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Exposure to Paracetamol and Antibiotics in Early Life and Elevated Risk of Asthma in Childhood

  • M. MucEmail author
  • C. Padez
  • A. Mota Pinto
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 788)

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.

Keywords

Antibiotics Asthma Children Paracetamol Rhinitis Wheeze 

Notes

Acknowledgments

Supported by a grant of the Fundação para a Ciência e a Tecnologia number SFRH/BD/66877/2009.

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

References

  1. Bakkeheim, E., Mowinckel, P., Carlsen, K. H., Haland, G., & Carlsen, K. C. (2011). Paracetamol in early infancy: The risk of childhood allergy and asthma. Acta Paediatrica, 100(1), 90–96.PubMedCrossRefGoogle Scholar
  2. Barragan-Meijueiro, M. M., Morfin-Maciel, B., & Nava-Ocampo, A. A. (2006). A Mexican population-based study on exposure to paracetamol and the risk of wheezing, rhinitis, and eeczema in childhood. Journal of Investigational Allergology and Clinical Immunology, 16(4), 247–252.PubMedGoogle Scholar
  3. Beasley, R., Clayton, T., Crane, J., von Mutius, E., Lai, C. K., Montefort, S., Stewart, A., & IPTS Group. (2008). Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: Analysis from phase three of the ISAAC programme. Lancet, 372(9643), 1039–1048.PubMedCrossRefGoogle Scholar
  4. Celedon, J. C., Litonjua, A. A., Ryan, L., Weiss, S. T., & Gold, D. R. (2002). Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years. American Journal of Respiratory and Critical Care Medicine, 166(1), 72–75.PubMedCrossRefGoogle Scholar
  5. Dimova, S., Hoet, P. H., Dinsdale, D., & Nemery, B. (2005). Acetaminophen decreases intracellular glutathione levels and modulates cytokine production in human alveolar macrophages and type II pneumocytes in vitro. The International Journal of Biochemistry & Cell Biology, 37(8), 1727–1737.CrossRefGoogle Scholar
  6. Eder, W., Ege, M. J., & von Mutius, E. (2006). The asthma epidemic. The New England Journal of Medicine, 355(21), 2226–2235.PubMedCrossRefGoogle Scholar
  7. Foliaki, S., Pearce, N., Bjorksten, B., Mallol, J., Montefort, S., von Mutius, E., & International Study of Asthma and Allergies in Childhood Phase III Study Group. (2009). Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III. The Journal of Allergy and Clinical Immunology, 124(5), 982–989.PubMedCrossRefGoogle Scholar
  8. Gonzalez-Barcala, F. J., Pertega, S., Castro, T. P., Sampedro, M., Lastres, J. S., Gonzalez, M. A., Bamonde, L., Garnelo, L., Valdes, L., Carreira, J. M., Moure, J., & Silvarrey, A. L. (2012). Exposure to paracetamol and asthma symptoms. European Journal of Public Health. doi: 10.1093/eurpub/cks061.PubMedGoogle Scholar
  9. Kozyrskyj, A. L., Ernst, P., & Becker, A. B. (2007). Increased risk of childhood asthma from antibiotic use in early life. Chest, 131(6), 1753–1759.PubMedCrossRefGoogle Scholar
  10. Kummeling, I., & Thijs, C. (2008). Reverse causation and confounding-by-indication: Do they or do they not explain the association between childhood antibiotic treatment and subsequent development of respiratory illness? Clinical and Experimental Allergy, 38(8), 1249–1251.PubMedCrossRefGoogle Scholar
  11. Kusel, M. M., de Klerk, N., Holt, P. G., & Sly, P. D. (2008). Antibiotic use in the first year of life and risk of atopic disease in early childhood. Clinical and Experimental Allergy, 38(12), 1921–1928.PubMedCrossRefGoogle Scholar
  12. Newson, R. B., Shaheen, S. O., Chinn, S., & Burney, P. G. (2000). Paracetamol sales and atopic disease in children and adults: An ecological analysis. The European Respiratory Journal, 16(5), 817–823.PubMedCrossRefGoogle Scholar
  13. Prescott, S. L., Macaubas, C., Smallacombe, T., Holt, B. J., Sly, P. D., & Holt, P. G. (1999). Development of allergen-specific T-cell memory in atopic and normal children. Lancet, 353(9148), 196–200.PubMedCrossRefGoogle Scholar
  14. Rahman, I., & MacNee, W. (2000). Oxidative stress and regulation of glutathione in lung inflammation. The European Respiratory Journal, 16(3), 534–554.PubMedCrossRefGoogle Scholar
  15. Rahwan, G. L., & Rahwan, R. G. (1986). Aspirin and Reye’s syndrome: The change in prescribing habits of health professionals. Drug Intelligence & Clinical Pharmacy, 20(2), 143–145.Google Scholar
  16. Risnes, K. R., Belanger, K., Murk, W., & Bracken, M. B. (2011). Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children. American Journal of Epidemiology, 173(3), 310–318.PubMedCrossRefGoogle Scholar
  17. Rusconi, F., Gagliardi, L., Galassi, C., Forastiere, F., Brunetti, L., La Grutta, S., Piffer, S., Talassi, F., & S-C. Group. (2011). Paracetamol and antibiotics in childhood and subsequent development of wheezing/asthma: Association or causation? International Journal of Epidemiology, 40(3), 662–667.PubMedCrossRefGoogle Scholar
  18. Schaub, B., Lauener, R., & von Mutius, E. (2006). The many faces of the hygiene hypothesis. The Journal of Allergy and Clinical Immunology, 117(5), 969–977.PubMedCrossRefGoogle Scholar
  19. Soutar, A., Seaton, A., & Brown, K. (1997). Bronchial reactivity and dietary antioxidants. Thorax, 52(2), 166–170.PubMedCrossRefGoogle Scholar
  20. Strachan, D. P. (1989). Hay fever, hygiene, and household size. BMJ, 299(6710), 1259–1260.PubMedCrossRefGoogle Scholar
  21. Varner, A. E., Busse, W. W., & Lemanske, R. F., Jr. (1998). Hypothesis: Decreased use of pediatric aspirin has contributed to the increasing prevalence of childhood asthma. Annals of Allergy, Asthma & Immunology, 81(4), 347–351.CrossRefGoogle Scholar
  22. Verhulst, S. L., Vael, C., Beunckens, C., Nelen, V., Goossens, H., & Desager, K. (2008). A longitudinal analysis on the association between antibiotic use, intestinal microflora, and wheezing during the first year of life. The Journal of Asthma, 45(9), 828–832.PubMedCrossRefGoogle Scholar
  23. Williams, L. K., Peterson, E. L., Ownby, D. R., & Johnson, C. C. (2004). The relationship between early fever and allergic sensitization at age 6 to 7 years. The Journal of Allergy and Clinical Immunology, 113(2), 291–296.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Department of Life SciencesUniversity of CoimbraCoimbraPortugal
  2. 2.CIAS – Research Center for Anthropology and HealthUniversity of CoimbraCoimbraPortugal
  3. 3.General Pathology Laboratory, Faculty of MedicineUniversity of CoimbraCoimbraPortugal

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