In Reply We thank the respondents to our article1 for their insights. Greenhawt et al refer to our use of International Classification of Diseases, Ninth Revision (ICD-9) codes as the sole means of diagnosing allergy and a lack of adjustment for a number of risk factors for allergy, including family history, prenatal exposures, breastfeeding, vitamin D levels, and timing of solid food introduction. We agree that these are important limitations. Greenhawt et al propose that our study makes little sense biologically because it does not show elevated risk for all food allergies. Our study actually observed an increased risk (adjusted hazard ratios >1) for all subsets of food allergy. These risks were statistically significant for all subsets other than seafood in children who had received antacid therapies and seafood and peanuts in children who had received antibiotics as infants. Seafood allergy was the least commonly diagnosed food allergy in our study cohort. We disagree with Greenhawt et al that there is little human evidence that alterations in the microbiome may predispose to allergy because several studies have shown this association in humans.2,3
Mitre E, Susi A, Nylund CM. Antibiotics and Acid-Suppressing Medications in Early Life and Allergic Disorders—Reply. JAMA Pediatr. 2018;172(10):990–991. doi:10.1001/jamapediatrics.2018.2513
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