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Paracetamol, antioxidants and asthma

The paper in the January issue of the journal by Shaheen et al. [1] using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) is another development in the story of how paracetamol consumption may be a potential risk factor for developing asthma and atopy. The authors demonstrated a positive association between paracetamol use in late pregnancy (defined as 20–32 weeks gestation), and subsequent asthma, wheezing and elevated serum IgE antibodies in 6-year-old children. The data are consistent with and builds upon earlier observation of the same cohort demonstrating that frequent use of paracetamol in late pregnancy is associated with increased risk of wheeze in the offspring aged 3 years old [2]. Assuming causality, the calculation that 7% of the asthma in this cohort is a consequence of pre-natal paracetamol exposure underlines the potential public health implications of these findings. This paper adds to the existing literature on paracetamol and asthma that has developed since the first publication in 2000 from Shaheen et al. [3]. Using a case–control study they demonstrated that frequent paracetamol consumption in adults was associated with approximately twice the risk of a diagnosis of asthma compared with those who never used paracetamol. This has been followed by data from the Nurses’ Health Study from the USA who reported that those taking paracetamol for more than 14 days per month had a 60% greater risk of incident asthma than those who never used paracetamol [4]. Recently data from New Zealand again demonstrated that current use of paracetamol was associated with a twofold increase in the prevalence of wheeze in children aged 6–7 years, with a smaller increase in wheeze in children who received paracetamol in the first year of their life [5]. Associations between paracetamol consumption and asthma in adults may result from aspirin avoidance, or from the use of paracetamol for asthma symptoms or for symptoms arising from the use of asthma medications. The advantage of Shaheen’s studies in which the association is between maternal consumption and infant or child symptoms is that these alternative explanations are less likely to operate. Maternal asthma or allergy may still confound the association, as it may be associated with both asthma in the child and preferential paracetamol use. However, in the most recent paper, the relationship persists after adjustment for maternal asthma [1].