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While snowed in... 02/11/2010
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??? |