Acetaminophen and asthma

[Guest guest]

Acetaminophen poses several risks for children with mercury-induced autism. It is a phenol; many of our kids need to avoid phenols, or take supplements such as NoFenol to counteract the negative effects.

Acetaminophen depletes glutathione levels, which are already low in many mercury-toxic children. (See the Environmental Working Group's report, "Overloaded? New science, new insights about mercury and autism in susceptible children.")http://www.ewg.org/reports/autism/

Hokkanen

Minneapolis

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Chest. 2005 Feb;127(2):604-12

Acetaminophen and the risk of asthma:

the epidemiologic and pathophysiologic evidence.*

*Eneli I, Sadri K, Camargo C Jr, Barr RG.*

Department of Pediatrics and Human Development, Michigan State

University, B220 Clinical Center Bldg, East Lansing, MI 48824-1313, USA.

Eneli@...

The prevalence of asthma has increased worldwide. The reasons for this rise remain unclear. Various studies have reported an association between acetaminophen, a widely used analgesic, and diagnosed asthma. In a prospective cohort study, the rate of newly diagnosed asthma was 63% higher among frequent acetaminophen users than nonusers in multivariate analyses. Studies of patients with asthma suggest that acetaminophen challenge can precipitate a decline in FEV(1) > 15% among sensitive individuals.

*Plausible mechanisms to explain this association include depletion of pulmonary glutathione and oxidative stress.* This article reviews the existing literature and evaluates the epidemiologic and pathophysiologic evidence underlying a possible link between acetaminophen and asthma.

Pearls for the article---

*The prevalence of asthma in the United States has risen by 75% in the last 3 decades, with a particularly marked increase in children < 5 years of age (160%). This rise transcends age, gender, ethnicity, and geographic location, but affects minority groups, the socioeconomically disadvantaged, and inner-city populations disproportionately.

*Acetaminophen* is the most common form of analgesia used in the United States, particularly in children.Kogan et al estimated that approximately two thirds of analgesia used over a 30-day period by US preschool-aged children was acetaminophen. Concurrent with the use of acetaminophen, a large increase in asthma, particularly in the pediatric population, has been reported.*

*The International Study of Asthma and Allergies in Childhood and the European Community Respiratory Health Survey (ECHRIS), the authors observed a positive correlation between acetaminophen sales and asthma symptoms, eczema, and allergic rhinoconjunctivitis *

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* For each gram increase in per capita paracetamol (Tylenol) sales in 1994/ 1995, the prevalence of wheeze increased by 0.52% among 13- to 14-year-old subjects in the International Study of Asthma and Allergies in Childhood study.

* * The results parallel comparative prevalence trends of asthma noted since acetaminophen became the primary over-the-counter analgesic.

* *The association between asthma and acetaminophen has also been seen at the individual level. In a large population-based, case- control study of young adults (n = 1,574), daily and weekly use of acetaminophen was strongly associated with asthma.

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* *A recent report from the Nurses' Health Study found that increased frequency of acetaminophen use in 1990 to 1992 was associated with a subsequent risk of physician diagnosis of new- onset asthma diagnosed between 1990 and 1996.*

* The risk of wheezing was increased twofold in 30-to 42-month-old children whose mothers frequently used acetaminophen prenatally during weeks 20 to 32 of gestation. This association was stronger if the child had wheezed before 6 months (OR, 2.34; 95% CI, 1.24 to 4.40).*

*A double-blinded randomized clinical trial to determine the safety of ibuprofen in children. The trial compared ibuprofen with acetaminophen for treatment of pediatric febrile illness among 84,000 children, but did not have a placebo study arm. Among 1,879 children with a physician diagnosis of asthma who received daily asthma medication, the risk of having an outpatient visit for asthma was significantly lower in children assigned to the ibuprofen group compared with the acetaminophen group.*

ACETAMINOPHEN, GLUTATHIONE, AND LUNG INFLAMMATION

-- Glutathione (L-gamma-glutamyl-L-cysteinyl glycine) is found in respiratory tract lining fluid, of which > 95% is present in the reduced form its an antioxidant

-- Glutathione has been implicated in lung inflammation in a number of studies.

-- Compared with healthy children, glutathione has been detected at lower levels in the exhaled breath condensate of asthmatic children during exacerbations.

-- Some studies report reduced glutathione peroxidase activity in platelets and whole blood in asthmatic and atopic patients

-- Genetic polymorphisms of glutathione-S- transferase enzyme systems, which counteract products of oxidant stress, have also been detected in asthmatic patients.

-- When glutathione levels are low, defective processing of disulfide bonds that are key in antigen presentation has been hypothesized.

-- Decreased levels of glutathione guide the expression of T-helper cell pathways by altering antigen presentation and recognition, favoring the TH2 allergic dominant pathway.