Preadmission antipyretics in Reye's syndrome.

Abstract

SUMMARY The parents of 106 children who had had Reye's syndrome and those of 185 comparison children who had febrile illnesses were interviewed in order to compare preadmission medication exposure rates in the two groups. Although comparable proportions of case and comparison patients had taken antipyretics in the three weeks before admission, a significant excess of cases (59% compared with 26% in the comparisons) had been given aspirin, whereas significantly more comparison children (49% compared with 25% in the cases) had taken paracetamol. There was an excess exposure to aspirin in children under 5 years of age; the excess observed in older patients just failed to reach significance. Separate analyses within Northern Ireland and England also showed a case-comparison difference. A significant correlation was shown between aspirin (but not paracetamol) exposure and the closeness with which cases

Reye's and Reye's‐like syndromes

“…However, most authors, and particularly Reye, confirm the correlation between this syndrome and treatments with salicylates and/or other anti-pyretic drugs. [6][7][8][9] In fact, in USA after the abolition of salicylate therapy for subjects under 18 years of age the incidence decreased from a mean of 350 cases per year, during the 1974-1984 decade, to a mean of only two cases per year subsequently. Moreover in the UK, where also attention to salicylate exclusion for children was made in the last two decades, the incidence decreased from 100 during 1984 to only 3 during 2000.…”

Reye syndrome revisited: a descriptive term covering a group of heterogeneous disorders

“…However, the nature of the association between viral infection and RS was not well understood. The sporadic occurrence of RS in a community in which viral infection is widespread made some authors believe that viral infection in itself was not sucient to explain the syndrome and that additional cofactors such as a¯atoxin [70] or salicylates [31,33,42,45,46,51,52,82,86] seem to be necessary. However, this hypothesis has to be challenged.…”

“…A possible link between acetylsalicylic acid and RS has been suggested by several epidemiological studies such as the ®ve CDC case-control surveys from the United States, [31,45,46,51,52,82,86]. In contrast, the epidemiological study in Japan failed to con®rm this association [88].…”

“…The CDC studies have been criticised by several authors [9,21,24,28,34,42,65,72], among them Hall [42] who enumerates ®ve biases, the ®rst one being the selection bias:``did the cases really have RS?''. Concerning this selection bias we want to add that cases of RS were reported not only by physicians, but also by nurses, hospital personnel and by parents [45,46]. Also Mowat [65] stressed that the vast majority of cases in epidemiological studies were in the least speci®c diagnostic category.…”

“…Forsyth et al [32] mentioned that no one has reported on the validity or reliability of this technique as it is used in clinical practice. Moreover, in the epidemiological studies, electron microscopy of the liver has been performed in relatively few cases [31,45,46,51,52,82,86]. Even in the two Task Force reports [51,52], we are not told whether the speci®c mitochondrial abnormality was ever demonstrated by electron microscopy.…”