Food allergy, dermatologic diseases, and anaphylaxis
Use of acetaminophen and the risk of self-reported allergic symptoms and skin sensitization in Butajira, Ethiopia

https://doi.org/10.1016/j.jaci.2005.05.045Get rights and content

Background

Studies in developed countries suggest that acetaminophen use is associated with increased risk of asthma, but it is unclear whether this association is causal.

Objective

To determine the relation among acetaminophen use, asthma, and allergy, and to explore potential biases in acetaminophen use, in a developing country population.

Methods

We surveyed 7649 adults and children from Butajira, Ethiopia, collecting data on self-reported symptoms of allergic disease, skin sensitization to Dermatophagoides pteronyssinus and cockroach, acetaminophen use, and potential confounders. We then collected detailed data on indications for acetaminophen use and reasons for aspirin avoidance in a nested follow-up study.

Results

Allergic symptoms increased significantly with frequency of acetaminophen use, with odds ratios in those using >3 tablets in the past month relative to none 1.89 (95% CI, 1.51-2.36) for wheeze, 2.14 (1.72-2.67) for nocturnal shortness of breath, 2.52 (1.99-3.20) for rhinitis, and 1.90 (1.39-2.61) for eczema. Cockroach sensitization was also more common in the highest acetaminophen category (odds ratio, 1.40; 95% CI, 1.10-1.79), but D pteronyssinus sensitization was not. Less than 1% of participants with asthma or wheeze in our nested study reported avoidance of aspirin because of asthma symptoms. None volunteered using acetaminophen to treat allergic symptoms.

Conclusion

There is a dose-related association between acetaminophen use and self-reported allergic symptoms in this population that is not a result of aspirin avoidance, reverse causation, or other bias. Acetaminophen may therefore be involved in the etiology of asthma and allergic disease.

Section snippets

Methods

The Butajira Rural Health Project is a dynamic cohort with an established data collection system covering more than 40,000 people living in 10 administrative areas (1 urban, 9 rural) of Meskan and Mareko district, 130 km southwest of Addis Ababa in Ethiopia. The source population, initial sampling procedure, and basic population characteristics of this cohort have been described in detail elsewhere.12

As part of an investigation into the relationship among wheeze, asthma, and parasite infection,

Results

Questionnaire and skin test data were obtained from 7649 (3485 urban and 4164 rural) individuals. The urban participants were 2679 of the original sample of 4300, and 806 substitutions for individuals who had left the area, giving a net response of 81%. The response in the rural area was 91%. The median age of participants was 20 (range, 5-95 years), and 3252 (42.5%) participants were male. A full description of the demographics of participants and comparison with source population is reported

Discussion

This study has demonstrated significant and consistent dose-related associations between acetaminophen use and reported symptoms of asthma, eczema, rhinitis, and 1 of 2 common local environmental allergens tested for skin sensitization. The study also demonstrates that these findings do not arise from use of acetaminophen to treat symptoms of allergic disease, from systematic avoidance of aspirin by individuals with allergic symptoms, or from use of acetaminophen to treat symptoms arising as

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    Another suggestion is that aspirin and non-steroidal anti-inflammatory drugs may have a beneficial effect59 in asthma and it is avoidance of these rather than exposure to acetaminophen that explains the association of the latter with asthma. This was rejected as an explanation in a rural Ethiopian study showing strong evidence of an acetaminophen link with asthma but where aspirin-avoidance was prevalent in less than 1% of the population studied and NSAIDs were generally unavailable.14 Similarly, in the original study in adults by Shaheen et al, a strong effect of acetaminophen was observed in individuals who reported taking acetaminophen and aspirin, and were therefore not avoiding the latter.12

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Supported by Asthma UK, grant number 02/058.

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