EDITOR, - Maria Casteels-Van Daele and Ephrem Eggermont propose that Reye's syndrome is associated not with aspirin but with antiemetics given for the profuse vomiting which characterises this disorder and that antiemetic toxicity is often misclassified as Reye's syndrome.1 As evidence they cite a paper describing two patients with classic extrapyramidal symptoms of antiemetic toxicity. Since these have been known for decades, it is unlikely that “better recognition” of these side effects could explain the decline of reported Reye's syndrome in the United States and the United Kingdom.

The authors criticise the North American case-control studies for recording only the drugs given before the onset of vomiting. They question whether this reflects the onset of Reye's syndrome itself. …