 40 ].
Additional investigation in a more socioeconomically diverse population would also be beneficial. In summary, we identified an association between antibiotic prescription and presence of food allergy diagnosis code in young children. Our results require cautious interpretation due to the limitations as discussed; however, our findings offer a plausible hypothesis for increasing food allergy prevalence since increased antibiotic use is common in many westernized countries.
Further research is needed to examine this association in larger, more diverse patient populations with confirmed food allergy. Conception and design of the study: Analysis and interpretation of the data: Preparation or critical revision of the manuscript: All authors read and approved the final manuscript. Antibiotic exposure and the risk of food allergy in young children.