Given that swelling is the body’s natural action to help …

  • Culture often surpasses science even when it’s to the hinderance of health. Unnecessary and even damaging suppression of particular kinds of inflammation falls in such a classification. The cultural aspect here maybe started with fever fear(1 ). Fever is after all one of the most commonly acknowledged signs of generalized, extensive swelling in the body. Thus this answer focuses on how as an example of swelling it’s become common practice to lower fever despite the fact that doing so may often be counter-productive in more than one way.

    Fever phobia is overstated fear of its potentially severe, irreversible effects, such as febrile seizures, mental retardation, coma, convulsions, dehydration and even death, especially in children (2 ). Created in 1980 (3 ), even today careful meta-analyses of research studies probing the public’s, and in specific parents’, attitude to fever find that this overstated worry of fever has actually barely eased off (2 ), implying it’s stably entrenched as a cultural attribute.

    So what was the source or impetus for fever phobia in current times? Rather plausibly, reports of higher risks of death from pediatric febrile seizures helped inscribe a cultural worry of fever As far back as 1950 a research study reported a 11%mortality danger for kids with febrile seizures (4 ). Considering that the majority of moms and dads have restricted knowledge of fever specifically its numerous benefits ( 5, 6), fear of febrile seizures rapidly permeated and became embedded culturally. This even when studies discover as much as a 3rd of children brought to clinics aren’t genuinely febrile (1, 7, 8, 9). Some examples of fever phobia:

    • 85%of surveyed US moms and dads reported they ‘d wake a kid to administer antipyretics (10) despite the fact that pediatricians advise versus it (11).
    • 33 to 65%of surveyed UAE and Israeli moms and dads reported providing acetaminophen for temperature levels < 1 million kids!) born between 1977 and 2004 discovered 132 of 100000 kids died within 2 years of a febrile seizure compared to 67 amongst those who didn't (16), i.e., ~ 2X increased threat However, more careful analysis showed short-term mortality risk amongst children with basic febrile seizure, i.e., no reoccurrence, resembled those without. The short-term death danger was just increased amongst those with recurrent febrile seizures, which ‘ was partially discussed by pre-existing neurological problems and subsequent epilepsy‘ (16). More significantly, long-lasting mortality rates were comparable amongst children who either skilled febrile seizures or didn’t Current studies recommend a strong influence of genetic danger elements for frequent, familial febrile seizures (17, 18). Since such recurrent febrile seizures are much more rare, particular hereditary risk factors therefore indicate large bulk of fevers, specifically in children, have low threat for them and for their recurrence.

      A minimum of 4 issues ensue from prevalent exaggerated perception of the threat of fever and the knee-jerk response to right away reduce it.

      • One, studies recommend antipyretics do not prevent febrile seizures(19, 20, 21, 22).
      • 2, antipyretics themselves can have extreme, though uncommon, side-effects such as liver or kidney failure, GI tract ulcers (1) and even Stevens-Johnson syndrome (23) or asthma (24, 25).
      • 3, often parents inadvertently compound such dangers by giving inaccurate dosages of antipyretics(12). For e.g., a research study discovered as many as 50%of United States parents did so (26).
      • Four, antipyretics such as paracetamol may hold-up healing from infections or restrain generation of reliable immune responses to vaccines
        • Antipyretics delay malaria parasite clearance for instance (27).
        • Widespread antipyretic usage may even help spread contagious illness such as flu (28), maybe due to the fact that patients stay sick and keep greater infectious viral titers longer.
        • In recent years, it’s become more commonplace for pediatricians (29, 30, 31, 32) and even the United States Advisory Committee on Immunization Practices(ACIP) (33) to recommend prophylactic antipyretic Rx prior to vaccinations to reduce the febrile response despite the fact that this is counter-productive For e.g., individuals pre-treated with antipyretics have reduced immune actions to vaccines This is seen not just in kids (to DTaP HBV IPV/Hib *) (34) however also in grownups (to HBV) (35).

      DTaP = Diphtheria-Tetanus-acellular Pertussis vaccine; HBV = Liver disease B vaccine; IPV = Inactivated Polio vaccine; Hib = Haemophilus influenzae vaccine.

      Bottomline, such a state of affairs recommends researchers interact poorly with medical physicians and both interact poorly with the public. As a result, both doctors and the general public are less well aware of the more recently found myriad benefits of inflammation and fever This has actually enabled older cultural beliefs to remain entrenched and hence exceed science in the ideal management of inflammation in basic and of fever in specific.


      1. Wallenstein, Matthew B., et al. “Fever literacy and fever phobia.” Scientific pediatrics 52.3 (2013): 254-259

      2. Purssell, Edward, and Jacqueline Collin. “Fever phobia: The impact of time and mortality– A methodical review and meta-analysis.” International journal of nursing research studies (2015).

      3. Schmitt, Barton D. “Fever phobia: mistaken beliefs of parents about fevers.” Archives of Pediatrics & & Teenager Medicine 134.2 (1980): 176.

      4. Ekholm, Erik, and Kalevi Niemineva. “On Convulsions in Early Childhood and Their Prognosis An examination with follow‐up assessments of patients treated for convulsions at the Kid’s Center of Helsinki University.” Acta paediatrica 39.1 (1950): 481-501

      5. Evans, Sharon S., Elizabeth A. Repasky, and Daniel T. Fisher. “Fever and the thermal guideline of resistance: the immune system feels the heat.” Nature Reviews Immunology 15.6 (2015): 335-349 n6/pdf/nri3843 pdf

      6. Harden, L. M., et al. “Fever and sickness behavior: Buddy or enemy?.” Brain, behavior, and immunity 50 (2015): 322-333 _ Fever_and_sickness_behavior_Friend_or_foe/ links/55 b5003 f08 ae9289 a08 a65 d9.pdf

      7. Casey, Rosemary, et al. “Fever Therapy: An Educational Intervention for Parents.” Pediatrics 73.5 (1984): 600-603 Identifying%20 fever%20 and%20 choice%20 of%20 antipyretics/CASEY%20 R.1984 PDF

      8. Wammanda, R. D., and S. O. Onazi. “Capability of mothers to assess the presence of fever in their children: Implication for the treatment of fever under the IMCI guidelines.” Records of African medicine 8.3 (2009).

      9. Graneto, JOHN W., and DAVID F. Soglin. “Maternal screening of youth fever by palpation.” Pediatric emergency care 12.3 (1996): 183-184

      10. Crocetti, Michael, Nooshi Moghbeli, and Janet Serwint. “Fever phobia reviewed: have adult misunderstandings about fever changed in 20 years?.” Pediatrics 107.6 (2001): 1241-1246

      11. May, Ariane, and Howard Bauchner. “Fever fear: the pediatrician’s contribution.” Pediatrics 90.6 (1992): 851-854

      12. Betz, Martin G., and Anton F. Grunfeld. “‘ Fever phobia’ in the emergency situation department: a survey of kids’s caregivers.” European Journal of Emergency Medication 13.3 (2006): 129-133

      13. Bilenko, Natalya, et al. “Factors of antipyretic misuse in children approximately 5 years of age: a cross-sectional research study.” Medical rehabs 28.5 (2006): 783-793

      14. Enarson, Mark C., et al. “Beliefs and Expectations of Canadian Moms And Dads Who Bring Febrile Children for Treatment.” Pediatrics (2012): peds-2011 peds.2011-2140 full.pdf

      15. El-Radhi, A. S. “Fever management: Evidence vs existing practice.” World J Clin Pediatr 1 (2012): 29-33 ejournals/WJCPv1i4. pdf #page =-LRB-

      16. Vestergaard, Mogens, et al. “Death in kids with febrile seizures: a population-based cohort study.” The Lancet 372.9637(2008): 457-463 _ Death_in_children_with_febrile_seizures_a_population-based_cohort_study/ links/0fcfd50 a5f0dd8f6ce000000 pdf

      17. Saghazadeh, Amene, Mario Mastrangelo, and Nima Rezaei. “Genetic background of febrile seizures.” Evaluations in the Neurosciences 25.1 (2014): 129-161 Hereditary background of febrile seizures

      18. Boillot, Morgane, et al. “Novel GABRG2 mutations cause familial febrile seizures.” Neurology Genetics 1.4 (2015): e35 pdf/NG2015000638 pdf

      19. Schnaiderman, D., et al. “Antipyretic effectiveness of acetaminophen in febrile seizures: continuous prophylaxis versus erratic use.” European journal of pediatrics 152.9 (1993): 747-749

      20. van Stuijvenberg, Margriet, et al. “Randomized, controlled trial of ibuprofen syrup administered during febrile health problems to prevent febrile seizure recurrences.” Pediatrics 102.5 (1998): e51- e51 pdf

      21. Esch, Adrianus van, et al. “A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence.” Ambulatory Child Health 6.1 (2000): 19-25

      22. El-Radhi, A., and W. Barry. “Do antipyretics avoid febrile convulsions?.” Archives of illness in youth 88.7 (2003):641 7/641 full.pdf

      23. Maggio, Maria Cristina, et al. “Stevens– Johnson syndrome and cholestatic hepatitis induced by intense Epstein– Barr virus infection.” European journal of gastroenterology & & hepatology 23.3 (2011): 289.

      24. El-Radhi, A. Sahib M. “Why is the evidence not affecting the practice of fever management?.” Archives of illness in youth 93.11(2008): 918-920

      25. McBride, John T. “The association of acetaminophen and asthma occurrence and severity.” Pediatrics 128.6 (2011): 1181-1185 6/1181 full.pdf

      26. LI, SIU FAI, BRITT LACHER, and ELLEN F. CRAIN. “Acetaminophen and ibuprofen dosing by moms and dads.” Pediatric emergency situation care 16.6 (2000): 394-397

      27. Brandts, Christian H., et al. “Result of paracetamol on parasite clearance time in Plasmodium falciparum malaria.” The Lancet 350.9079(1997): 704-709

      28. Earn, David JD, Paul W. Andrews, and Benjamin M. Bolker. “Population-level impacts of reducing fever.” Proceedings of the Royal Society of London B: Biological Sciences 281.1778(2014):20132570 full.pdf

      29. Kohl, Katrin S., et al. “Fever after immunization: current principles and better future clinical understanding.” Clinical contagious illness 39.3 (2004): 389-394 Current Concepts and Improved Future Scientific Understanding

      30. Marcy, S. Michael, et al. “Fever as an unfavorable occasion following immunization: case meaning and guidelines of information collection, analysis, and presentation.” Vaccine 22.5 (2004): 551-556 _1567 pdf

      31. Lewis, Karen, et al. “The impact of prophylactic acetaminophen administration on reactions to DTP vaccination.” American Journal of Diseases of Kid 142.1 (1988): 62-65

      32. Moshe, M., et al. “Acetaminophen prophylaxis of unfavorable responses following vaccination of infants with diphtheria-pertussis-tetanus toxoids-polio vaccine.” The Pediatric contagious illness journal 6.8 (1987): 721-724

      33. Centers for Disease Control and Avoidance. Pertussis vaccination: usage of acellular pertussis vaccines among infants and kids suggestions of the Advisory Committee on Immunization Practices (ACIP). Pertussis Vaccination: Use of Acellular Pertussis Vaccines Amongst Babies and Kids Recommendations of the Advisory Committee on Immunization Practices (ACIP)

      34. Prymula, Roman, et al. “Effect of prophylactic paracetamol administration sometimes of vaccination on febrile reactions and antibody reactions in children: two open-label, randomised regulated trials.” The Lancet 374.9698(2009): 1339-1350 jc.pdf

      35. Doedée, Anne MCM, et al. “Effects of prophylactic and healing paracetamol treatment during vaccination on liver disease B antibody levels in grownups: two open-label, randomized regulated trials.” PloS one 9.6 (2014): e98175 pone.0098175 PDF

      Thanks for the R2A, Adriana Heguy.

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