The adaptive immune response, marked by antibody production, is clearly coregulated by activity of the innate immune response. In fact, the importance of the innate immune response and its relationship to the adaptive immune response was identified as the rationale for awarding all three Nobel prizes in medicine in 2011.
The results of recent prior work suggesting that prophylactic acetaminophen should not be used as a routine has a sound evidence-based rationale within the known functioning of the innate immune system. "Proinflammatory" processes are part of the innate immune response, and so, to suppress those responses unnecessarily as with prophylactic acetaminophen might not be the best strategy.
Use of therapeutic acetaminophen should be fine and I employ that strategy. Regarding the issue of sleep, I am not aware of the evidence base to support the observation. The observation may be valid but what would be the mechanism? Are the differences clinically relevant?
Also, it is hard enough to get all of our physicals scheduled and meet the complex schedules of parents. An attempt to limit visits where vaccines might be administered to only the afternoon would be impractical and might lead to an employee revolt by our schedulers.
Dr. Michael E. Pichichero, a specialist in pediatric infectious diseases, is director of the Rochester (N.Y.) General Research Institute. He said he had no relevant financial disclosures.
