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Hey all:

So most of you know that have seen my posts, i do sports med and gave up the FP portion of my practice.

I have a 6 month old kid (mine). He has been sick with fevers for a couple days. Don't worry I am not asking for you to diagnose and treat, but a question about kids in general.

I have exercised induced asthma and pediatrician said we can't use tylenol becuase of chances of allergic reaction. Is there something I can't find, or is it more likely they were talking about the higher incidence of asthma in kids who had tylenol as infants? If this is the case was there a link to family members with asthma as well? (i requested the article from library but prob won't get for a couple days and of course want to know now lol).

Thanks for anyone who has read the articles on this.

Ketan,
Haven't heard that one in the last 30 years. Anybody else want to help a brother?
Dave
FP

From Up to Date. Sounds iffy.

Acetaminophen/paracetamol use has been postulated to be a risk for asthma because this agent induces depletion of the antioxidant glutathione in lung tissue [85-92]. As a result, oxidative damage may occur, prostaglandin E2 production increases, and Th2 processes may be promoted. Conflicting results have been reported in population based studies of acetaminophen/paracetamol use and asthma.

Several studies have noted a dose-dependent relationship between the regular use of acetaminophen (or paracetamol) and the risk of developing allergic disease in general and asthma in particular [93-102]. In the largest of these, parents of 205,487 children were asked retrospectively about paracetamol use in the first year of life and about current asthma symptoms [101]. Use of paracetamol in the first year of life was associated with a small increase in risk of asthma at age six to seven; current paracetamol use was associated with a dose dependent increase in risk of asthma symptoms. The effect was also noted in both adults and in offspring of mothers taking regular acetaminophen during pregnancy [103].

In another population based study, regular acetaminophen use, but not aspirin or ibuprofen, was linked to the risk of reporting asthma or chronic obstructive pulmonary disease, even after controlling for smoking [94].

Many of the studies that have described an association between acetaminophen use and asthma are retrospective and therefore subject to recall bias [104,105]. An additional problem with studies evaluating over-the-counter medications such as acetaminophen is the possibility that the indication for the medication introduces confounding bias. As an example, asthmatics and those who are at risk for developing asthma are more likely to have co-morbidities (eg, respiratory infections) for which they may take acetaminophen for its analgesic or antipyretic effects. In a study of 1164 children enrolled in a birth cohort, intake of acetaminophen during the first year of life was associated with wheezing at two years of age; however, this association was significantly attenuated when respiratory infection was controlled for [106].

To reduce the risk of confounding bias, the Melbourne Atopy Cohort Study obtained frequent prospective documentation of paracetamol use and its indication in 620 children with a family history of allergic disease [107]. After adjustment for the frequency of respiratory infections, the association between paracetamol use and parental report of asthma at age six or seven disappeared. Paracetamol use for nonrespiratory indications was not associated with asthma.

Well, there was a retrospective study back a couple years ago (09) that suggested a link between acetaminophen use and asthma. There was no control on the frequency of use or the severity of the asthma, only that asthmatics had a statistically significant increased likelihood of using acetaminophen.

I did a quick search before responding, because I really have not heard anything more since then. What I saw on the reviews did not tell me much more than what I had seen (and reported above) before.

Given that he does not HAVE asthma, but is at a slightly increased risk, and that the data is NOT strong, I certainly would have no issue with short term fever control. The flip side of this is that ibuprofen is not approved for < 6 months, so he is at the lower range of it's use.

Oops, better response put in before I completed mine, but I concur.

Bill and Wendell's responses combined are correct. 1/8 people may have exercise asthma most not associated with "allergies" per se anyway.

Most recent study I am aware of is the Copenhagen prospective study of 400 plus children whose mothers have asthma. They were randomized into using either acetaminophen or ibuprofen for respiratory infections then evaluated for "TROLLS". Though the incidence of troublesome lower lung symptoms seemed to be greater in the acetaminophen group initially there was no difference between groups at age 7. Nada. Not a striking correlation especially when linked to a parent with EIA, in my opinion.

Frankly, I would appreciate your Ped's reference to "allergic reaction" to acetaminophen, though the term is perhaps used generically.