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Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study
  1. John Penders1,
  2. Carel Thijs2,
  3. Piet A van den Brandt1,
  4. Ischa Kummeling1,
  5. Bianca Snijders1,
  6. Foekje Stelma4,
  7. Hanne Adams4,
  8. Ronald van Ree3,
  9. Ellen E Stobberingh4
  1. 1Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands
  2. 2Department of Epidemiology, Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, the Netherlands
  3. 3Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
  4. 4Department of Medical Microbiology, University Hospital of Maastricht, Maastricht, the Netherlands
  1. Correspondence to:
    John Penders
    Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; j.penders{at}


Background and aims: Perturbations in intestinal microbiota composition due to lifestyle changes may be involved in the development of atopic diseases. We examined gut microbiota composition in early infancy and the subsequent development of atopic manifestations and sensitisation.

Methods: The faeces of 957 infants aged 1 month and participating in the KOALA Birth Cohort Study were analysed using quantitative real-time PCR. Information on atopic symptoms (eczema, wheeze) and potential confounders was acquired through repeated questionnaires. Total and specific IgE were measured in venous blood samples collected during home visits when the infant was 2 years old. During these home visits a clinical diagnosis of atopic dermatitis was made according to the UK-Working Party criteria.

Results: The presence of Escherichia coli was associated with a higher risk of developing eczema (ORadj = 1.87; 95% CI 1.15 to 3.04), this risk being increased with increasing numbers of E coli (pfor trend = 0.016). Infants colonised with Clostridium difficile were at higher risk of developing eczema (ORadj = 1.40; 95% CI 1.02 to 1.91), recurrent wheeze (ORadj = 1.75; 95% CI 1.09 to 2.80) and allergic sensitisation (ORadj = 1.54; 95% CI 1.02 to 2.31). Furthermore, the presence of C difficile was also associated with a higher risk of a diagnosis of atopic dermatitis during the home visit (ORadj = 1.73; 95% CI 1.08 to 2.78).

Conclusion: This study demonstrates that differences in gut microbiota composition precede the development of atopy. Since E coli was only associated with eczema and C difficile was associated with all atopic outcomes, the underlying mechanisms explaining these association may be different.

  • CFU, colony forming units
  • Ig, immunoglobulin
  • IL, interleukin
  • OR, odds ratio
  • Th1, Th2, T helper 1, 2
  • Treg, regulatory T cell
  • UK-WP, UK-Working Party
  • atopy
  • Clostridium difficile
  • Escherichia coli
  • gut microbiota
  • infant

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  • Published Online First 15 October 2006

  • Funding: This study was supported by grants from the Dutch Asthma Foundation (grant and Royal Friesland Foods (the Netherlands).

  • Competing interests: None declared.

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