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We were interested to read the article by Shaheenet al on the relationship between paracetamol and asthma.1 We have been interested in patients with analgesic induced asthma (AIA) since 1991 and now have a total of about 238 patients who have been followed up in our allergy unit. We have previously reported some related allergic conditions and risk factors for AIA, one of which was cumulative life long analgesic consumption.2-4 After reading the paper by Shaheenet al we re-analysed our data and compared the consumption of analgesics by patients with analgesic tolerant asthma (group 1, n=103) and those with AIA (group 2, n=191 (132 published2 + 59 new cases)). The mean ages of the patients were 43.1 (14.0) years and 40.9 (12.3) years and there were 89 (86.4%) and 140 (73.3%) women in groups 1 and 2, respectively. The life long analgesic consumption was evaluated by a question included in the standard questionnaire about the number of boxes of analgesics used before analgesic intolerance was diagnosed (each box contains 20 pills).
There was no significant difference between the two groups in the total consumption of analgesics (9.1 (12.5) v 12.1 (15.1)), aspirin (5.1 (10.3) v 4.4 (8.1)), metamizole (4.9 (7.5) v 3.3 (4.8)), and paracetamol (3.5 (4.1) v 5.1 (9.8)). The independent samples t test was used to compare the severity of asthma and the amount of analgesic consumption and the total analgesic and paracetamol consumption was found to be significantly higher in AIA patients with mild, moderate and severe asthma than in those with mild analgesic tolerant asthma (table 1). However, the correlation between the severity of asthma and the consumption of analgesics (overall, aspirin, metamizole, paracetamol) was not significant in either group when Spearman's non-parametric correlation test was applied to the data.
It is already known that the clinical course of patients with AIA is more severe than for those with analgesic tolerant asthma, and the overall consumption of analgesics and paracetamol by AIA patients has been found to be higher.2 It should also be added that the increased consumption of paracetamol in these patients results from physicians' analgesic preference and our re-analysis showed a weak relation. Certainly the clinical and epidemiological surveys should be evaluated separately, but our results seem to support the results of Shaheen et al.1 Since these retrospective surveys might include “recall bias”, prospective studies of asthma patients could help to elucidate the difference between the analgesic consumption of patients with AIA and those without analgesic intolerance.