Do painkillers put children at risk for asthma?

For most of the 20th century, pediatricians and parents preferred aspirin for lowering fevers and easing pain in children. But in 1980, a report linked aspirin to Reye’s syndrome, a rare but potentially fatal childhood disease.

Although aspirin manufacturers resisted adding a warning, the evidence became strong enough that the Food and Drug Administration required a change to the label in 1986.

Acetaminophen became the drug of choice to lower a child’s fever.

Ever since then, the rate of childhood asthma has been rising. In 2008, a study published in The Lancet revealed an association between administration of acetaminophen during infancy and development of asthma by age 6 or 7. Those who were given the pain reliever as often as once a month had triple the background risk of developing allergy-related wheezing. (This analysis also found a link to nasal allergies and eczema.) Now an article in the journal Pediatrics (Dec. 1) takes a stronger position. Dr. John McBride is a pediatric pulmonologist who declares, “Considering currently available data, I now recommend that any child with asthma or a family history of asthma avoid using acetaminophen.”

Such a precaution also might apply to pregnant women. Researchers in New Zealand, where acetaminophen is called paracetamol, analyzed data from six studies (Clinical and Experimental Allergy, April). The investigators concluded: “The use of paracetamol during pregnancy is associated with an increased risk of childhood asthma.”

Some pediatricians and allergists feel that there is not yet enough data to justify a prohibition. McBride disagrees. He told The New York Times: “If studies prove that acetaminophen makes asthma worse, I can’t imagine telling my patients that I knew about this five years ago, but I wasn’t sure so I didn’t mention it.”