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Louchet M, Tisseyre M, Kaguelidou F, Treluyer JM, Préta LH, Chouchana L. Drug-induced fetal and offspring disorders, beyond birth defects. Therapie 2024; 79:205-219. [PMID: 38008599 DOI: 10.1016/j.therap.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/28/2023]
Abstract
Studies on drug utilization in western countries disclosed that about nine over ten women use at least one or more drugs during pregnancy. Determining whether a drug is safe or not in pregnant women is a challenge of all times. As a developing organism, the fetus is particularly vulnerable to effects of drugs used by the mother. Historically, research has predominantly focused on birth defects, which represent the most studied adverse pregnancy outcomes. However, drugs can also alter the ongoing process of pregnancy and impede the general growth of the fetus. Finally, adverse drug reactions can theoretically damage all developing systems, organs or tissues, such as the central nervous system or the immune system. This extensive review focuses on different aspects of drug-induced damages affecting the fetus or the newborn/infant, beyond birth defects, which are not addressed here.
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Affiliation(s)
- Margaux Louchet
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Service de gynécologie-obstétrique, Fédération hospitalo-universitaire PREMA, hôpital Louis-Mourier, AP-HP Nord - Université Paris Cité, 75000 Paris, France
| | - Mylène Tisseyre
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France
| | - Florentia Kaguelidou
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre d'investigation clinique pédiatrique, Inserm CIC 1426, hôpital Robert-Debré, AP-HP Nord - Université Paris Cité, 75000 Paris, France
| | - Jean-Marc Treluyer
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France
| | - Laure-Hélène Préta
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France
| | - Laurent Chouchana
- URP 7323 "Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte", Université Paris Cité, 75000 Paris, France; Centre régional de pharmacovigilance, service de pharmacologie périnatale, pédiatrique et adulte, hôpitaux Cochin-Necker, AP-HP Centre - Université Paris Cité, 75000 Paris, France.
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Long-Term Safety of Prenatal and Neonatal Exposure to Paracetamol: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042128. [PMID: 35206317 PMCID: PMC8871754 DOI: 10.3390/ijerph19042128] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Paracetamol is the most commonly used antipyretic and analgesic in pregnancy. It is also increasingly used off-label in the neonatal intensive care unit. Despite the frequent use of paracetamol, concerns have been raised regarding the high variability in neonatal dosing regimens and the long-term safety of early life exposure. Objective: To investigate the available evidence on the long-term safety of prenatal and neonatal paracetamol exposure. Methods: We conducted a systematic search of the electronic databases Ovid Medline, Ovid Embase and Web of Science from inception to August 2021 for original research studies of any design that described the use of paracetamol in the prenatal or neonatal (within the first four weeks of life) periods and examined the occurrence of neurodevelopmental, atopic or reproductive adverse outcomes at or beyond birth. Results: We identified 1313 unique articles and included 30 studies in the final review. Of all studies, 27 (90%), two (7%) and one (3%) were on the long-term safety of prenatal, neonatal and both prenatal and neonatal exposure, respectively. Thirteen (46%), 11 (39%) and four (15%) studies examined neurodevelopmental, atopic and reproductive outcomes. Eleven (100%), 11 (100%), and three (27%) studies on prenatal exposure reported adverse neurodevelopmental, atopic and reproductive outcomes. Only one study found a possible correlation between neonatal paracetamol exposure and long-term adverse outcomes. Conclusions: The available evidence, although limited, suggests a possible association between prenatal paracetamol exposure and an increased risk of neurodevelopmental, atopic and reproductive adverse outcomes. There is an immediate need for robust data on the long-term safety of paracetamol exposure in the prenatal and neonatal periods.
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García-Almaraz R, Reyes-Noriega N, Del-Río-Navarro BE, Berber A, Navarrete-Rodríguez EM, Ellwood P, García Marcos Álvarez L. Prevalence and risk factors associated with allergic rhinitis in Mexican school children: Global Asthma Network Phase I. World Allergy Organ J 2021; 14:100492. [PMID: 34659624 PMCID: PMC8495464 DOI: 10.1016/j.waojou.2020.100492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 01/05/2023] Open
Abstract
Background The International Study of Asthma and Allergies in Childhood (ISAAC) showed a wide variability in prevalence and severity of allergic rhinitis (AR) and rhinoconjunctivitis (ARC), in addition to other atopic diseases (Asher et al, 2006).1 The Global Asthma Network (GAN) has continued to study these conditions. Objective To estimate the prevalence of AR and ARC in children and adolescents in Mexico and to assess their association with different risk factors. Methods GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by 35 780 parents of 6–7 year old primary school pupils (children) and by 41 399 adolescents, 13–14 years old. Results The current and cumulative prevalence of AR was higher in the adolescents (26.2–37.5%, respectively) in comparison to the children (17.9–24.9%, respectively), especially in female participants. This tendency was also observed in the current prevalence of ARC, where 15.1% of female adolescents reported nasal symptoms accompanied with itchy-watery eyes in the past year. The most important risk factors for AR and ARC were the presence of wheezing in the past 12 months, wheezing in the first year of life, the previous diagnosis of asthma and eczema symptoms. Furthermore, allergic symptoms had a negative tendency concerning altitude. Conclusion This is the largest AR epidemiological study ever conducted in Mexico. It shows an increase in AR prevalence, as well as significant associations with modifiable risk factors, which could help to establish recommendations to reduce the burden of this condition.
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Affiliation(s)
| | - Nayely Reyes-Noriega
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Arturo Berber
- Asesor Externo del Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand
| | - Luis García Marcos Álvarez
- Pediatric Allergy and Pulmonology Units, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, ARADyAL network and Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
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Singh M, Varukolu S, Chauhan A, Jaiswal N, Pradhan P, Mathew JL, Singh M. Paracetamol exposure and asthma: What does the evidence say? An overview of systematic reviews. Pediatr Pulmonol 2021; 56:3189-3199. [PMID: 34425045 DOI: 10.1002/ppul.25595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To conduct an umbrella review collating the existing evidence to determine whether there is an association between exposure of Paracetamol in-utero or in infancy and the development of childhood Asthma. METHODS In this review, systematic reviews with or without meta-analysis that reported the association between paracetamol and asthma in children were included. To identify relevant reviews, a search was performed in the electronic databases PubMed, the Cochrane Library, and Ovid MEDLINE. The protocol was registered in PROSPERO CRD42020156023. A separate search was conducted for primary studies from the last 5 years not yet included in systematic reviews reporting the association from January 2016 to March 2021. RESULTS The electronic searches identified 1966 review titles. After the removal of 493 duplicates, 1475 titles and abstracts were screened against the eligibility criteria. Full-text screening yielded six systematic reviews to be included in this review. The search for primary studies in the last 5 years yielded 1214 hits, out of which 5 studies were found suitable for inclusion. Three of them, that were not included in the systematic reviews, and have been summarised in this paper. The odds ratios (ORs) for the outcome of asthma in offspring of mothers with prenatal paracetamol consumption in any trimester were 1.28 (1.13-1.39) and 1.21 (1.02-1.44). For first trimester exposures, they were 1.12 (0.99-1.27), 1.39 (1.01-1.91), and 1.21 (1.14-1.28), for the second or third trimester, they were 1.49 (1.37-1.63) and 1.13 (1.04-1.23). For the third trimester only, the figure was 1.17 (1.04-1.31). Of the six reviews included, 1 had a low risk of bias, 2 had an unclear risk while 3 had a high risk of bias assessed using the ROBIS tool. There was no significant increased risk of asthma with early infancy exposure. The inter-study heterogeneity varied from I2 = 41% to I2 = 76% across reviews. In the primary studies, the OR for prenatal exposure ranged from 1.12 (0.25-4.98) to 4.66 (1.92-11.3) and for infancy exposure was 1.56 (1.06-2.30). All three included primary studies were adjudged to be of high quality using the Newcastle Ottawa scale. CONCLUSIONS There is a modest association between paracetamol exposure in-utero and the future development of asthma. Exposure in infancy has a less consistant association. All the studies done thus far are observational in nature, with their inherent biases. Further research, preferably randomized controlled trials are recommended to answer this pertinent question.
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Affiliation(s)
- Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and research, Chandigarh, India
| | - Suresh Varukolu
- Health Economics and Outcomes Research, Smartanalyst Pvt. Ltd., Hyderabad, Telangana, India
| | - Anil Chauhan
- Department of Pediatrics, Postgraduate Institute of Medical Education and research, Advanced Center for Evidence Based Child Health, Chandigarh, India
| | - Nishant Jaiswal
- Health Economics and Health Technology Assessment, The University of Glasgow, Scotland, UK
| | - Pranita Pradhan
- Department of Pediatrics, Postgraduate Institute of Medical Education and research, Advanced Center for Evidence Based Child Health, Chandigarh, India
| | - Joseph L Mathew
- Department of Pediatrics, Postgraduate Institute of Medical Education and research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and research, Chandigarh, India.,Department of Pediatrics, Postgraduate Institute of Medical Education and research, Chandigarh, India
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[Pain management during pregnancy : An expert-based interdisciplinary consensus recommendation]. Schmerz 2021; 35:382-390. [PMID: 34324048 PMCID: PMC8613155 DOI: 10.1007/s00482-021-00571-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Schwangerschaft und Schmerzen unterschiedlicher Herkunft sind eine ungünstige Kombination, die alle BehandlerInnen vor besondere Herausforderungen stellt. Schmerzen beeinflussen die Homöostase des Menschen negativ. Compliance der Patientin und fundiertes Wissen über Fetotoxizität und Teratogenität von Analgetika sind nötig, um die Balance zwischen Therapie der Mutter und Sicherheit des Ungeborenen zu wahren. Ziel der Arbeit ExpertInnen verschiedener Disziplinen, die mit der Betreuung von schwangeren Schmerzpatientinnen betraut sind, haben sich zusammengeschlossen, um medikamentöse und nichtmedikamentöse Therapiekonzepte zu erstellen, mit dem Ziel, eine suffiziente Analgesie von schwangeren Schmerzpatientinnen zu ermöglichen. Material und Methode Relevante Fragestellungen wurden durch ExpertInnen formuliert und einer Literatursuche unterzogen. Kombiniert mit weiteren nationalen und internationalen Empfehlungen wurden Behandlungskonzepte entwickelt, interdisziplinär diskutiert und im Anschluss Kernaussagen erstellt, die mit Empfehlungsgraden abgestuft wurden. Ergebnisse Abhängig vom Trimenon können bei Schmerzen Paracetamol, Ibuprofen, Diclofenac, Metamizol und Opioide wohlüberlegt verabreicht werden, besondere Vorsicht ist bei nichtsteroidalen Antirheumatika (NSAR) im letzten Trimenon geboten. COX-2-Hemmer werden nicht empfohlen. Bei neuropathischen Schmerzen gelten Amitriptylin, Duloxetin, Venlafaxin als sicher. Bei starker Migräne kann Sumatriptan zum Einsatz kommen. Nichtmedikamentöse Therapien wie transkutane elektrische Nervenstimulation (TENS-Therapie), Kinesio-Tapes und Akupunktur gelten als sicher. Lymphdrainagen werden bei Ödemen empfohlen, sofern sie nicht durch eine Präeklampsie bedingt sind. Schlussfolgerung Die Therapie sollte mit einer nichtmedikamentösen Behandlung beginnen und eskalierend in einer Kombination aus medikamentösen und nichtmedikamentösen Konzepten enden.
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Zeng Y, Song B, Gao Y, Cao W, Li J, Liu Q, Liu J. Cumulative Evidence for Association of Acetaminophen Exposure and Allergic Rhinitis. Int Arch Allergy Immunol 2020; 181:422-433. [PMID: 32396912 DOI: 10.1159/000506807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Several studies have linked acetaminophen exposure to the risk of allergic rhinitis, with controversial results. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted up to December 1, 2019. We included observational studies that examined the association between acetaminophen exposure and the risk of allergic rhinitis. Two reviewers independently extracted data and assessed study quality. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. RESULTS Eighteen studies with 870,492 participants were included. Analysis showed that acetaminophen exposure was associated with an increased risk of allergic rhinitis (OR: 1.54, 95% CI: 1.41-1.69). Also, early exposure and exposure in the past year to acetaminophen was positively associated with risk of allergic rhinitis (OR: 1.34, 95% CI: 1.21-1.49 and OR: 1.74, 95% CI: 1.48-2.04, respectively). The risk of allergic rhinitis was greater for people who had acetaminophen exposure once per month over the past year (OR: 1.90, 95% CI: 1.60-2.26) compared to once per year (OR: 1.28, 95% CI: 1.11-1.48). CONCLUSION With our meta-analysis, we provide the evidence that exposure to acetaminophen is associated with an increased risk of allergic rhinitis. In addition, acetaminophen exposure in early life and acetaminophen exposure in the past year are positively associated with the risk of allergic rhinitis. Future research is needed to evaluate whether the association is causal.
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Affiliation(s)
- Yan Zeng
- Department of Pediatrics, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
| | - Bin Song
- Department of Nephrology, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China,
| | - Yang Gao
- Department of Pediatrics, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
| | - Wen Cao
- Department of Nephrology, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
| | - Jia Li
- Department of Pediatrics, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
| | - Qianfang Liu
- Department of Pediatrics, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
| | - Jian Liu
- Department of Pediatrics, People's Hospital of Deyang City, Affiliated Hospital of Chengdu Medical College, Deyang, China
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Ray-Griffith SL, Morrison B, Stowe ZN. Chronic Pain Prevalence and Exposures during Pregnancy. Pain Res Manag 2019; 2019:6985164. [PMID: 31485284 PMCID: PMC6702808 DOI: 10.1155/2019/6985164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
Pregnant women with chronic pain present a unique clinical challenge for both chronic pain and obstetrical providers, and clinical guidelines do not exist. The present study describes the prevalence and management of chronic pain during pregnancy in a perinatal mood disorder clinic. A retrospective chart review of pregnant women who presented to the Women's Mental Health Program at the University of Arkansas for Medical Sciences (UAMS) for an initial evaluation from July 2013 to June 2016 was conducted to obtain demographic and medical information, including pharmacological exposures. Data are described using the mean and standard deviation for continuous data and frequency for categorical data. Pain complaints and medications are presented as counts and percentages. Differences between women with and without chronic pain were assessed by t-tests for continuous variables and chi-square analysis for categorical variables. Of the 156 pregnant women, chronic pain conditions were reported by 44 (28.2%). The most common chronic pain complaints included neck and/or back pain (34.1%) and headaches (31.8%). Of subjects with chronic pain, 95.5% were taking at least one prescription medication (mean = 2.6 ± 2.1, range of 0-10). Acetaminophen (43.2%) and opioids (43.2%) were the most common. The complexity of managing maternal benefits of treatment with the risks of fetal exposures presents a uniquely challenging clinical scenario for healthcare providers.
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Affiliation(s)
- Shona L. Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bethany Morrison
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N. Stowe
- Department of Psychiatry, University of Wisconsin at Madison, Madison, WI, USA
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Piler P, Švancara J, Kukla L, Pikhart H. Role of combined prenatal and postnatal paracetamol exposure on asthma development: the Czech ELSPAC study. J Epidemiol Community Health 2018; 72:349-355. [PMID: 29371328 DOI: 10.1136/jech-2017-209960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prenatal and postnatal paracetamol exposure has been previously associated with asthma development in childhood in Western populations. We explore the association between prenatal and postnatal paracetamol exposure and asthma development in a Central European sample of Czech children, suggesting possible additive effect of the both exposures. Furthermore, since aspirin had been used more widely during study data collection in Central Europe, we also compared asthma development for those exposed to paracetamol and aspirin. METHODS We used data from 3329 children born in the 1990s as members of the prospective Czech European Longitudinal Study of Pregnancy and Childhood. Data about prenatal and postnatal paracetamol and aspirin exposure, and potential covariates were obtained from questionnaires completed by mothers. Data about incident asthma were obtained from paediatrician health records. RESULTS 60.9% of children received paracetamol only postnatally, 1.5% only prenatally and 4.9% of children were exposed both during pregnancy and infancy. Prevalence of asthma in following population was 5% at 11 years. Being exposed to paracetamol both in prenatal and postnatal period was associated with asthma development (unadjusted OR 1.98, 95% CI 1.02 to 3.87). Being exposed only in the postnatal period was also significantly associated with increased risk of asthma. No association between prenatal exposure only and outcome was found. A higher but non-significant risk of asthma was observed for those whose mothers used paracetamol during pregnancy compared with those who used aspirin. CONCLUSIONS The main findings of this prospective birth cohort study add to previous observations linking prenatal and early postnatal paracetamol exposure to asthma development. However, the magnitude of effect is relatively modest, and therefore, we recommend paracetamol to remain the analgesic and antipyretic of choice throughout pregnancy and early childhood.
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Affiliation(s)
- Pavel Piler
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jan Švancara
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lubomír Kukla
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Hynek Pikhart
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic.,Department of Epidemiology and Public Health, University College London, London, UK
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Lourido-Cebreiro T, Salgado FJ, Valdes L, Gonzalez-Barcala FJ. The association between paracetamol and asthma is still under debate. J Asthma 2016; 54:32-38. [PMID: 27575940 DOI: 10.1080/02770903.2016.1194431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the relationship between paracetamol and asthma. DATA SOURCES An English literature search using electronic search engines (PubMed and EMBASE) was conducted. STUDY SELECTIONS Articles published in peer-review journals, from 1990 to December 2015 were included. To perform the search for the most suitable and representative articles, keywords were selected ("asthma," "paracetamol" and "acetaminophen"). The evidence level was rated according to the criteria of the Oxford Centre For Evidence-Based Medicine. RESULTS The exposure to paracetamol during pregnancy was analysed in several cohort studies, showing an association between the prenatal exposure to paracetamol with suffering from asthma or presence of wheezing in childhood, especially for persistent wheezing. Nevertheless, a recent study concluded that the relationship between asthma and paracetamol is explained, at least in part, by confounding factors. Several works have also associated the exposure to paracetamol in the first years of life or in adults with the development of childhood asthma. Several pathophysiological mechanisms are known that could explain this relationship, such as the glutathione pathway, the decrease in the release of Th1 cytokines that are normally produced during febrile episodes, which would then lead to a predominance of Th2 cytokines, the cytotoxic effect of paracetamol for pneumocytes, a modulator effect on the activity of myeloperoxidase, as well as the possible antigenic effect of paracetamol, mediated by IgE. CONCLUSIONS There are many arguments that suggest a relationship between the use of paracetamol with the appearance of asthmatic symptoms, however the evidence is inconclusive.
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Affiliation(s)
- Tamara Lourido-Cebreiro
- a Department of Respiratory Medicine - University Hospital of Santiago de Compostela , Spain
| | - Francisco-Javier Salgado
- b Spanish Biomedical Research Networking Centre-CIBERES , Madrid , Spain.,c Department of Biochemistry and Molecular Biology , Faculty of Biology/CIBUS University of Santiago de Compostela , Spain
| | - Luis Valdes
- a Department of Respiratory Medicine - University Hospital of Santiago de Compostela , Spain.,d Department of Medicine - University of Santiago de Compostela , Spain.,e Health Research Institute of Santiago de Compostela (IDIS) , Spain
| | - Francisco-Javier Gonzalez-Barcala
- a Department of Respiratory Medicine - University Hospital of Santiago de Compostela , Spain.,b Spanish Biomedical Research Networking Centre-CIBERES , Madrid , Spain.,d Department of Medicine - University of Santiago de Compostela , Spain.,e Health Research Institute of Santiago de Compostela (IDIS) , Spain
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Magnus MC, Karlstad Ø, Håberg SE, Nafstad P, Davey Smith G, Nystad W. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study. Int J Epidemiol 2016; 45:512-22. [PMID: 26861478 DOI: 10.1093/ije/dyv366] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Paracetamol exposure has been positively associated with asthma development. The relative importance of prenatal vs infant exposure and confounding by indication remains elusive. We examined the association of prenatal and infant (first 6 months) paracetamol exposure with asthma development while addressing confounding by indication. METHODS We used information from the Norwegian Mother and Child Cohort Study, including 53169 children for evaluation of current asthma at 3 years, 25394 for current asthma at 7 years and 45607 for dispensed asthma medications at 7 years in the Norwegian Prescription Database. We calculated adjusted relative risks (adj. RR) and 95% confidence intervals (CI) using log-binomial regression. RESULTS There were independent modest associations between asthma at 3 years with prenatal paracetamol exposure (adj. RR 1.13; 95% CI: 1.02-1.25) and use of paracetamol during infancy (adj. RR 1.29; 95% CI: 1.16-1.45). The results were consistent for asthma at 7 years. The associations with prenatal paracetamol exposure were seen for different indications (pain, respiratory tract infections/influenza and fever). Maternal pain during pregnancy was the only indication that showed an association both with and without paracetamol use. Maternal paracetamol use outside pregnancy and paternal paracetamol use were not associated with asthma development. In a secondary analysis, prenatal ibuprofen exposure was positively associated with asthma at 3 years but not asthma at 7 years. CONCLUSIONS This study provides evidence that prenatal and infant paracetamol exposure have independent associations with asthma development. Our findings suggest that the associations could not be fully explained by confounding by indication.
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Affiliation(s)
- Maria C Magnus
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Nafstad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway Department of Community Medicine, University of Oslo, Oslo, Norway and
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Wenche Nystad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Hamre H, Glockmann A, Schwarz R, Riley D, Baars E, Kiene H, Kienle G. Antibiotikaverbrauch bei Kindern mit akuten Atemwegs- oder Ohrinfekten: eine prospektive Beobachtungsstudie zum Vergleich zwischen anthroposophischer und konventioneller Behandlung in der hausärztlichen Routineversorgung. ACTA ACUST UNITED AC 2016. [DOI: 10.14271/dms-20637-de] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Liu X, Liew Z, Olsen J, Pedersen LH, Bech BH, Agerbo E, Yuan W, Li J. Association of prenatal exposure to acetaminophen and coffee with childhood asthma. Pharmacoepidemiol Drug Saf 2015; 25:188-95. [PMID: 26676925 DOI: 10.1002/pds.3940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/22/2015] [Accepted: 11/23/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE Some studies have suggested that maternal acetaminophen use during pregnancy is associated with asthma in the offspring, and coffee consumption may modify the toxicity of acetaminophen. We aim to examine whether pregnancy maternal acetaminophen use increases the risk for offspring asthma, and whether such a potential association could be modified by maternal coffee consumption. METHODS We included 63,652 live-born singletons enrolled in the Danish National Birth Cohort. Maternal acetaminophen use and coffee consumption during pregnancy were assessed prospectively via the enrolment questionnaire and three computer-assisted telephone interviews. Asthma cases were identified by using the Danish National Patient Register and the Danish National Prescription Registry. We estimated the hazard ratios (HRs) for asthma according to prenatal acetaminophen and coffee exposure using Cox proportional hazards regression model. RESULTS After adjusting for potential confounders, acetaminophen use during pregnancy was associated with an increased risk of offspring asthma (HR = 1.16, 95% confidence interval (CI): 1.11-1.22). Coffee drinking during pregnancy was associated with a slightly decreased risk (HR = 0.94, 95%CI: 0.90-0.99). But there was no strong evidence of effect measure modification of acetaminophen use on offspring asthma by coffee consumption. CONCLUSIONS Acetaminophen use during pregnancy was associated with a modest increased risk for offspring asthma, which was not modified by coffee consumption.
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Affiliation(s)
- Xiaoqin Liu
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Zeyan Liew
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Wei Yuan
- Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, WHO Collaborating Center for Research in Human Reproduction, National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai, China
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Weatherall M, Ioannides S, Braithwaite I, Beasley R. The association between paracetamol use and asthma: causation or coincidence? Clin Exp Allergy 2015; 45:108-13. [PMID: 25220564 DOI: 10.1111/cea.12410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A better understanding of the causation of asthma and allergic disorders could potentially lead to intervention strategies that reduce their prevalence and severity. One potential causative factor is the use of paracetamol. Most of the evidence for the link with asthma is from non-experimental studies of paracetamol exposure in utero, infancy, childhood and adult life; however, it has been difficult to rule out confounding and bias in the associations observed. The two randomized clinical trials of the effect of paracetamol in patients with asthma have been difficult to interpret, due to methodological issues. There have been no randomized controlled trials of paracetamol use and the development of asthma. Both asthma and paracetamol use are common, and so even if there is a relatively small effect of paracetamol exposure on the development of asthma or its severity, then such an effect would be of major public health significance. It is proposed that randomized controlled trials of the effect of paracetamol on the development of asthma and its severity are a high research priority.
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Affiliation(s)
- M Weatherall
- University of Otago Wellington, Wellington, New Zealand
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Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain Management in Pregnancy: Multimodal Approaches. PAIN RESEARCH AND TREATMENT 2015; 2015:987483. [PMID: 26448875 PMCID: PMC4584042 DOI: 10.1155/2015/987483] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To address common pain conditions that present during pregnancy and the available pharmacological and nonpharmacological treatment options, for each of the pain conditions identified, a search using MEDLINE, PubMed, Embase, and Cochrane databases was performed. The quality of the evidence was evaluated in the context of study design. This paper is a narrative summary of the results obtained from individual reviews. There were significant disparities in the studies in terms of design, research and methodology, and outcomes analyzed. There is reasonable evidence available for pharmacological approaches; however, these are also associated with adverse events. Evidence for nonpharmacological approaches is limited and hence their efficacy is unclear, although they do appear to be primarily safe. A multimodal approach using a combination of nonpharmacological and pharmacological options to treat these pain conditions is likely to have the most benefit while limiting risk. Research trials with sound methodology and analysis of outcome data are needed.
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Affiliation(s)
- Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
| | - Esther T. Banh
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
| | - Katharine Koury
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Gaurav Bhatia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Roneeta Nandi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Padma Gulur
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
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Migliore E, Zugna D, Galassi C, Merletti F, Gagliardi L, Rasero L, Trevisan M, Rusconi F, Richiardi L. Prenatal Paracetamol Exposure and Wheezing in Childhood: Causation or Confounding? PLoS One 2015; 10:e0135775. [PMID: 26305473 PMCID: PMC4549146 DOI: 10.1371/journal.pone.0135775] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/24/2015] [Indexed: 01/24/2023] Open
Abstract
Background Several studies have reported an increased risk of wheezing in the children of mothers who used paracetamol during pregnancy. We evaluated to what extent this association is explained by confounding. Methods We investigated the association between maternal paracetamol use in the first and third trimester of pregnancy and ever wheezing or recurrent wheezing/asthma in infants in the NINFEA cohort study. Risks ratios (RR) and 95% confidence intervals (CI) were estimated after adjustment for confounders, including maternal infections and antibiotic use during pregnancy. Results The prevalence of maternal paracetamol use was 30.6% during the first and 36.7% during the third trimester of pregnancy. The prevalence of ever wheezing and recurrent wheezing/asthma was 16.9% and 5.6%, respectively. After full adjustment, the RR for ever wheezing decreased from 1.25 [1.07–1.47] to 1.10 [0.94–1.30] in the first, and from 1.26 [1.08–1.47] to 1.10 [0.93–1.29] in the third trimester. A similar pattern was observed for recurrent wheezing/asthma. Duration of maternal paracetamol use was not associated with either outcome. Further analyses on paracetamol use for three non-infectious disorders (sciatica, migraine, and headache) revealed no increased risk of wheezing in children. Conclusion The association between maternal paracetamol use during pregnancy and infant wheezing is mainly, if not completely explained by confounding.
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Affiliation(s)
- Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
- * E-mail:
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
| | - Claudia Galassi
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
| | - Luigi Gagliardi
- Woman and Child Health Department, Pediatrics and Neonatology Division, Ospedale Versilia, Viareggio, Italy
| | - Laura Rasero
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Morena Trevisan
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
| | - Franca Rusconi
- Unit of Epidemiology, ‘Anna Meyer’ Children’s University Hospital, Florence, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, CPO Piemonte, CERMS, and University of Turin, Turin, Italy
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Messerer B, Grögl G, Stromer W, Jaksch W. [Pediatric perioperative systemic pain therapy: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:43-64. [PMID: 24550026 DOI: 10.1007/s00482-013-1384-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many analgesics used in adult medicine are not licensed for pediatric use. Licensing limitations do not, however, justify that children are deprived of a sufficient pain therapy particularly in perioperative pain therapy. The treatment is principally oriented to the strength of the pain. Due to the degree of pain caused, intramuscular and subcutaneous injections should be avoided generally. NON-OPIOIDS The basis of systemic pain therapy for children are non-opioids and primarily non-steroidal anti-inflammatory drugs (NSAIDs). They should be used prophylactically. The NSAIDs are clearly more effective than paracetamol for acute posttraumatic and postoperative pain and additionally allow economization of opioids. Severe side effects are rare in children but administration should be carefully considered especially in cases of hepatic and renal dysfunction or coagulation disorders. Paracetamol should only be taken in pregnancy and by children when there are appropriate indications because a possible causal connection with bronchial asthma exists. To ensure a safe dosing the age, body weight, duration of therapy, maximum daily dose and dosing intervals must be taken into account. Dipyrone is used in children for treatment of visceral pain and cholic. According to the current state of knowledge the rare but severe side effect of agranulocytosis does not justify a general rejection for short-term perioperative administration. OPIOIDS In cases of insufficient analgesia with non-opioid analgesics, the complementary use of opioids is also appropriate for children of all age groups. They are the medication of choice for episodes of medium to strong pain and are administered in a titrated form oriented to effectiveness. If severe pain is expected to last for more than 24 h, patient-controlled anesthesia should be implemented but requires a comprehensive surveillance by nursing personnel. KETAMINE Ketamine is used as an adjuvant in postoperative pain therapy and is recommended for use in pediatric sedation and analgosedation.
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Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, LKH-Universitätsklinikum Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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Cheelo M, Lodge CJ, Dharmage SC, Simpson JA, Matheson M, Heinrich J, Lowe AJ. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis. Arch Dis Child 2015; 100:81-9. [PMID: 25429049 DOI: 10.1136/archdischild-2012-303043] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE While paracetamol exposure in pregnancy and early infancy has been associated with asthma, it remains unclear whether this is confounded by respiratory tract infections, which have been suggested as an alternative explanation. We undertook a systematic review and meta-analysis of longitudinal studies that reported the association between paracetamol exposure during pregnancy or infancy and the subsequent development of childhood asthma (≥5 years). METHODS Two independent researchers searched the databases EMBASE and PUBMED on 12 August 2013 for relevant articles using predefined inclusion and exclusion criteria. Study quality was assessed and results were pooled using fixed effect models or random effect models when moderate between-study heterogeneity was observed. We explicitly assessed whether the observed associations are due to confounding by respiratory tract infections. RESULTS Eleven observational cohort studies met the inclusion criteria. Any paracetamol use during the first trimester was related to increased risk of childhood asthma (5 studies, pooled OR=1.39, 95% CI 1.01 to 1.91) but there was marked between-study heterogeneity (I(2)=63%) and only one of these studies adjusted for maternal respiratory tract infections. Increasing frequency of use of paracetamol during infancy was associated with increased odds of childhood asthma (3 studies, pooled OR=1.15, 95% CI 1.00 to 1.31 per doubling of days exposure), but in these same three studies adjusting for respiratory tract infections reduced this association (OR=1.06, 95% CI 0.92 to 1.22). DISCUSSION The association during early pregnancy exposure was highly variable between studies and exposure during infancy appears to be moderately confounded by respiratory tract infections. There is insufficient evidence to warrant changing guidelines on early life paracetamol exposure at this time.
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Affiliation(s)
- M Cheelo
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - C J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - J A Simpson
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - M Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - J Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München-German Research Centre for Environmental Health, Neuherberg, Germany Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians University, Munich, Germany
| | - A J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
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Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:243801. [PMID: 25505919 PMCID: PMC4251819 DOI: 10.1155/2014/243801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022]
Abstract
Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P < 0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.
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Sordillo JE, Scirica CV, Rifas-Shiman SL, Gillman MW, Bunyavanich S, Camargo CA, Weiss ST, Gold DR, Litonjua AA. Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. J Allergy Clin Immunol 2014; 135:441-8. [PMID: 25441647 DOI: 10.1016/j.jaci.2014.07.065] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several studies have reported an association between use of over-the-counter antipyretics during pregnancy or infancy and increased asthma risk. An important potential limitation of these observational studies is confounding by indication. OBJECTIVES We investigated the association of antipyretic intake during pregnancy and during the first year of life (infancy) with asthma-related outcomes before and after controlling for early-life respiratory tract infections. METHODS We included 1490 mother-child pairs in Project Viva, a longitudinal prebirth cohort study. We categorized prenatal acetaminophen exposure as the maximum intake (never, 1-9 times, or ≥10 times) in early pregnancy or midpregnancy and ibuprofen intake as presence or absence in early pregnancy. We expressed intake of antipyretics in infancy as never, 1 to 5 times, 6 to 10 times, or more than 10 times. We examined the associations of acetaminophen and ibuprofen (per unit increase in exposure category) during pregnancy and infancy with wheeze, asthma, and allergen sensitization in early childhood (3-5 years of age, n = 1419) and midchildhood (7-10 years of age, n = 1220). RESULTS Unadjusted models showed an increased asthma risk in early childhood for higher infant acetaminophen (odds ratio [OR], 1.21; 95% CI 1.04-1.41) and ibuprofen (OR, 1.35; 95% CI, 1.19-1.52) intake. Controlling for respiratory tract infections attenuated estimates for acetaminophen (OR, 1.03; 95% CI, 0.88-1.22) and ibuprofen (OR, 1.19; 95% CI, 1.05-1.36). Prenatal acetaminophen was associated with increased asthma (OR, 1.26; 95% CI, 1.02-1.58) in early childhood but not midchildhood. CONCLUSIONS Adjustment for respiratory tract infections in early life substantially diminished associations between infant antipyretic use and early childhood asthma. Respiratory tract infections should be accounted for in studies of antipyretics and asthma to mitigate bias caused by confounding by indication.
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Affiliation(s)
- Joanne E Sordillo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Christina V Scirica
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | | | - Carlos A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
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The association between acetaminophen and asthma: is there anything to learn from the upper airways? Curr Opin Allergy Clin Immunol 2014; 14:25-8. [PMID: 24322007 DOI: 10.1097/aci.0000000000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the literature evidence for the association between acetaminophen (paracetamol) use and development of rhinitis. RECENT FINDINGS Increased use of acetaminophen (paracetamol) as the favored antipyretic during pregnancy and infancy has been hypothesized to be a risk factor for the development of asthma. There is a paucity of well designed birth cohort studies to examine paracetamol as a risk factor in the development of rhinitis. Confounding by antibiotic use, viral infections, and recall bias are problematic for many of the studies that are published. SUMMARY Prospective birth cohorts need to dedicate sufficient time and research personnel to adequately assess paracetamol exposure as a primary variable of interest rather than as an incidental exposure variable collected during routine questionnaire administration.
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Muc M, Padez C, Pinto AM. Exposure to paracetamol and antibiotics in early life and elevated risk of asthma in childhood. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:393-400. [PMID: 23836003 DOI: 10.1007/978-94-007-6627-3_53] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prospective studies on increased risk of childhood asthma due to exposure to paracetamol and antibiotics in early life have yielded contradictory results. Therefore, the aim of the present study was to investigate the association between administration of paracetamol and antibiotics in the first 12 months of life and delayed asthma symptoms later in childhood. This is a cross-sectional study that included 1,063 children from the primary schools in Coimbra, Portugal. ISAAC-based environmental and core asthma and rhinitis questionnaires were used to obtain information about children's respiratory health and administration of paracetamol and antibiotics. We found that early paracetamol use significantly increased the risk of asthma ever (at least one episode in life) (OR = 2.9; 95 %CI:1.8-4.5), current asthma (OR = 2.4; 95 %CI:1.5-3.6), wheezing ever (OR = 2.5; 95 %CI:1.8-3.4), rhinitis ever (OR = 2.4; 95 %CI:1.7-3.3), and current rhinitis (OR = 2.8; 95 %CI:2.0-3.9). Antibiotic exposure showed a similar effect with the risk for current asthma (OR = 1.6; 95 %CI:1.0-2.5), asthma ever (OR = 2.0; 95 %CI:1.3-3.1), wheeze ever (OR = 2.3; 95 %CI:1.7-3.2), and rhinitis symptoms (OR = 1.8; 95 %CI:1.3-2.6, OR = 1.8; 95 %CI:1.3-2.6, OR = 1.9; 95 %CI:1.2-3.0 for rhinitis ever, current rhinitis, and tearing, respectively). We further found that increased frequency of paracetamol use during the last 12 months preceding the study facilitated the appearance of allergic symptoms, suggesting a dose-dependent associations. In conclusion, the study shows a significant association between exposure to paracetamol and antibiotics in the first 12 months of life and both prevalence and severity of asthma and rhinitis symptoms in children 5-9 years old.
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Affiliation(s)
- M Muc
- Department of Life Sciences, University of Coimbra, Apartado 3046, 3001-401, Coimbra, Portugal,
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Moraes LSL, Takano OA, Mallol J, Solé D. Risk factors associated with wheezing in infants. J Pediatr (Rio J) 2013; 89:559-66. [PMID: 24035876 DOI: 10.1016/j.jped.2013.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 04/10/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil. METHODS this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46). CONCLUSIONS the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.
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Affiliation(s)
- Lillian S L Moraes
- Pediatrics Department, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.
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Kang SH, Jung YH, Kim HY, Seo JH, Lee JY, Kwon JW, Kim BJ, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Shim JY, Kim JH, Kang MJ, Yu HS, Yu J, Hong SJ. Effect of paracetamol use on the modification of the development of asthma by reactive oxygen species genes. Ann Allergy Asthma Immunol 2013; 110:364-369.e1. [PMID: 23622008 DOI: 10.1016/j.anai.2013.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 03/06/2013] [Accepted: 03/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent studies have identified an increase in the prevalence of asthma associated with paracetamol use. OBJECTIVE To identify the relationship among asthma, biomarkers, genes, and paracetamol use in preschool children. METHODS We undertook a population-based, cross-sectional survey of 933 preschool children. Asthma status was classified according to medical history and asthmatic symptoms. History of paracetamol use in infancy was recorded. Impulse oscillometry, blood tests for eosinophils and total IgE, and genotyping of NAT2, Nrf2, and GSTP1 polymorphisms by TaqMan assay were conducted. RESULT Paracetamol use in infancy was associated with an increased risk of treatment for asthma within the previous 12 months. Paracetamol use together with a family history of asthma increased the risk of asthma diagnosis ever, current asthma, and treatment for asthma within the previous 12 months. Gene polymorphisms in NAT2 (rs4271002), Nrf2 (rd6726395), and GSTP1 (rd1695) increased the risk of treatment for asthma within the last 12 months. Eosinophils were significantly elevated in the group with paracetamol use and a family history of asthma; however, the serum total IgE level and IOS did not show any significant difference. CONCLUSION Paracetamol use in infancy was significantly associated with increased risk of asthma. The association is more significant in genetically susceptible children, related to antioxidant genes, and the effect may be mediated by eosinophilic inflammation.
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Affiliation(s)
- Sung Han Kang
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Heintze K, Petersen KU. The case of drug causation of childhood asthma: antibiotics and paracetamol. Eur J Clin Pharmacol 2013; 69:1197-209. [PMID: 23292157 PMCID: PMC3651816 DOI: 10.1007/s00228-012-1463-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/27/2012] [Indexed: 12/15/2022]
Abstract
AIM The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mounting evidence, which is reviewed here, points to various confounding factors as the major reasons for these reported associations. METHODS PubMed and EMBASE were systematically searched for studies on associations between antibiotics and/or paracetamol with asthma and/or wheezing, published up to November 2012. A total of 64 pertinent studies were identified, 35 focusing on antibiotics, 19 on paracetamol, and ten addressing both antibiotics and paracetamol, bringing the number of relevant datasets to 74. RESULTS Numerous studies were cross-sectional and made no adjustment for the indication of antibiotics or paracetamol; consequently, they were unable to dismiss possible confounding by indication. Where such adjustments could be performed (mostly in longitudinal studies), they substantially weakened or entirely eliminated the association with asthma or asthma surrogates present in the unadjusted data. CONCLUSION The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. Truly indicated antibiotics should not be withheld from infants or young children for fears they might develop asthma. Likewise, there is no sound reason to replace paracetamol as the preferred pain relief and fever medication in this age group.
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Affiliation(s)
| | - Karl-Uwe Petersen
- Institute of Pharmacology and Toxicology, RWTH Aachen University, 52072 Aachen, Germany
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Bauer AZ, Kriebel D. Prenatal and perinatal analgesic exposure and autism: an ecological link. Environ Health 2013; 12:41. [PMID: 23656698 PMCID: PMC3673819 DOI: 10.1186/1476-069x-12-41] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 04/02/2013] [Indexed: 05/04/2023]
Abstract
BACKGROUND Autism and Autism Spectrum Disorder (ASD) are complex neurodevelopmental disorders. Susceptibility is believed to be the interaction of genetic heritability and environmental factors. The synchronous rises in autism/ASD prevalence and paracetamol (acetaminophen) use, as well as biologic plausibility have led to the hypothesis that paracetamol exposure may increase autism/ASD risk. METHODS To explore the relationship of antenatal paracetamol exposure to ASD, population weighted average autism prevalence rates and paracetamol usage rates were compared. To explore the relationship of early neonatal paracetamol exposure to autism/ASD, population weighted average male autism prevalence rates for all available countries and U.S. states were compared to male circumcision rates - a procedure for which paracetamol has been widely prescribed since the mid-1990s. Prevalence studies were extracted from the U.S. Centers for Disease Control and Prevention Summary of Autism/ASD Prevalence Studies database. Maternal paracetamol usage and circumcision rates were identified by searches on Pub Med. RESULTS Using all available country-level data (n = 8) for the period 1984 to 2005, prenatal use of paracetamol was correlated with autism/ASD prevalence (r = 0.80). For studies including boys born after 1995, there was a strong correlation between country-level (n = 9) autism/ASD prevalence in males and a country's circumcision rate (r = 0.98). A very similar pattern was seen among U.S. states and when comparing the 3 main racial/ethnic groups in the U.S. The country-level correlation between autism/ASD prevalence in males and paracetamol was considerably weaker before 1995 when the drug became widely used during circumcision. CONCLUSIONS This ecological analysis identified country-level correlations between indicators of prenatal and perinatal paracetamol exposure and autism/ASD. State level correlation was also identified for the indicator of perinatal paracetamol exposure and autism/ASD. Like all ecological analyses, these data cannot provide strong evidence of causality. However, biologic plausibility is provided by a growing body of experimental and clinical evidence linking paracetamol metabolism to pathways shown to be important in autism and related developmental abnormalities. Taken together, these ecological findings and mechanistic evidence suggest the need for formal study of the role of paracetamol in autism.
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Affiliation(s)
- Ann Z Bauer
- Department of Work Environment, School of Health and Environment, University of Massachusetts- Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - David Kriebel
- Department of Work Environment, School of Health and Environment, University of Massachusetts- Lowell, 1 University Avenue, Lowell, MA, 01854, USA
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Abstract
Acetaminophen is a widely used medication for the treatment of pain and fever in children and pregnant women. There is substantial epidemiological evidence in adults and children that acetaminophen use is associated with asthma symptoms. There is also a considerable body of evidence that supports a modest but consistent association of acetaminophen use in pregnancy and early infancy with asthma in later childhood. This relationship is robust to adjustment for a large range of potential confounding factors and, in some studies, shows clear evidence of a dose-dependent association but the possibility of confounding by indication has remained a concern. However, the epidemiological evidence is now compelling and there is a clear need to establish causation so that appropriate advice and interventions can be developed for children at risk of asthma. This requires randomised trials of analgesics and antipyretics, including acetaminophen, in a variety of clinical settings.
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Affiliation(s)
- A John Henderson
- School of Social and Community Medicine, University of Bristol, UK.
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Källén B, Finnström O, Nygren KG, Otterblad Olausson P. Maternal drug use during pregnancy and asthma risk among children. Pediatr Allergy Immunol 2013; 24:28-32. [PMID: 23331527 DOI: 10.1111/pai.12034] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal use of some drugs, notably paracetamol and drugs for gastroesophageal reflux, has been associated with an increased risk of childhood asthma in the child. We wanted to analyze these associations with consideration to the confounding of maternal asthma. METHODS Childhood asthma was identified from the Swedish National Prescription Register and maternal drug use during the latter part of pregnancy from antenatal records, computerized in the Swedish Medical Birth Register. Risks were estimated as odds ratios (OR) with 95% confidence intervals, using Mantel-Haenszel technique with adjustment for year of birth, maternal age, parity, smoking habits, and BMI. RESULTS A statistical association between maternal use of many different drugs, including paracetamol, and childhood asthma existed but was mainly due to concomitant drug use, related to maternal asthma. The only associations that appeared to be true were with drugs for gastroesophageal reflux (adjusted (OR) = 1.32, 95% CI, 1.18-1.54) and with opiates (adjusted OR = 1.56 (96% CI, 1.05-2.34). CONCLUSIONS Maternal use of paracetamol did not seem to increase the risk of childhood asthma, but the previously described association with drugs for gastroesophageal reflux was supported. The analysis is complicated by the confounding from maternal asthma.
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Affiliation(s)
- Bengt Källén
- Tornblad Institute, University of Lund, Lund, Sweden.
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Soferman R, Tsivion A, Farber M, Sivan Y. The effect of a single dose of acetaminophen on airways response in children with asthma. Clin Pediatr (Phila) 2013; 52:42-8. [PMID: 23047989 DOI: 10.1177/0009922812462764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
UNLABELLED Accumulating evidence suggests that the use of acetaminophen increases the risk of developing asthma and that its widespread use has contributed to the increasing prevalence of asthma. STUDY DESIGN To investigate the immediate effect of a single dose of acetaminophen on airways reactivity and inflammation in asthmatic and controls. A double blind placebo-controlled study was conducted on 42 asthmatic children and 21 healthy age-matched controls. Each participant received one oral dose of acetaminophen (15 mg/kg [160 mg/mL]) and one dose of a volume-matched placebo. Physical examination, spirometry results, and fractional exhaled nitric oxide levels were assessed before and 60 minutes following acetaminophen or placebo ingestion. RESULTS None of the studied variables showed any significant change after acetaminophen or placebo ingestion in either the asthmatic or the control groups. CONCLUSIONS One single dose of acetaminophen neither evokes a bronchoconstriction response nor an increase in airway inflammation in children with asthma.
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Affiliation(s)
- Ruth Soferman
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv 64239, Israel.
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Virus infection and allergy in the development of asthma: what is the connection? Curr Opin Allergy Clin Immunol 2012; 12:151-7. [PMID: 22356945 DOI: 10.1097/aci.0b013e3283520166] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Information is accumulating which implicates airway inflammation resulting from respiratory viral infections, acting against a background of atopy, in both the cause and pathogenesis of atopic asthma. This review brings together the most recent publications relevant to this rapidly evolving area, particularly those focusing on underlying pathogenic mechanisms. RECENT FINDINGS Salient findings from the recent literature include increased respiratory infection-associated symptom severity/duration and loss of asthma control in atopic relative to nonatopic children; up-regulation of FcεR1 expression on circulating monocytes/dendritic cells occurs during virus-associated atopic asthma exacerbations, providing a mechanism for transient amplification of underlying allergic airways inflammation; high potency of hRV-type C in induction of infection-associated wheeze; Th2-polarized immunity to mucosal dwelling bacteria and protection against asthma; a role for IL-15 in viral-associated airways inflammation; vitamin D and protection against infection-associated asthma exacerbations; strategies for reduction of infection-associated wheezing severity by boosting mucosal Treg cell activity via immunostimulation of the gut mucosa. SUMMARY Research in this area is pointing towards new rationales for development of early intervention strategies for prevention of asthma initiation and progression in childhood, based on control of respiratory infections and/or sensitization to aeroallergens.
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Chiappini E, Venturini E, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, Esposito S, Festini F, Galli L, Lucchesi B, Mugelli A, de Martino M. Update of the 2009 Italian Pediatric Society Guidelines About Management of Fever in Children. Clin Ther 2012; 34:1648-1653.e3. [DOI: 10.1016/j.clinthera.2012.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 12/20/2022]
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Gonzalez-Barcala FJ, Pertega S, Perez Castro T, Sampedro M, Sanchez Lastres J, San Jose Gonzalez MA, Bamonde L, Garnelo L, Valdes L, Carreira JM, Moure J, Lopez Silvarrey A. Exposure to paracetamol and asthma symptoms. Eur J Public Health 2012; 23:706-10. [PMID: 22645237 DOI: 10.1093/eurpub/cks061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Paracetamol is one of the factors that have been associated with the observed increase in asthma prevalence in the last few years. The influence of environmental or genetic factors in this disease may be different in some countries than in others. The purpose of this study was to analyse the relationship between the paracetamol consumption and asthma prevalence in our community. METHODS A cross-sectional study was conducted on more than 20,000 children and adolescents in Galicia, Spain. The International Study of Asthma and Allergies in Childhood methodology was used to collect the information on asthma symptoms in children, paracetamol consumption, body mass index (BMI), pets in the home, education level of the mother and parental asthma and smoking habits. The influence of paracetamol consumption on the prevalence of asthma symptoms was calculated using logistic regression, adjusted for the other parameters included in the study. RESULTS After adjusting for gender, BMI, having a cat or dog, maternal education, parental asthma and smoking, in 6- to 7-year-old children, the consumption of paracetamol during the first year of life is associated with asthma [odds ratio (OR) 2.04 (1.79-2.31) for wheezing at some time]. Paracetamol consumption in the previous year leads to a significant increase in the probability of wheezing at some time [OR 3.32 (2.51-4.41)] in young children and adolescents [OR 2.12 (1.68-2.67)]. CONCLUSIONS Paracetamol consumption is associated with a significant increase in asthma symptoms. The effect is greater the more often the drug is taken.
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Plutzer K, Spencer AJ, Keirse MJNC. How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child Care Health Dev 2012; 38:292-9. [PMID: 21375564 DOI: 10.1111/j.1365-2214.2011.01215.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teething, especially in their first child, continues to be a daunting problem for parents. OBJECTIVE The objective of this paper was to assess the effects of providing first-time mothers with information about symptoms commonly associated with teething and ways to manage these. METHODS In a randomized controlled trial to decrease the incidence of early childhood caries, we included information on teething as another issue in a child's oral health. Mothers in the intervention group received three rounds of printed information: at enrolment during pregnancy and when the child was 6 and 12 months old. Information on teething arrived when a child reached 6 months of age. Outcome assessment was at 20 ± 2.5 months of age. Data were complemented with a systematic search for evidence on teething symptoms and how to alleviate them in other populations. RESULTS Of 649 expectant mothers enrolled in the study, 441 completed the 'Child's oral health' questionnaire. There were no significant differences in teething symptoms reported by mothers in the intervention (n = 232) and control (n = 209) groups. However, mothers in the intervention group were less likely to use topical and oral medications to manage teething problems (P < 0.03) and relied more on rubbing the gums to ease discomfort (P < 0.005) than mothers in the control group. CONCLUSIONS Providing mothers with information on how to address teething symptoms markedly reduced the use of medications for symptom relief. There is still need for better evidence, first, on what symptoms can or cannot be attributed to teething and, second, on what is effective in alleviating them.
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Affiliation(s)
- K Plutzer
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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Rasmussen SA. Human teratogens update 2011: can we ensure safety during pregnancy? BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2012; 94:123-8. [PMID: 22328359 PMCID: PMC4490791 DOI: 10.1002/bdra.22887] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/09/2022]
Abstract
Anniversaries of the identification of three human teratogens (i.e., rubella virus in 1941, thalidomide in 1961, and diethylstilbestrol in 1971) occurred in 2011. These experiences highlight the critical role that scientists with an interest in teratology play in the identification of teratogenic exposures as the basis for developing strategies for prevention of those exposures and the adverse outcomes associated with them. However, an equally important responsibility for teratologists is to evaluate whether medications and vaccines are safe for use during pregnancy so informed decisions about disease treatment and prevention during pregnancy can be made. Several recent studies have examined the safety of medications during pregnancy, including antiviral medications used to treat herpes simplex and zoster, proton pump inhibitors used to treat gastroesophageal reflux, and newer-generation antiepileptic medications used to treat seizures and other conditions. Despite the large numbers of pregnant women included in these studies and the relatively reassuring results, the question of whether these medications are teratogens remains. In addition, certain vaccines are recommended during pregnancy to prevent infections in mothers and infants, but clinical trials to test these vaccines typically exclude pregnant women; thus, evaluation of their safety depends on observational studies. For pregnant women to receive optimal care, we need to define the data needed to determine whether a medication or vaccine is "safe" for use during pregnancy. In the absence of adequate, well-controlled data, it will often be necessary to weigh the benefits of medications or vaccines with potential risks to the embryo or fetus.
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Affiliation(s)
- Sonja A Rasmussen
- Centers for Disease Control and Prevention, Atlanta, Georgia 300333, USA.
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Andersen ABT, Farkas DK, Mehnert F, Ehrenstein V, Erichsen R. Use of prescription paracetamol during pregnancy and risk of asthma in children: a population-based Danish cohort study. Clin Epidemiol 2012; 4:33-40. [PMID: 22355259 PMCID: PMC4614522 DOI: 10.2147/clep.s28312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Use of paracetamol during pregnancy may increase the risk of asthma in offspring. The association between prenatal exposure to maternal use of paracetamol and risk of asthma was investigated. METHODS A cohort study of 197,060 singletons born in northern Denmark in 1996-2008 was conducted, with follow-up until the end of 2009. Maternal paracetamol use during pregnancy was defined as a redeemed prescription. Asthma in offspring was defined as at least two prescriptions of both a β-agonist and an inhaled glucocorticoid and/or a hospital diagnosis of asthma during follow-up. Absolute risk of asthma in offspring was estimated using the Kaplan-Meier method and incidence rate ratios adjusted for known risk factors were estimated using Cox proportional-hazards regression. RESULTS Overall, 976 (0.5%) children were exposed prenatally to maternal use of prescription paracetamol. During follow-up, 24,506 (12.4%) children developed asthma. Absolute risk of asthma was 7.5% after 2 years and 14.4% after 10 years among the unexposed children. Corresponding risks were 12.7% and 21.6% among the exposed children. The adjusted incidence rate ratio was 1.35 (95% confidence interval: 1.17-1.57) for exposure in any trimester of pregnancy. A similar association was present for paracetamol exposure in each of the trimesters and for maternal use of prescription nonsteroidal anti-inflammatory drugs. Furthermore, maternal prescription use in the year following the relevant delivery also showed similar associations. CONCLUSION A robust association was found between prenatal exposure to maternal use of prescription paracetamol and the risk of asthma; however, noncausal explanations could not be ruled out for such association.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paul IM. Advances in pediatric pharmacology, therapeutics, and toxicology. Adv Pediatr 2012; 59:27-45. [PMID: 22789573 DOI: 10.1016/j.yapd.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA.
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Goksör E, Thengilsdottir H, Alm B, Norvenius G, Wennergren G. Prenatal paracetamol exposure and risk of wheeze at preschool age. Acta Paediatr 2011; 100:1567-71. [PMID: 21767300 DOI: 10.1111/j.1651-2227.2011.02403.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To analyse the association between prenatal paracetamol exposure and preschool wheeze. METHODS Data were obtained from a prospective, longitudinal study of a cohort of children born in the region of western Sweden in 2003; 8176 families were randomly selected. The parents answered questionnaires at 6 and 12 months and at 4.5 years of age. The response rate was 55%, i.e. 4496 of the 5398 questionnaires distributed at 4.5 years (83%). Inhaled corticosteroid (ICS) treated wheeze during the last year was regarded as a proxy for doctor-diagnosed asthma. Episodic viral wheeze was defined as wheezing only with viral infections and multiple-trigger wheeze as wheezing also in between infections. RESULTS In the multivariate analysis, the risk of ICS-treated wheeze was increased by paracetamol (OR 1.6; 95% CI 1.01-2.6). Within the ICS-treated group, the effect was significant for multiple-trigger wheeze (OR 2.4; 1.2-4.8) but not for episodic viral wheeze (OR 1.1; 0.5-2.3). CONCLUSION Prenatal paracetamol exposure was an independent risk factor for ICS-treated wheeze at preschool age, especially among children with ICS-treated multiple-trigger wheeze. Although the analysis adjusted for e.g. maternal asthma and antibiotic use, the possibility of residual confounding by maternal indication (respiratory illness) should be acknowledged.
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Affiliation(s)
- Emma Goksör
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden.
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Abstract
PURPOSE OF REVIEW To summarize the data related to the association between acetaminophen and allergic diseases, and to try to establish a conclusion regarding the extent to which the association is unbiased and what its strength might be. RECENT FINDINGS Several studies have shown an association between acetaminophen use during pregnancy and allergic diseases in the offspring. Furthermore, this association has also been found between early exposure and recent exposure to the drug and several allergic conditions. However, other studies did not confirm those associations. Taken together, the available data suggest an unbiased but weak association between acetaminophen consumption and asthma/wheezing. Additional studies are needed to definitely confirm the association with rhinitis, eczema and sensitization. SUMMARY Although the use of acetaminophen is weakly associated with asthma/wheezing, the widespread use of the drug might have important public health implications. Thus, controlled studies to definitely establish not only causality but also the magnitude in which acetaminophen might increase allergic disorders are needed.
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Influencing mucosal homeostasis and immune responsiveness: the impact of nutrition and pharmaceuticals. Eur J Pharmacol 2011; 668 Suppl 1:S101-7. [PMID: 21810416 DOI: 10.1016/j.ejphar.2011.05.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 05/16/2011] [Accepted: 05/22/2011] [Indexed: 02/07/2023]
Abstract
Both nutrition and orally ingested drugs pass the gastrointestinal mucosa and may affect the balance between the mucosal immune system and microbial community herein, i.e. affecting composition of the microbial community as well as the status of local immune system that controls microbial composition and maintains mucosal integrity. Numerous ways are known by which the microbial community stimulates mammalian host's immune system and vice versa. The communication between microbiota and immune system is principally mediated by interaction of bacterial components with pattern recognition receptors expressed by intestinal epithelium and various local antigen-presenting cells, resulting in activation or modulation of both innate and adaptive immune responses. Current review describes some of the factors influencing development and maintenance of a proper mucosal/immune balance, with special attention to Toll like receptor signaling and regulatory T cell development. It further describes examples (antibiotic use, HIV and asthma will be discussed) showing that disruption of the balance can be linked to immune function failure. The therapeutic potential of nutritional pharmacology herein is the main focus of discussion.
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Verd S, Nadal-Amat J. Paracetamol and asthma and lactation. Acta Paediatr 2011; 100:e2-3; author reply e3. [PMID: 21244486 DOI: 10.1111/j.1651-2227.2011.02163.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:269-73. [PMID: 21516010 DOI: 10.1097/aci.0b013e3283473da8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Göran Wennergren
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children’s Hospital, Sweden.
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Leifer CA, Dietert RR. Early life environment and developmental immunotoxicity in inflammatory dysfunction and disease. TOXICOLOGICAL AND ENVIRONMENTAL CHEMISTRY 2011; 93:1463-1485. [PMID: 26146439 PMCID: PMC4486307 DOI: 10.1080/02772248.2011.586114] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Components of the innate immune system such as macrophages and dendritic cells are instrumental in determining the fate of immune responses and are, also, among the most sensitive targets of early life environmental alterations including developmental immunotoxicity (DIT). DIT can impede innate immune cell maturation, disrupt tissue microenvironment, alter immune responses to infectious challenges, and disrupt regulatory responses. Dysregulation of inflammation, such as that observed with DIT, has been linked with an increased risk of chronic inflammatory diseases in both children and adults. In this review, we discuss the relationship between early-life risk factors for innate immune modulation and promotion of dysregulated inflammation associated with chronic inflammatory disease. The health risks from DIT-associated inflammation may extend beyond primary immune dysfunction to include an elevated risk of several later-life, inflammatory-mediated diseases that target a wide range of physiological systems and organs. For this reason, determination of innate immune status should be an integral part of drug and chemical safety evaluation.
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Affiliation(s)
- Cynthia A. Leifer
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Rodney R. Dietert
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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