Dangerous liaisons: Bacteria, antimicrobial therapies, and allergic diseases

Gerdien Tramper-Stranders*, Dominika Ambrożej, the EAACI Task Force on Conscious and Rational use of Antibiotics in Allergic Diseases, Alessandra Arcolaci, Marina Atanaskovic-Markovic, Cristina Boccabella, Matteo Bonini, Aspasia Karavelia, Ervin Mingomataj, Liam O' Mahony, Milena Sokolowska, Eva Untersmayr, Wojciech Feleszko

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)


Microbiota composition and associated metabolic activities are essential for the education and development of a healthy immune system. Microbial dysbiosis, caused by risk factors such as diet, birth mode, or early infant antimicrobial therapy, is associated with the inception of allergic diseases. In turn, allergic diseases increase the risk for irrational use of antimicrobial therapy. Microbial therapies, such as probiotics, have been studied in the prevention and treatment of allergic diseases, but evidence remains limited due to studies with high heterogeneity, strain-dependent effectiveness, and variable outcome measures. In this review, we sketch the relation of microbiota with allergic diseases, the overuse and rationale for the use of antimicrobial agents in allergic diseases, and current knowledge concerning the use of bacterial products in allergic diseases. We urgently recommend 1) limiting antibiotic therapy in pregnancy and early childhood as a method contributing to the reduction of the allergy epidemic in children and 2) restricting antibiotic therapy in exacerbations and chronic treatment of allergic diseases, mainly concerning asthma and atopic dermatitis. Future research should be aimed at antibiotic stewardship implementation strategies and biomarker-guided therapy, discerning those patients that might benefit from antibiotic therapy.

Original languageEnglish
Pages (from-to)3276-3291
Number of pages16
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number11
Early online date13 Aug 2021
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
Outside the budget from the EAACI for the task force, no funds were granted to this project We want to thank Zuzana Lukasik for the creative work.

Publisher Copyright:
© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.


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