CMAJ • October 27, 2009; 181 (9). doi:10.1503/cmaj.109-2026.
© 2009 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Acetaminophen and asthma

Akashdeep Singh

senior pulmonologist, SPS Apollo Hospital, Ludhiana, India

I must congratulate Padmaja Subbarao and colleagues for their elegant review, Asthma: epidemiology, etiology and risk factors 1. But they missed covering acetaminophen as an etiological cause of asthma in both adults and children. Several studies have shown a relationship between acetaminophen consumption and presence of asthma. For example, Cohet and colleagues 2 studied the association between infections in children aged 0 to 4 years and medications used (antibiotics and acetaminophen) and the subsequent presentation of asthma at age 6 to 7; the authors observed that the use of acetaminophen in the first year of life was weakly associated with wheezing, asthma, rhinitis, and eczema. In their prospective study, Barr and colleagues 3 found that acetaminophen use was associated with the presence of newly diagnosed asthma among women. Several mechanisms have been postulated that may explain the possible risk of asthma with acetaminophen use. The main mechanism involves glutathione, which is a potent antioxidant found in lung tissue. Acetaminophen has shown to lower serum glutathione levels in healthy volunteers. 4 A second possible mechanism is thought to be acetaminophen’s lack of inhibition of the enzyme cyclooxygeanse, the key enzyme involved in the production of prostaglandins playing a major role in the inflammatory cascade in asthma. 5 Finally, an emerging hypothesis involves the possible antigenic effect of acetaminophen and subsequent rise in IgE and histamine levels with exposure to acetaminophen. 6

Footnotes

For the full letter, go to: www.cmaj.ca/cgi/eletters/cmaj.080612v1#201684


REFERENCES

  1. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ 2009. DOI:10.1503/cmaj.080612
  2. Cohet C, Cheng S, MacDonald C, et al. Infections, medication use, and the prevalence of symptoms of asthma, rhinitis, and eczema in childhood. J Epidemiol Community Health 2004;58:852–7.[Abstract/Free Full Text]
  3. Barr RG, Wentowski CC, Curhan GC, Somers SC, et al. Prospective study of acetaminophen use and newly diagnosed asthma among women. Am J Respir Crit Care Med 2004;169:836–41.[Abstract/Free Full Text]
  4. Nuttall SL, Khan JN, Thorpe GH, et al. The impact of therapeutic doses of acetaminophen on serum total antioxidant capacity. J Clin Pharm Ther 2003;28,289–94.
  5. Varner AE, Busse WW, Lemanske RF Jr. Hypothesis: decreased use of pediatric aspirin has contributed to the increasing prevalence of childhood asthma. Ann Allergy Asthma Immunol 1998;81: 347–51.[Medline]
  6. De Paramo BJ, Gancedo SQ, Cuevas M, et al. Acetaminophen (acetaminophen) hypersensitivity. Ann Allergy Asthma Immunol 2000;85:508.[Medline]




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