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NEWS 67 OCTOBER 2001
The world’s largest asthma study seems to discount the notion that environmental allergens could account for the huge variation in asthma rates across Europe, but does link paracetamol use with increased susceptibility to asthma. The European community respiratory health survey, a cross sectional study of atopy, asthma, and other chronic respiratory disorders, was carried out in 22 countries around the world (mostly in Europe) during the early 1990s and involved around 140,000 participants. It found a fourfold difference in the prevalence of nasal allergy between the most and least affected countries, a sixfold difference in the prevalence of current asthma, and an eightfold difference in the prevalence of wheezing. Britain, Ireland, Australia, New Zealand and the United States had the most asthma, while low rates were found in Iceland, Norway, Spain, Germany, Italy, Algeria, India, and the former Warsaw Pact countries. A strong genetic association was found in both asthma and atopy. Children whose mothers had asthma were at 3.2 times more likely to develop the disease, 2.9 times if the father had asthma, and 7 times if both parents had asthma. Having a large number of siblings seems to reduce the risk of asthma and of allergy. House dust mites and cat allergens were the most frequent allergic causes of airway constriction. However allergic sensitisation accounted for only 13% of the overall variation in bronchial responsiveness. With paracetamol use it was found that the prevalence of wheezing in 13-14 year olds increased by 0.5% for every gram of drug taken per person per year. It is not known whether this might be due to an actual effect of paracetamol, or an unexplained preventive effect of aspirin in countries where it is preferred to paracetamol. (European Respiratory Journal (2001;18:598-611); BMJ 2001;323:592, 15/9/01).