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In this months AAP News (the official newletter of the American Academy of Pediatrics) a recent article in The Lancet- "More study needed on antipyretics' effect on vaccine resonses" was reviewed.  This article has caused confusion cioncerning the common practice ofrecommending prophylactic antipyretics sucha s acetaminophen (Tylenol) to children prior to or within 24 hours of receiving their immunizations to prevent fever and discomfort (Prymla R, etal. Lancet, 2009;374:1339-1350)

When I was practicing general pediatrics, I recommended this preventative practice to all my patients.  My son, in fact, was one of those kids who always ran high fevers (103-104 F) after routine immunizations.  Apparently the study in two randomized controlled trials concluded that antibody response was diminished in response to some of the the vaccines that were administered if acetaminophen (or paracetamol in England and Europe) was given prophylactically to reduce fever and discomfort from the vaccines. It was also concluded that despite having statistically significant differences in the antibody response, the children had what would be considered protective levels of antibodies to all of the antigens given during the primary and booster series doses.

My question is, knowing that acetaminophen inhibits the production of glutathione, the major detoxification agent on which our immune systems rely, is it possible that this reduction in immune response to the vaccines may also extend to a reduction in the immune response to other immune system stressors; eg: toxins, foods, inhalant pollens, medications etc. Unlike the authors of the study who felt that "for the individula child it is unlikely that prplylactic antipyretics would have any detrimental effect," I wonder if that is true for all children taking antipyretics like Tylenol for any reason.  The authors do raise the concern that universal use of prophylactic antipyretics might have some implications for the community if the decreased level of antibody resonse has an effect o9n the frequency of development of the carrier state or transition.  

I wonder???
 
 
In the forefront of medical coding news, the diagnosis of Asperger's syndrome is about to be dropped from the DSM IV listings and rolled up into the categoryof 'autism spectrum disorder."   Well, Asperger's is an autism spectrum disorder!  The feeling is the diagnosis is misleading and invalid.  Maybe all of these diagnoses, which essentially describe what the patient is like but not WHY they are that way, should be dropped.  What is PDD-NOS anyway??  Most of these terms are merely descriptions of behaviors without getting to the root of the problem.  This is where investigation into mitochondrial function, central nervous system and immune system functions need to be investigated.  

As the author says about her daughter, diagnosed at age 3 years, "we no longer need the diagnosis of Asperger's disorder to reduce stigma And my daughter does not need the term Asperger's to bolster her self-esteem. Just last week, she introduced herself to a new teacher in her high school health class. "My name is Isabel," she said, "and my strength is that I have autism."
 
 
As a pediatrician reading this study back in 1998 I was shocked that someone had found evidence of measles virus living in the intestinal cells of children on the autistic spectrum.  As a neophyte in the field of autism then, the article made me think a little about the vaccines that were preventing 3 of the so called "usual childhood diseases" that we all contracted.  So routine were these viruses that when I contracted one, my brother and all my friends were moved into my room so that they could catch it and be done with the process for life.

The purpose of vaccinating against these viruses was to prevent the 1 in 100,000 chances of measles encephalitis, mumps orchitis leading to sterility in male children and rubella or german measles which could be devastating to a pregnant mom and her fetus.  While these viruses were known to have these consequences, there were no studies to corroborate their safetey or the remote possibility of adverse sequellae we are trying to address.  In fact, the original measles virus vaccine dating back to the 1950's was insufficient to provide life long immunity thus leading the American Academy of Pediatrics to recommend and ultimately require a second vaccination before college entry and prior to entering kindergarten.

There was never any question as from whom Dr. Wakefield received his funding. Is funding from anti-vaccine lawyers and parents any different than funding from pharmaceutical companies who promote many drugs without adequate testing on children? Is it any different than drug companies pushing swine flu vaccine with many known potentially toxic adjuvants on pregnant mothers and 6 month olds without adequate testing?

In truth, I am not anti vaccine.  What I am against is the notion that we should believe everything we hear that is perpetrated by drug companies and the congress who is lobbied  by drug companies. In fact, thanks to Dr Wakefield's work and the work of others in the autism community, we have learned about the high incidence of  inflammatory bowel/irritable bowel syndromes affecting the large percentage of patients on the autism spectrum.  Regardless of the coincidental findings of bowel disease, measles viruses inhabiting the bowel, lymphonodular hyperplasia in the ileum or the fact that most of our patients dont even know what a normal bowel movement is, it is important to stay on task to determine which of our patients is susceptible to these issues and what the genetic and environmental triggers are at play in determining bowel problems.

Yes, Lancet retracted the study as being biased. However, there are many studies that seem to be biased in favor of continuing the path we are on; the one where autism is increasing exponentially and pediatricians like me are scratching our heads trying to solve this mystery.