Medicines for Reye's syndrome

What it is

Reye's syndrome is a very rare but serious condition that causes swelling of the brain and problems with the liver, mainly affecting children and teenagers. It can be life-threatening and needs urgent treatment. Although the exact cause is not fully understood, a very important and well-established association is that Reye's syndrome has been linked to the use of aspirin in children and young people, particularly when given during a viral illness (such as a cold, flu, or chickenpox). Because of this link, there is a key public health message: aspirin should not be given to children and young people under 16 years of age, unless specifically advised by a doctor (for example for certain particular medical conditions where it is needed and prescribed). Since this advice was introduced, Reye's syndrome has become extremely rare, which shows how effective this simple prevention is. Reye's syndrome typically develops in a child who is recovering from a viral infection, when they suddenly become unwell with the features of the condition. The symptoms can include: persistent or continuous vomiting; unusual sleepiness, lethargy, or a lack of energy; and, as it progresses, features reflecting the effect on the brain — such as confusion, irritability or unusual behaviour, disorientation, and, in more severe cases, seizures, loss of consciousness, or coma; in babies and very young children, signs can include diarrhoea and fast breathing. Because Reye's syndrome affects the brain and liver and can progress rapidly and be life-threatening, it is a medical emergency, and these symptoms — particularly persistent vomiting and unusual sleepiness or behaviour changes in a child recovering from a viral illness — need urgent medical attention. There is no specific cure, so treatment is supportive care in hospital (often intensive care), aimed at managing the brain swelling and supporting the liver and body while the condition is treated, and prompt treatment improves the outcome. The key messages are that Reye's syndrome is a very rare but serious condition affecting the liver and brain (mainly in children), that the key preventive message is not to give aspirin to under-16s (unless specifically advised), and that its warning signs need urgent medical attention.

How it is treated

Reye's syndrome is prevented primarily by not giving aspirin to under-16s (its key link), and, for the rare cases, treated as a medical emergency with supportive care in hospital; prompt recognition and treatment are important. Prevention is the most important and effective message: because Reye's syndrome is linked to the use of aspirin in children and young people (particularly during viral illnesses), aspirin should not be given to children and young people under 16 years of age unless specifically advised and prescribed by a doctor for a particular condition; parents and carers should check that medicines given to children do not contain aspirin (also sometimes listed as acetylsalicylic acid), and use suitable alternatives (such as paracetamol or, where appropriate, ibuprofen) for fever and pain in children, as advised, and check with a pharmacist if unsure. Following this advice has made Reye's syndrome extremely rare. For the rare cases where Reye's syndrome develops, it is a medical emergency: the warning signs — particularly persistent or continuous vomiting, and unusual sleepiness, lethargy, confusion, irritability, or behaviour changes, especially in a child recovering from a viral illness — need urgent medical attention (emergency services or urgent hospital assessment). In hospital, Reye's syndrome is diagnosed based on the clinical picture and tests (such as blood tests showing effects on the liver, and other investigations), and, because there is no specific cure, treatment is supportive care, often in intensive care: this focuses on managing the swelling of the brain (which is the main danger) and the raised pressure within the skull, supporting the liver and the body’s functions, managing any seizures, and supporting the child while the condition is treated; prompt treatment improves the outcome. The outlook depends on how quickly treatment is started and the severity; with prompt treatment, children can recover, though Reye's syndrome is serious and can be life-threatening or, in some cases, leave lasting effects. Because prevention is so effective and important, the key public message is about avoiding aspirin in under-16s. The reassuring and important messages are that Reye's syndrome is now extremely rare because of the simple and effective prevention of not giving aspirin to under-16s (unless specifically advised), that its warning signs need urgent medical attention, and that, for the rare cases, prompt supportive hospital care improves the outcome; so avoiding aspirin in children, and urgent assessment of the warning signs, are the keys.