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Abstract

To the Editor:We thank Dr Shulman for his response to our letter. We concluded from the study by Melish et al that 2 g/kg intravenous gamma globulin plus either high-dose (80 to 100 mg/kg/d) or very low-dose (3 to 5 mg/kg/d) acetylsalicylic acid (ASA) in the treatment of acute Kawasaki disease showed no difference in coronary artery disease between the high-dose and low-dose groups. There was a significantly shorter duration of fever and other indicators of inflammation in the high-dose aspirin recipients.Tinnitus and abdominal pain, which herald salicylate-induced ototoxicity and gastroduodenal injury, are difficult to appreciate in very young children. In a cohort study of 17 children with juvenile rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs including ASA and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers.1Mulberg AE Linz C Bern E Tucker L Verhava M et al.Identification of non-steroidal anti-inflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis.J Pediatr. 1993; 122: 647-649Abstract Full Text PDF PubMed Scopus (66) Google ScholarWe remain concerned as to whether the benefits of high-dose ASA in Kawasaki disease (eg, shorter duration of fever, faster normalization of acute reactants) outweigh the risks of high-dose ASA use. Other means of fever control may be the safer alternative, because the rationale of ASA use is primarily to reduce the cardiac sequelae that are life-threatening. To the Editor:We thank Dr Shulman for his response to our letter. We concluded from the study by Melish et al that 2 g/kg intravenous gamma globulin plus either high-dose (80 to 100 mg/kg/d) or very low-dose (3 to 5 mg/kg/d) acetylsalicylic acid (ASA) in the treatment of acute Kawasaki disease showed no difference in coronary artery disease between the high-dose and low-dose groups. There was a significantly shorter duration of fever and other indicators of inflammation in the high-dose aspirin recipients.Tinnitus and abdominal pain, which herald salicylate-induced ototoxicity and gastroduodenal injury, are difficult to appreciate in very young children. In a cohort study of 17 children with juvenile rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs including ASA and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers.1Mulberg AE Linz C Bern E Tucker L Verhava M et al.Identification of non-steroidal anti-inflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis.J Pediatr. 1993; 122: 647-649Abstract Full Text PDF PubMed Scopus (66) Google ScholarWe remain concerned as to whether the benefits of high-dose ASA in Kawasaki disease (eg, shorter duration of fever, faster normalization of acute reactants) outweigh the risks of high-dose ASA use. Other means of fever control may be the safer alternative, because the rationale of ASA use is primarily to reduce the cardiac sequelae that are life-threatening. We thank Dr Shulman for his response to our letter. We concluded from the study by Melish et al that 2 g/kg intravenous gamma globulin plus either high-dose (80 to 100 mg/kg/d) or very low-dose (3 to 5 mg/kg/d) acetylsalicylic acid (ASA) in the treatment of acute Kawasaki disease showed no difference in coronary artery disease between the high-dose and low-dose groups. There was a significantly shorter duration of fever and other indicators of inflammation in the high-dose aspirin recipients. Tinnitus and abdominal pain, which herald salicylate-induced ototoxicity and gastroduodenal injury, are difficult to appreciate in very young children. In a cohort study of 17 children with juvenile rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs including ASA and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers.1Mulberg AE Linz C Bern E Tucker L Verhava M et al.Identification of non-steroidal anti-inflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis.J Pediatr. 1993; 122: 647-649Abstract Full Text PDF PubMed Scopus (66) Google Scholar We remain concerned as to whether the benefits of high-dose ASA in Kawasaki disease (eg, shorter duration of fever, faster normalization of acute reactants) outweigh the risks of high-dose ASA use. Other means of fever control may be the safer alternative, because the rationale of ASA use is primarily to reduce the cardiac sequelae that are life-threatening.