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. 2010 Sep 15:341:c4616.
doi: 10.1136/bmj.c4616.

Paracetamol use in early life and asthma: prospective birth cohort study

Adrian J Lowe  1 , John B Carlin, Catherine M Bennett, Clifford S Hosking, Katrina J Allen, Colin F Robertson, Christine Axelrad, Michael J Abramson, David J Hill, Shyamali C Dharmage
Affiliations

Paracetamol use in early life and asthma: prospective birth cohort study

Adrian J Lowe et al. BMJ. .

Abstract

Objective: To determine if use of paracetamol in early life is an independent risk factor for childhood asthma.

Design: Prospective birth cohort study.

Setting: Melbourne Atopy Cohort Study.

Participants: 620 children with a family history of allergic disease, with paracetamol use prospectively documented on 18 occasions from birth to 2 years of age, followed until age 7 years.

Main outcome measures: The primary outcome was childhood asthma, ascertained by questionnaire at 6 and 7 years. Secondary outcomes were infantile wheeze, allergic rhinitis, eczema, and skin prick test positivity.

Results: Paracetamol had been used in 51% (295/575) of children by 12 weeks of age and in 97% (556/575) by 2 years. Between 6 and 7 years, 80% (495/620) were followed up; 30% (148) had current asthma. Increasing frequency of paracetamol use was weakly associated with increased risk of childhood asthma (crude odds ratio 1.18, 95% confidence interval 1.00 to 1.39, per doubling of days of use). However, after adjustment for frequency of respiratory infections, this association essentially disappeared (odds ratio 1.08, 0.91 to 1.29). Paracetamol use for non-respiratory causes was not associated with asthma (crude odds ratio 0.95, 0.81 to 1.12).

Conclusions: In children with a family history of allergic diseases, no association was found between early paracetamol use and risk of subsequent allergic disease after adjustment for respiratory infections or when paracetamol use was restricted to non-respiratory tract infections. These findings suggest that early paracetamol use does not increase the risk of asthma.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) DJH has received support from Nestec (a subsidiary of Nestlé Australia) for the submitted work; (2) within the previous 3 years, SCD has received a grant from GlaxoSmithKline for unrelated work, MJA received funding from Reckitt Benckiser for an unrelated research project, CFR is on the GlaxoSmithKline Pediatric Asthma Scientific Board, and MJA is on the GlaxoSmithKline Scientific Advisory Committee for the Australian Asthma Study, and these companies might have an interest in the submitted work; (3) all authors their spouses, partners, or children have no other financial relationships that may be relevant to the submitted work; and (4) all authors have no non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Age at first introduction of paracetamol (with 95% confidence interval)
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Fig 2 Days of paracetamol use (by indication) between children with and without asthma in childhood. LRTS=lower respiratory tract symptoms. Box plots show median (centre line) and interquartile range (bottom to top of box) for paracetamol use within first two years of life, for each indication of use, grouped according to whether child did or did not have childhood asthma. Whiskers represent 1.5 times the interquartile range, with outliers beyond this shown as circles
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