PEDIATRICS Vol. 107 No. 1 January 2001, pp. 214

Aspirin and Reye's Syndrome

To the Editor.

The study reported by Ploin et al¹ was well-designed, well-executed, and clearly demonstrated the equivalent effect of albuterol given with a spacer device and with a nebulizer. A small detail caught my eye, and may have bothered other North American pediatricians practicing since at least the 1970s, namely the administration of aspirin to febrile children with viral infections. The literature on Reye's syndrome, recently summarized in editorials by Monto² and by Sarnaik,³ is virtually unanimous that aspirin is a major risk factor for developing Reye's syndrome, especially in the presence of a viral illness.

Ifand it is a major "if"fevers of 38.0°C need treatment and do not respond to acetaminophen, ibuprofen is a safer choice.

Howard Fischer
Wayne State University School of Medicine
Department of Pediatrics
Detroit, MI 48201

REFERENCES

1. Ploin D, Chapuis FR, Stamm D, et al. High-dose albuterol by metered-dose inhaler plus a spacer device versus nebulization in preschool children with recurrent wheezing: a double-blind, randomized equivalence trial. Pediatrics. 2000:106:311-317
2. Monto AS The disappearance of Reye's syndromea public health triumph. N Engl J Med. 1999; 340:1423-1424 [Free Full Text]
3. Sarnaik AP Reye's syndrome: Hold the obituary. Crit Care Med. 1999; 27:1674-1676 [Medline]

In Reply.

Reye's syndrome has been related to aspirin intake in children, but the definitive causal relationship is still lacking. As Orlowski¹ demonstrated in 1999, most cases of what would have been called Reye's syndrome in the 1970s and 1980s were actually cases of inborn error of metabolism.

Aspirin remained the first intention antipyretic drug in France until the 1980s (71%), but since then, many French clinicians began to follow the conclusions of American epidemiologic studies. Between 1981 and 1992, the use of aspirin decreased dramatically (51%) in children with chickenpox or influenza-like syndrome.² A French national survey (November 1995-October 1996) showed that among 11 289 133 children <15 years old, incidence was 15 cases (metabolic disorder in 5 children, unexplained Reye's syndrome in 9 children, no investigations in 1 child).³ The Agence Française du Médicament (French Medication Agency) recommended then that aspirin should not be used in chickenpox and influenza-like syndrome but recommendations didn't concern bacterial infections such as otitis media.

In our clinical trial, febrile children were systematically treated with 1 or 2 antipyretic drugs to minimize the interference between fever and respiratory assessment. In our daily practice, we totally agree with Dr Fischer to consider that, even in France, acetaminophen is the best choice to treat fever (when needed) in children. Ibuprofen should also be recommended now as the second intention drug to treat viral respiratory tract infections (when needed) in children.

Dominique Ploin
Daniel Floret
Service d'Urgence et de Réanimation Pédiatrique
Hôpital Edouard Herriot Place d'Arsonval
F-69437 Lyon Cedex 03, France

REFERENCES

1. Orlowski JP Whatever happened to Reye's syndrome? Did it ever really exist? Crit Care Med. 1999; 27:1582-1587 [CrossRef][Medline]
2. Maison P, Guillemot D, Vauzelle-Kervroedan F, Trends in aspirin, paracetamol and non-steroidal anti-inflammatory drug use in children between 1981 and 1992 in France. Eur J Clin Pharmacol. 1998; 54:659-664 [CrossRef][Medline]
3. Autret-Leca F, Jonville-Bera AP, Llau ME, Bavoux F, Saudubray JM, Laugier J, Devictor D, Barbier P, and all French Departments of Pediatrics. Reye's Syndrome in France: A National Registry; 6th Congress of the European Society for Developmental Pharmacology; June 4-5, 1998; Ajaccio, France