f:id:MotoNesu:20101005051724g:image

 パラセタモール(アセトアミノフェン)は、小児の鎮痛剤で汎用されていますが、小児期での使用は喘息、湿疹やアレルギー性鼻炎の原因になるといくつかの報告がされています。

 72カ国が参加したInternational Study of Asthma and Allergy in Childhood (ISAAC)のフェーズ3試験では、1歳のころにパラセタモールを投与すると、6から7歳で喘息を発症するリスクが1.46倍と報告されています。しかし、この研究は、幼少期に呼吸器感染に罹患している交絡因子と、研究デザインそのものの想起バイアスが指摘されています。

 そこで、今回はCohort Studyで、2歳までにパラセタモールを投与した患者を7歳までフォローして追跡し、喘息発作の有無を調査したところ、呼吸器感染を除外して補正をすると喘息の罹患リスクのオッズ比は、0.96倍(crude odds ratio 0.95, 0.81 to 1.12)で、関連性は否定されたという報告です。

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

BMJ 2010; 341:c4616

http://www.bmj.com/content/341/bmj.c4616.full

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.

気づき)

 ・アセトアミノフェンの喘息リスク除外で、1つの安心材料になるか?

 ・”crude odds ratio”とは?、調べておく

 ・小児科からもコメントをもらっておく

これから)

 卒後臨床評価機構の受審日

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