Tylenol and Asthma

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September 19, 2008 at 8:55 AM EDT

With much trepidation, researchers yesterday revealed that they have found a

possible link between the use of the pain medication acetaminophen in early

childhood and the later development of asthma, nasal allergies and eczema.

" We are saying there may be a link. We don't yet know whether it is

causative, " said Beasley who led the international study involving

more than 200,000 children in 31 countries including Canada.

Dr. Beasley, of the Medical Research Institute of New Zealand, said more

study is needed to establish if the risk is indeed real.

In the meantime, acetaminophen - sold under the brand name Tylenol in North

America and Paracetamol in other parts of world - is still the safest drug

for treating fever and pain in early childhood, he said.

" What we don't want is people changing from acetaminophen to Aspirin, " he

said in a telephone interview from his office in Wellington. He noted that

young children who take Aspirin, or acetylsalicylic acid, can develop Reye's

syndrome, a rare but sometimes fatal illness.

" I think there is potential for harm from our findings if we don't get the

correct message to the public, " Dr. Beasley said.

" We stress the findings do not constitute a reason to stop using

[acetaminophen] in childhood, " the research team wrote in the study

published in The Lancet, a British-based medical journal.

For the study, the researchers asked parents or guardians of children aged 6

to 7 to complete a questionnaire.

They were asked if the children were given acetaminophen-based medications

and whether the kids later developed asthma or other symptoms.

The results revealed that children who received acetaminophen for the

treatment of fever in the first year of life were, on average, 46 per cent

more likely to develop asthma by the age of 6 or 7, compared with infants

not given the medication.

What's more, the use of acetaminophen during the first year was associated

with a boost in the risk of rhinoconjunctivitis (nasal allergies) by 48 per

cent and eczema (a skin condition) by 35 per cent.

The risks were highest among those children who were treated the most

frequently with acetaminophen.

Asthma rates have been rising in many countries in recent decades. At the

same time, the use of acetaminophen has been growing by leaps and bounds.

Some researchers have speculated there may be a connection between the two

situations. So Dr. Beasley and his colleagues decided to do some preliminary

research.

Even though their study involved a relatively large number of children in a

wide variety of countries, the methodology had certain limitations, Graham

Barr of Columbia University Medical Center in New York wrote in an editorial

that accompanied the study. For one thing, it depended on parents having

accurate memories.

To clear up the uncertainty, Dr. Barr said, what is needed now is a large

randomized trial in which some children are treated with acetaminophen while

other are given placebos. The children would then be observed for a number

of years to see if differences emerged in disease rates between the two

groups.

Dr. Beasley agreed, saying " this is an issue that needs to be looked at

fairly urgently. "

Still, Dr. Beasley believes the existing research, including the results

from his own study, lends support to the current guidelines of the World

Health Organization, which recommend that acetaminophen should not be used

routinely, but only when children have a fever of 38.5 Celsius or more.

He also emphasized that acetaminophen remains the preferred pain reliever

for adults with asthma. That's because ASA and other so-called non-steroidal

anti-inflammatory drugs, such as naproxen and ibuprofen, may sometimes

provoke severe asthma attacks in asthmatics of all ages.