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Posts Tagged ‘adolecentes’

Clinical Context

 

A recent study, published in the current issue of the American Journal of Respiratory and Critical Care Medicine, conducted by Amberbir and colleagues reported that acetaminophen use was associated with increased risk of wheeze, but not eczema, in a small cohort of patients in Ethiopia.

Previously, in 2008, Beasley and colleagues, the current study authors, conducted Phase Three of ISAAC, and in the September 20, 2008, issue of The Lancet, they reported that acetaminophen use (paracetamol) in the first year of life was associated with a greater risk for asthma symptoms in children aged 6 to 7 years.

The current study by Beasley and colleagues uses data from ISAAC Phase Three to evaluate whether acetaminophen use is linked with a greater risk for asthma, allergy, or eczema symptoms in children aged 13 to 14 years.

 

Study Highlights

 

  • Data were available for 322,959 children aged 13 to 14 years from 113 centers in 50 countries.
  • Subjects completed a written environmental questionnaire about protective and risk factors including acetaminophen use in the past 12 months; a written questionnaire about current symptoms of asthma, rhinoconjunctivitis, and eczema; and a video questionnaire about asthma symptoms.
  • Exclusion criteria were centers that deleted the acetaminophen use question, centers with less than 70% data for current acetaminophen use, centers with less than 1000 enrolled children, missing data for sex, and missing data for current acetaminophen use.
  • Adjusted and multivariate analyses included 180,887 subjects with complete covariate data or subjects who came from centers with at least 70% covariate data.
  • Current acetaminophen use was considered medium if taken at least once in the past 12 months and high if taken at least once a month in the past 12 months.
  • Current asthma symptoms were defined as reported wheezing or whistling in the chest in the past 12 months.
  • Separate assessment of current wheeze was defined as reported symptoms similar to a video showing wheezing at rest.
  • Current rhinoconjunctivitis symptoms were defined as sneezing, a runny or blocked nose, or itchy watery eyes in the absence of a cold or the flu in the past 12 months.
  • Current eczema symptoms were defined as an itchy rash in the folds of the elbows; behind the knees; in front of the ankles; under the buttocks; or around the neck, ears, or eyes recurring for at least 6 months in the past 12 months.
  • Severe asthma was defined as 4 or more wheezing attacks, 1 or more nights per week of disturbed sleep because of wheezing, or wheezing severe enough to limit speech in the past 12 months.
  • The primary outcome measure was the OR of current asthma symptoms linked with acetaminophen use.
  • Medium acetaminophen use occurred in 73% of participants (range, 41% in China to 92% in Panama).
  • High acetaminophen use occurred in 30% of subjects (range, 2% in Taiwan to 68% in Nigeria).
  • Analysis adjusting for sex, region of the world, language, and gross national income showed that an increased risk for current asthma symptoms was dependent on exposure to acetaminophen use:
    • Medium vs no acetaminophen use (OR, 1.38; 95% CI, 1.31 – 1.46)
    • High vs no acetaminophen use (OR, 2.36; 95% CI, 2.24 – 2.50)
  • Multivariate analysis adjusted for maternal education, current maternal smoking, siblings, and current intake of vegetables and fruit.
  • Multivariate analysis showed that an increased risk for current asthma symptoms was dependent on exposure to acetaminophen use:
    • Medium vs no acetaminophen use (OR, 1.43; 95% CI, 1.33 – 1.53)
    • High vs no acetaminophen use (OR, 2.51; 95% CI, 2.33 – 2.70)
  • In multivariate analysis, there was also an acetaminophen exposure–dependent increased risk for current symptoms of rhinoconjunctivitis:
    • Medium vs no acetaminophen use (OR, 1.38; 95% CI, 1.29 – 1.47)
    • High vs no acetaminophen use (OR, 2.39; 95% CI, 2.24 – 2.55)
  • In multivariate analysis, there was an acetaminophen exposure–dependent increased risk for current symptoms of eczema:
    • Medium vs no acetaminophen use (OR, 1.31; 95% CI, 1.21 – 1.42)
    • High vs no acetaminophen use (OR, 1.99; 95% CI, 1.82 – 2.16)
  • Current acetaminophen use was linked with an exposure-dependent increased risk for current wheeze determined by video questionnaire, severe asthma, current rhinoconjunctivitis, and eczema.
  • After exclusion of subjects with current wheeze, an increased risk for current rhinoconjunctivitis was linked with current acetaminophen use:
    • Medium vs no acetaminophen use (OR, 1.33; 95% CI, 1.25 – 1.42)
    • High vs no acetaminophen use (OR, 2.18; 95% CI, 2.04 – 2.33)
  • After exclusion of subjects with current wheeze, an increased risk for current eczema was linked with current acetaminophen use:
    • Medium vs no acetaminophen use (OR, 1.32; 95% CI, 1.21 – 1.44)
    • High vs no acetaminophen use (OR, 1.87; 95% CI, 1.7 – 2.05)
  • Study limitations include possible confounding and possible increased use of acetaminophen in persons with asthma.

 

Clinical Implications

 

  • Recent acetaminophen use is linked with an exposure-dependent increased risk for asthma symptoms in adolescents.
  • Recent acetaminophen use is linked with an exposure-dependent increased risk for rhinoconjunctivitis and eczema symptoms in adolescents.

fonte: 

 MedscapeCME Clinical Briefs

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