Introduction - Uppsala Monitoring Centre

ullous eruption < 1 % and purpura.
B) Opthalmological events (Type B events): ptosis, strabismus and amaurosis may
only be relevant to salicylic acid as I have found no confirmation of a causal
association with Aspirin. There have been two reports of myopia and raised
intraocular pressure, but these are only likely to have been tested if there were
ocular symptoms, which had been referred to an ophthalmologist. Similarly
papilloedema. They might be more frequent than this figure suggests.
C) Aspirin idiosyncrasy (Type B events): These are substantiated by many papers,
but the mechanism is not certain. It is likely that hypotension is secondary to
anaphylactoid shock (or poisoning) and that hypersensitivity is part of the same
syndrome, which is not an allergy since no antigen–antibody reactions have
been identified (Freie, 2000).
D) Haematological events (Type B events): There is some evidence supporting
thrombocytopenia, agranulocytosis and aplastic anaemia. The relative risks were
1.9 and 2.9 respectively and, according to Dr Shapiro, the results were equivocal
(IAAAS, 1986) slightly elevated, but the relative risks were of borderline statistical
significance (Scrip, 1986).
E) Renal events: oliguria, renal failure, acute and/or chronic interstitial nephritis,
acute tubular necrosis, papillary necrosis, analgesic nephropathy: haematuria,
nocturia, symptoms of urinary tract infection, renal colic, renal calculi, renal
failure, dehydration, acidosis, anaemia, hypertension, dyspepsia, peptic ulcers
with haemorrhage are common. ‘Reported in a considerable number of patients
who have consumed a large amount of Aspirin’, (Wigley, 1973).
F) Salicylism - mild chronic intoxication (Type A events): tinnitus, dizziness,
diminished vision, hearing loss, headache, feeling of intoxication, nausea,
vomiting. The onset of these symptoms indicates that the plasma concentration
was approaching 35 mgm per 100cc. (Graham & Parker, 1948). To keep below
the threshold for salicylism a dose of 12 to 20 gr every 4 hours to start with and
then every six hours maintained a plasma salicylate value of 20 – 25 mgm per
100cc. The threshold for salicylism was 30 mgm per 100cc. (Hoffman et al.,
1949).
G) Reproductive events (Type A events): prolonged labour, teratogenicity (animals
only), increased bleeding.
H) Reye’s Syndrome is a rare paediatric disorder characterized by an initial
febrile illness, commonly influenza or varicella, followed in several days by
vomiting, disorientation, seizures and loss of consciousness. Signs – liver
histology, hyperammonemia, lactic acidemia, elevated free fatty acids and
amino acids (Raye et al., 1963). Most of the children died within a few days
and at autopsy there was diffuse fatty infiltrate of the liver and severe cerebral
oedema. The clinical and pathological features of the syndrome were first
clearly defined by Dr. Reye and his associates in 1963 in Australia. Numerous