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Aspirin and Reye's Syndrome

Аuthor: Аldanova Aziza

Editor: Аibulova Diana






      Aspirin or acetylsalicylic acid (ASA) is one of the most common drugs in the world. Aspirin, like all non-steroidal anti-inflammatory drugs, has antipyretic, anti-inflammatory, and analgesic effects in infectious diseases. Moreover, long-term use of aspirin in recommended doses can reduce the risk of cardiovascular disease, and it is also used in the treatment of cancer. However, what do we know about aspirin contraindications specifically for children? The first outgoing warning on the aspirin label is "Reye's syndrome," which informs us that children or adolescents with infectious inflammatory diseases like flu, measles and chickenpox should not use the product. For what reason? You can read more about that in this article.


        Reye syndrome is an acute condition in children and adolescents resulting from the treatment of fevers of viral origin (measles, influenza, chickenpox, diphtheria, etc.) with ASA-containing drugs and characterized by acute liver failure and brain edema (encephalopathy). The syndrome was first described by the Austrian pathologist Ralph Douglas Kenneth Reye and his co-authors in 1963. According to the U.S. National Monitoring in 1979-1980, there was a peak incidence of the disease where 555 cases were reported. After cautions were put in place for the ASA drug for children, the number of cases mostly declined. And as early as 1980-1997, there were 1,207 cases. 


        Reye's syndrome is a disease manifested by acute encephalopathy combined with fatty dystrophy of internal organs, mainly the liver. Two types of Reye syndrome are classified: classical and atypical. Unfortunately, the pathogenesis of the syndrome is not fully understood, which makes it difficult to imagine the effect of ASA. However, the disease occurs due to generalized damage of mitochondria in the brain, liver, kidneys, muscles, myocardium and pancreas with impaired oxidation of fatty acids, which further leads to fatty dystrophy. And breakdown products of ASA drugs inhibit these processes and increase clinical manifestations of Reye's syndrome. The syndrome occurs in children 5-14 years old, and rarely occurs in infants and children over 18 years old.


        In children over 5 years of age, the syndrome is associated with the prodrome of viral disease and the administration of ASA drugs. Clinical signs of Reye's syndrome appear after the onset of viral infection and during a latent (incubation) period of 12 days to 3 weeks. And in chickenpox, on the 4th-5th day of the rash. The child suddenly develops nausea and vomiting; if there is no vomiting, it could be any illness not indicative of Reye's syndrome. Then, quickly or within 24 hours of the vomiting attack, changes in the child's behavior are noticed: neurological disorders like drowsiness, irritability, apathy, psychomotor agitation. The child's consciousness changes from a mild form of lethargy to a deep coma. Coma state can vary from 24 to 96 hours, it is possible that the child lies in a coma for up to several weeks.


      In addition to classical Reye syndrome, atypical Reye syndrome or Reye's syndrome, a similar disorder occurring in children under 5 years of age, has been isolated. Clinical manifestations are similar to the usual syndrome, but in children with Reye - similar syndrome was found that with congenital disorders of fatty acid oxidation and impaired enzymes in the urea ornithine cycle, this cycle converts nitrogen-containing products into urea. It also occurs without the use of ASCs. According to some studies, other drugs such as tetracycline, paracetamol, amiodarone, warfarin, histamine blockers, and valproic acid can also cause the syndrome to develop. Insecticides, herbicides, and hepatotoxic fungi may also manifest as triggers of the syndrome.


      There are situations where children need ASA therapy, for example, in Kawasaki disease. But this intervention takes place under the strict supervision of the attending physician and with minimal doses of aspirin, or drugs from another group are used.


      The spectrum of triggers of Reye syndrome is expanding: now not only influenza, measles and chickenpox can awaken the disease, but also a number of other infectious diseases. Of course, many drugs are contraindicated for use in children, this limitation is due to the fact that drugs are not tested on children. However, ibuprofen and paracetamol are antipyretic and safe drugs for children when the therapeutic dosages are observed. Preserving a child's health is an important modern concept, always read the instructions for any medication before using it and, most importantly, use them as prescribed by your doctor.