Could paracetomol use cause teenage asthma and eczema?

New studies have reinforced earlier work to suggest that paracetomol (known by brand names such as Anacin, Panadol, Tylonol and many others) may increase the risk of asthma and eczema in teenagers.

A study carried out by Dr Richard Beasley, professor of medicine, at the Medical Research Institute of New Zealand on behalf of the International Study of Asthma and Allergies in Childhood, administered two written questionnaires and one video questionnaire to more than 300,000 13- and 14 year old children in 113 centres throughout 50 countries, asking them to quantify their use of paracetomol (none, ‘medium’— at least once in the last year, or ‘high’— at least once in the last month) and their asthma, eczema and allergy symptoms.

For ‘medium’ users the risk of asthma 43% higher than non-users; high users had 2.51 times the risk of non-users. Similarly, the risk of rhinoconjunctivitis (allergic nasal congestion) was 38% higher for medium users and 2.39 times as great for high users compared to non-users. For eczema, the relative risks were 31% and 99% respectively.

As this was a cross-sectional study, causality could not be determined. However, there is mounting evidence that suggests a causal link.

A longitudinal study on a small population in Ethiopia (also so be published in the American Journal of Respiratory and Critical Care Medicine) lends more evidence to the possibility that paracetomol usage may indeed cause the increased risk. While, in an earlier study from the United States, 13 and 14-year-old children with asthma were randomized to take either paracetomol or ibuprofen after a febrile illness. For those whose illness had been respiratory, there was an increased risk of subsequent asthma.

There are a number of biologically plausible explanations for how paracetomol might be implicated. It may have a systemic inflammatory effect, possibly increasing oxygen stress resulting from the depletion of glutathione-dependent enzymes, which may in turn lead to enhanced TH2 allergic immune responses. It may also suppress the immune response to rhinovirus infections, which are a common cause of asthma in childhood.

If further research confirms this relationship it could have major public health significance.

The research results will be published online on the American Thoracic Society's website ahead of the print edition of the American Journal of Respiratory and Critical Care Medicine.

Courtesy of EurekAlert!

August 2010

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