1.What is allergic purpura?
Allergic purpura (also called Schonlein-Henoch) is one of the most common vasculitis in childhood and belongs to a group of vascular metaplasia hemorrhagic diseases, with hemorrhagic rash, arthritis or arthralgia, abdominal pain, gastrointestinal bleeding and nephritis as the main clinical manifestations.
2, the cause of the development of allergic purpura?
The cause of the disease is not fully understood. However, for most children, infection is the most common cause of “allergic purpura”. The most common of these is upper respiratory tract infection. A history of streptococcal infection has been reported in 50% of cases. Almost 80% of our outpatients and inpatients had fever, cough, sore throat and runny nose within 1-3 weeks of onset. Purpura manifestations began to appear after the resolution of these symptoms. In addition to respiratory tract infections, infections of other sites and organs such as diarrhea, urinary tract infections, and skin sores can also serve as triggers for the onset of the disease. In addition to infections, a few children are also associated with food allergies, insect bite medications or exposure to certain chemicals.
3. What are the main manifestations of allergic purpura?
Allergic purpura belongs to the category of vasculitis, so as long as there are blood vessels in the organs and systems may be damaged, but generally common is the skin, joints, digestive tract and kidney damage is more common.
(1) Allergic purpura rash characteristics.
It is mostly seen on the lower limbs, more often near the ankle joints and less often on the trunk. The rash is characterized by bright red or dark red macules, slightly protruding from the skin, and a hemorrhagic rash. In severe cases, hemorrhagic blisters, necrosis, and ulcers may appear. Purpura can fuse into patches and fade within 1-2 weeks without leaving traces, but the rash can recur.
(2) Gastrointestinal symptoms of allergic purpura.
About 2/3 of children present with GI symptoms. The lesions may involve the entire GI tract. They usually appear within 1 week of the onset of the rash. The most common symptom is abdominal pain, mostly in the form of paroxysmal periumbilical colic, which can also spread to any part of the abdomen and may be accompanied by vomiting. Some children develop bloody stools or even vomit blood. In some children, abdominal pain may precede the onset of cutaneous symptoms. A small number of children may have intussusception, intestinal obstruction, intestinal perforation, and hemorrhagic small bowel infection, requiring surgical intervention. When the appearance of gastrointestinal symptoms, it is important to seek medical attention in a timely manner, under the guidance of a doctor
(3) Allergic purpura nephritis manifestation.
In the allergic purpura, the most worrying to parents and the most raised question is the kidney damage caused by allergic purpura. Domestic reports about 30-50% of children with allergic purpura show kidney damage, and foreign reports have reported about 80% of children with allergic purpura show kidney damage. Most children present with microscopic hematuria and proteinuria, and in severe cases, carnivorous hematuria may be seen. Renal symptoms can occur at any time during the course of allergic purpura. However, we have seen them most often 2-4 weeks after the appearance of purpura, but also after the rash has subsided or during the quiescent phase of the disease. Renal failure and hypertension can occur in severely affected children.
(4) Allergic purpura joint symptoms.
Some children can see symptoms of joints in the early stages of the disease. Mostly seen in elbow, knee, ankle and other joints. The joints can be seen red and swollen with limited movement. But the joint symptoms caused by allergic purpura don’t need to worry too much, after rest and recuperation, most of the children can be gradually relieved after 1-3 days.
4.What kind of allergic purpura patients need hormone treatment?
Hormone is not a routine medicine for allergic purpura, most of the children can be completely relieved after symptomatic and comprehensive treatment. However, it is recommended to use hormones when the following manifestations occur: (1) severe gastrointestinal lesions (2) nephrotic syndrome (3) acute nephritis (4) obvious organ damage. The short-term use of hormones has little effect on the growth and development of the child, but the appearance of side effects still needs to be monitored regularly.
5, Chinese medicine on allergic purpura identification and typing treatment
The allergic purpura acute stage can be manifested as actual evidence, heat evidence, if the disease is not cured for a long time, it turns into chronic, can be manifested as deficiency evidence, cold evidence. According to the different manifestations of allergic purpura, the clinical classification of allergic purpura into the following 4 types of symptoms.
(1) Blood heat delusion
The main manifestations: obvious hematuria of the naked eye, may be accompanied by skin purpura, irritability, thirst for cool water, red and vivid tongue, yellow coating, and counted pulse.
(2) Yin deficiency and fire exuberance
Main manifestations: prolonged illness or recurrent attacks, blood in the urine, swelling, heat in the heart of the hands and feet, dry mouth, sleeplessness, hot flashes and night sweats, dizziness and weakness, red tongue with little fluid, and counted pulse.
(3) Qi deficiency
Main manifestations: blood in urine, swelling, aggravated by exertion, shortness of breath, laziness in eating, palpitation and dizziness, withered face, loose stools, fat tongue with pale texture, white fur, and deficient pulse.
(4) Spleen and kidney Yang deficiency
Main manifestations: swelling and urination, cold body and cold limbs, yellowish white face, fatigue, loose stools, pale fat tongue with teeth marks, white fur and sunken and weak pulse.
The typological treatment of allergic purpura in Chinese medicine is mainly divided into the above four different groups of symptoms, and the symptomatic treatment is different according to the stage the patient is in. Our department has been treating patients with allergic purpura for a long time, and has formed a complete Chinese medicine treatment system under the leadership of the old generation of Chinese medicine doctors. Combining the respective characteristics of Chinese and Western medicine, the treatment of allergic purpura and allergic purpura nephritis has characteristics!
6.Life conditioning
Infection is one of the triggering factors of allergic purpura, so pay attention to the prevention and control of respiratory tract infection and digestive tract infection, etc. Weather changes pay attention to increase and decrease clothing, avoid using unclean food. Avoid mosquito and insect bites. At the same time animal protein in the intake of too much, is not conducive to recovery, and at the same time easy to lead to relapse, so in the acute phase of allergic purpura try to avoid the intake of animal protein, such as meat, eggs, milk, etc.; wait for the condition to improve and then increase the intake of animal protein one by one. You should also avoid the intake of stimulating foods such as ginger, onion, garlic, leek, etc. Eat green vegetables and fruits rich in vitamin C, such as: kiwi, red dates, spinach, cabbage, tomatoes, oranges, grapefruit, peaches, lemons, strawberries, hawthorn, etc. can improve capillary permeability, which is conducive to the improvement of the disease. In addition, allergen contact is also easy to induce allergic purpura, so to avoid allergen contact, such as pollen, chemicals, gasoline, paint, dust mites, etc.