Overview
The manifestation of dark purple patches on the skin, may be accompanied by rash, arthralgia, abdominal pain and kidney damage, etc. may be related to infections, allergies, genetics and other factors to remove the causative factors, through the general treatment and medication to alleviate the symptoms of the disease is self-limiting, and most of the prognosis is good.
What is Anaphylactic Purpura?
Definition
Allergic purpura is a common vascular allergic disease, also known as allergic cutaneous vasculitis.
Its pathogenesis is mainly due to the occurrence of allergic reactions in the human body, leading to an increase in capillary permeability and fragility, accompanied by small-vessel vasculitis.
Typing
Clinically, purpura is divided into purpura type, abdominal type, joint type, renal type and mixed type according to the lesion site.
Morbidity
The disease can occur throughout the year, but is more frequent in spring and fall.
It can occur in all ages, and is most common in school-age children, with 3 to 14 years old being the most common age.
There are more males than females, with a male to female incidence ratio of (1.4 to 2):1.
Questions you may be concerned about
Can allergic purpura be cured?
Most of the allergic purpura can be cured, and a small number of serious complications are more difficult to treat.
Most cases of purpura are self-limiting, with most cases resolving spontaneously within 6 to 8 weeks of onset of the disease, and the prognosis is good. Some cases of purpura can be cured after effective treatment and no recurrence of the disease.
A small number of serious complications, such as renal lesions, due to recurrent episodes of the disease, can be transformed into chronic nephritis or nephrotic syndrome, difficult to cure, and need to continue to be treated with glucocorticosteroids, such as prednisone, dexamethasone and other medications, and return to the hospital for regular review under the guidance of a physician to monitor changes in indicators.
How long can I live with Henochipura?
It is not possible to generalize how long a patient with purpura can live.
Most of the patients are self-healing and can survive for a long time with effective targeted treatment, no difference with healthy people; some serious patients can have their survival period shortened to several years to decades due to prolonged illness; a small number of patients can have their lives endangered in a short period of time due to serious bleeding from the digestive tract and the brain if they do not receive effective treatment.
Is Henoch-Schönlein purpura a leukemia?
Anaphylactic purpura is not leukemia.
Henoch-Schönlein purpura is a type of immune-complex vasculitis that mainly affects small blood vessels. Clinical manifestations include skin purpura, abdominal pain, gastrointestinal bleeding, recurrent joint pain, hematuria, proteinuria, dizziness and vomiting. With effective treatment, most patients can survive for a long time.
Leukemia is a malignant proliferative disease originating from bone marrow hematopoietic stem progenitor cells. Clinical symptoms include bleeding, anemia and fever. The prognosis is poor and can be life-threatening due to complications if not treated aggressively.
Causes
Currently, the etiology and pathogenesis of this disease are not clear, and may be related to infection, allergy, drugs, genetics and other factors.
Causes
Infection
Bacterial infections, such as Staphylococcus aureus, Mycobacterium tuberculosis and pneumococcus, with bacterial infections of the upper respiratory tract being the most common.
Rash viral infections, such as measles, chickenpox and rubella.
Parasitic infections, such as roundworm infections.
Allergy
Certain foods cause allergies, such as seafood (fish, shrimp, crab, etc.), poultry, eggs, milk and other foods in the heterogeneous protein caused by the body to produce an allergic reaction.
Vaccination, mosquito bites, cold irritation, pollen, dust, etc. cause allergic reactions.
Medications
Antibiotics, such as penicillin and cephalosporin antibiotics.
Antipyretic and analgesic drugs, such as salicylic acid, pau tazone, indomethacin, etc.
Diuretics, such as hydrochlorothiazide.
Other drugs such as sulfonamides, isoniazid, etc.
Genetic factors
The disease has a genetic predisposition.
Pathogenesis
The main pathogenesis of this disease is that protein and other macromolecules act as antigens to stimulate the body to produce IgA or IgG class circulating immune complexes, which are deposited in the upper layer of dermal capillaries, causing vasculitis, activating complement, leading to infiltration of neutrophils and releasing a series of inflammatory mediators, and releasing protein hydrolyzing enzymes that cause the intima-media layer of the blood vessels to be damaged and ruptured, resulting in a vasculitic inflammatory reaction.
Symptoms
Main Symptoms
Purpura simplex
Also known as purpura purpura, the most common, mainly manifested as skin purpura, mostly distributed in the lower limbs and buttocks, with a symmetrical distribution bilaterally, but also seen in the trunk and upper limbs, and even the face.
Dark purple patches (purpura) appear on the skin and mucous membranes. The rash varies in size, is purplish red, appears in batches, usually slightly above the skin, does not fade when pressed, and finally changes to brown, usually the rash subsides within 1 to 2 weeks, and is prone to recurring episodes.
Petechiae (or hemorrhagic spots): less than 2 mm in diameter.
Purpura: 3 to 5 millimeters in diameter.
Petechiae: greater than 5 mm in diameter.
Hematoma: flaky hemorrhage with significant skin elevation.
Abdominal purpura
In addition to skin purpura, abdominal pain, vomiting, diarrhea and blood in stool may occur due to the involvement of the mucous membrane of the digestive tract or peritoneal capillaries.
Abdominal pain is the most common. It is mostly paroxysmal severe colic, or dull pain, mostly located around the umbilicus, lower abdomen or the whole abdomen.
Arthritic purpura
In addition to skin purpura, due to the involvement of blood vessels in the joint area, joint swelling, pain, pressure pain and dysfunction and other manifestations. It mostly occurs in large joints such as knees, ankles, elbows and wrists.
There are no sequelae after the joint symptoms subside and no joint deformity remains.
Nephrogenic purpura
On the basis of skin purpura, glomerular capillary involvement may appear hematuria, followed by proteinuria and tubular pattern. Renal damage most often occurs 2 to 4 weeks after the appearance of purpura, or may be delayed.
The overall prognosis is good; a few develop chronic nephritis, eventually leading to uremia.
Mixed purpura
Skin purpura combining two or more of the above clinical manifestations.
Other symptoms
Prodromal symptoms
Low-grade fever, malaise, general malaise or respiratory tract infection (coughing, sneezing, runny nose, etc.) may precede the onset of the disease.
Central nervous system symptoms
When the lesion affects the brain and meningeal vessels, various neuropsychiatric symptoms, such as headache, dizziness, vomiting, trance, irritability, coma, etc., may occur, but are rare.
Respiratory system
Symptoms such as hemoptysis, chest pain, restriction of respiratory movement, and shortness of breath may occur, but are rare in clinical practice.
Eye symptoms
Loss of vision, photophobia, blurred vision, eye pain and redness.
Others
Nosebleeds, gum bleeding, muscle bleeding, testicular swelling and bleeding or pulmonary ferritin deposits are rare.
Complications
Chronic kidney damage occurs in about 2% of patients, and in a very small percentage, severe intestinal bleeding or even intussusception occurs.
Chronic nephritis
It may involve the kidneys and cause diseases such as chronic nephritis in about 2% of patients.
The main manifestations are hematuria, proteinuria, tubular urine, hypertension and edema, and in severe cases, it may cause renal failure, which is manifested as oliguria and anuria.
Intussusception
A very small number of patients with abdominal purpura may cause intussusception, intestinal obstruction, intestinal perforation and other diseases in the digestive system, which may lead to death in serious cases; the main manifestations are abdominal pain with paroxysmal colic, vomiting, diarrhea, and blood in stool.
Consultation
Department of Medicine
Hematology
If symmetrical dark purple patches appear on the skin of both lower limbs and buttocks, accompanied by arthralgia, abdominal pain and other symptoms, it is recommended to consult a doctor promptly.
Dermatology
If you have symptoms of bruising and blue spots on the skin, you can also consult the Department of Dermatology.
Pediatrics
Pediatric internal medicine may be consulted if the above symptoms occur in a child patient.
Preparation for medical treatment
Preparing for your visit: registering, preparing your documents, and frequently asked questions.
Tips for seeking medical treatment
In the absence of a confirmed diagnosis, vomiting, abdominal pain, diarrhea symptoms prohibit the use of haloperidol, belladonna tablets and other drugs to self-treat, so as not to delay the condition and affect the doctor’s diagnosis.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
What are the parts of the skin where bruises and blue spots occur? Does the color change? Are they symmetrically distributed?
How long has the bruising lasted? Does it resolve on its own?
Have you had fever, fatigue, or discomfort recently?
Any symptoms such as abdominal pain, vomiting, hematuria, blood in stool?
List of medical history
Are there any allergies to food, drugs or other substances?
Any recent infectious diseases such as colds, chicken pox, rubella, etc.?
Are there any patients with similar symptoms in the family?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Blood test and coagulation test
Urine routine, stool routine
Medication List
Medication in the last 3 months, if available, bring along the box or package to the doctor.
Antibiotics: Amoxicillin, Cefadroxil, Cefadroxil, etc.
Antipyretics and analgesics: acetaminophen, indomethacin, prednisone, etc.
Diuretics: hydrochlorothiazide, etc.
Antihistamines: Promethazine hydrochloride, chlorpheniramine, astemizole, loratadine, etc.
Glucocorticoids: prednisone, methylprednisolone, dexamethasone, etc.
Diagnosis
Diagnosis is based on
Medical history
Past history of allergy or family history of purpura.
Clinical manifestations
It manifests as dark purple plaques on the skin and mucous membranes, which may be accompanied by rash, arthralgia, abdominal pain and renal damage.
Physical examination is mainly to observe the distribution and pattern of the rash, and whether the joints are swollen, and abdominal palpation is performed to make a preliminary judgment of the condition.
Laboratory Tests
Blood routine
To understand the changes of blood cells and platelets.
The white blood cell count is normal or increased, and the neutrophil and eosinophil counts may be increased; the platelet count is normal.
Urine routine
To determine whether hematuria and proteinuria are present.
Renal and mixed types may have hematuria, proteinuria, and tubular urine.
Before urine specimen collection, the urethral opening and surrounding parts should be cleaned, and mid-stream urine should be retained.
Stool routine
Determine the presence of gastrointestinal bleeding.
A positive fecal occult blood test suggests a lesion in the digestive system.
Meat and animal blood should be prohibited for 3 days before the examination, and iron and vitamin C should be prohibited.
Serologic examination
To determine the level of immunoglobulin in the body.
In immunological examination, serum immunoglobulin A (IgA) and immunoglobulin E (IgE) are often increased; in addition, according to the presence or absence of antigenic antibody and rheumatoid factor, tuberculosis and rheumatoid arthritis can be excluded.
Pathologic examination
If the kidney lesions are severe, the doctor will do a kidney biopsy to get a detailed picture of the kidneys.
Individuals with Henoch-Schönlein purpura often have deposits of a certain protein, IgA, on the affected organs. if the kidneys are severely involved, a kidney biopsy is recommended.
Diagnostic Criteria for Anaphylactoid Purpura
Skin purpura is essential, plus at least one other criterion for the diagnosis of purpura.
Cutaneous purpura: palpable purpura appearing in batches, or marked petechiae on the lower extremities, without thrombocytopenia.
Abdominal pain: acute diffuse abdominal pain, which may present with intussusception or gastrointestinal bleeding.
Histologic examination: leukocytoclastic vasculitis with predominantly IgA immune complex deposition, or proliferative glomerulonephritis with predominantly IgA deposition.
Arthritis or arthralgia: arthritis, acute joint swelling or pain with limitation of motion; arthralgia, acute joint pain without joint swelling or limitation of motion.
Renal involvement, proteinuria: 24-hour urine protein quantitatively >0.3 g, or morning urine sample with native albumin creatinine ratio >30 mmol/mg. Hematuria, erythrocyte tubular pattern: >5 red blood cells per high power field of view, or positive urine occult test (≥++), or erythrocyte tubular pattern seen on urine sediment.
Differential Diagnosis
Thrombocytopenic purpura
Similarities: Both are characterized by skin purpura.
Differences: Thrombocytopenic purpura rash does not rise above the surface of the skin, no itching. The platelet count is lower than normal, the coagulation time is prolonged, and there are megakaryocyte maturation disorders on bone marrow examination.
Rheumatoid arthritis
Similarities: fever, redness, swelling, heat and pain in joints.
Differences: rheumatoid arthritis can be seen as subcutaneous nodules and circular erythema of the skin, positive throat swab culture for beta-hemolytic streptococcus, positive C-reactive protein.
Surgical acute abdomen
Similarity: both may present with abdominal pain.
Differences: the abdominal pain of this disease is paroxysmal colic, mostly occurring around the umbilicus, upper and lower abdomen or the whole abdomen, without rebound pain and muscle tension, white blood cell count is usually normal. Acute abdomen abdominal pain is persistent pain progressively aggravated, and there is pressure, rebound pain and muscle tension, systemic toxic symptoms are obvious, white blood cell count is increased.
Acute glomerulonephritis
Similarities: both present with hematuria, proteinuria, etc.
Differences: glomerulonephritis may show dynamic changes in serum complement (C3) and elevated titer of anti-streptococcal hemolysin “O” antibody (ASO), which is used for differential diagnosis.
Lupus nephritis
Similarities: both present with hematuria and proteinuria.
Differences: patients with lupus nephritis have multiple organ damage, decreased white blood cell count, increased erythrocyte sedimentation rate, positive lupus cells, and other positive immune indicators.
Treatment
Principles of treatment
The treatment of purpura is mainly to avoid exposure to pathogenic factors, control the acute symptoms, and actively prevent and treat the comorbidities.
General treatment
Avoiding allergens: searching for and removing various pathogenic factors, such as expelling intestinal parasites and avoiding contact with allergens.
Daily life: bed rest is needed in the acute stage, avoiding strenuous activities.
Skin care: keep the skin clean, avoid scratching and stimulation of the skin in the purpura area; if there is ulceration, treat it in time to prevent bleeding and infection.
Body position: take a comfortable position, such as abdominal pain should take the knees lying position.
Diet: Patients with abdominal purpura should have small meals. Patients with renal damage should limit salt and water intake.
Medication
Antihistamines
First-generation antihistamines such as ipratropium hydrochloride and chlorpheniramine, and new-generation antihistamines such as astemizole and loratadine can reduce allergic symptoms.
First generation antihistamines often have side effects of tiredness and drowsiness.
Glucocorticosteroids
Commonly used prednisone, methylprednisolone, dexamethasone and so on.
They are mainly used for joint swelling and pain, severe abdominal pain combined with gastrointestinal bleeding and those with severe kidney lesions such as acute progressive nephritis or nephrotic syndrome.
Glucocorticosteroids may cause adverse effects such as obesity, osteoporosis, hypertension, diabetes or gastrointestinal discomfort and should be monitored.
Calcium and vitamin D supplements are recommended for patients taking glucocorticoids.
Methylprednisolone or prednisone is usually applied for a course of treatment not exceeding 30 days.
Immunosuppressants
When glucocorticoid therapy is ineffective or significant renal damage occurs, immunosuppressive drugs such as cyclophosphamide, azathioprine and cyclosporine may be used.
Liver and kidney functions should be closely monitored during the medication to prevent liver and kidney damage.
Anticoagulants
For patients with renal type, treatment with heparin sodium or aspirin can be used to prevent blood clotting and formation of thrombus.
Others
Patients with severe abdominal pain can use drugs such as scopolamine for analgesia.
Patients with gastrointestinal bleeding can be treated with drugs such as omeprazole.
Those with arthralgia use NSAIDs or analgesics as appropriate.
Those with severe vomiting can also use antiemetic drugs.
Proprietary Chinese medicines
Compound Qingdai Capsule: clearing heat and removing toxins, resolving blood stasis and eliminating spots. It is suitable for blood-heat spotting.
Zhi Bai Di Huang Wan: nourishing yin and lowering fire, ninluo and stopping bleeding. It is suitable for the evidence of yin deficiency and fire exuberance.
Gui Spleen Pill: benefiting qi and strengthening the spleen, nourishing blood and tranquilizing the mind. Suitable for syndrome of spleen deficiency with loss of regeneration.
Important Tips
The use of medication should be based on the advice of a doctor and should not be changed or discontinued at one’s own discretion.
Traditional Chinese Medicine (TCM)
Internal treatment, according to TCM diagnosis and treatment can be divided into different types, such as blood-heat spotting, damp-heat blood stasis, different types of different prescriptions, such as Rhinoceros Jiao Dihuang Tang combined with Cooling Blood and Five Roots Soup plus and minus, Xuanpai Tang combined with Cooling Blood and Five Roots Soup plus and minus, and so on.
External treatment, can also be combined with traditional Chinese medicine fumigation, acupuncture treatment, should be carried out under the guidance of the doctor. Some Chinese medicine treatments or medicines can relieve symptoms, and it is recommended to go to a regular medical institution and be treated under the guidance of a doctor.
Other treatments
Plasma exchange
For acute purpura nephritis (pathology suggestive of crescent formation) and allergic purpura with severe comorbidities.
It removes antibodies, complement, immune complexes and inflammatory mediators from plasma, thereby relieving the associated symptoms.
Prognosis
Cure
Most patients have a favorable prognosis. Some patients may relapse.
Most pediatric cases usually recover within 2 weeks, and some patients may have recurrent episodes with intervals between recurrences ranging from weeks to months.
A small number of patients with renal forms may turn into nephrotic syndrome or chronic nephritis, and about 2% of patients develop end-stage nephritis, which has a poor prognosis.
In most cases recurrent symptoms are less severe than those of the first episode.
Hazards
Skin ulceration: allergic purpura can cause skin purpura rash with edema, necrosis and blisters, which affects the aesthetic appearance. Scratching, which can cause skin breakouts, causing infections, etc.
The abdominal pain and arthralgia caused by purpura of allergy affect normal work, study and life.
Some of the allergic purpura is easy to recur, which will aggravate the psychological burden of patients.
If allergic purpura is not treated in time, it may develop into serious kidney disease when it affects the kidneys.
Daily
Daily Management
Life management
Increasing bed rest and avoiding getting up and moving too early or too much will help relieve symptoms.
Exercise is prohibited during the flare-up period, and moderate exercise after the stabilization period. Patients with purpura need to take a good rest and remember not to exercise strenuously; not to stay up all night.
Patients with purpura are prone to relapse within half a year after the purpura subsides, so it is recommended to continue to consolidate the treatment program for a period of time after the cure.
Pay attention to dietary hygiene and weather changes in daily life to avoid diarrhea, colds and other induced purpura recurrence.
Dietary management
Avoid eating allergenic food.
During the onset of the disease, the diet should be rich in easily digestible, fresh vegetables and fruits, low protein and foods rich in vitamins. If the lesion involves the digestive system, a soft, semi-liquid diet can be eaten.
During the stabilization period, high-quality, high-protein, high-vitamin foods can be added gradually, and foods containing vitamin C can be chosen, which play an important role in maintaining the normal function of blood vessels.
Medication management
When using glucocorticoid, strengthen the respiratory tract and other care, pay attention to personal hygiene and prevent infection.
When using cyclophosphamide, drink more water and pay attention to changes in urine volume and color.
Local care
Avoid scratching and irritating the lesion skin; cold compresses can be applied to the swollen and painful joints for analgesia, but not hot compresses.
Observation
Closely observe the shape, quantity, distribution and fading of purpura.
There is no new issue of blood, kidney damage, joint mobility disorders and other manifestations.
Whether there is edema and changes in urine volume and color.
Changes in the nature and color of feces.
Follow-up examination
After the treatment of Henoch-Schönlein purpura, it is necessary to follow the doctor’s instructions to review the diagnosis. If there are abnormal symptoms such as a large number of new petechiae or purpura, obvious abdominal pain or blood in the stool, swollen and painful joints, hematuria, edema, foamy urine, or even oliguria, the patient should be reviewed in time.
Urine routine review time
Within 2 to 3 months of allergic purpura, patients need to check urine routine once a week.
After 3 months of the onset of purpura, the urine routine should be checked every 2 to 3 weeks.
After 6 months from the onset of purpura, the urine routine should be checked once a month.
After 1 year, check urine routine 1 to 2 times a year. Prevent kidney damage.
Prevention
For those who are susceptible to allergy, allergen testing can be done to avoid contact with easily sensitized substances.
Avoid infections: Develop good personal hygiene habits, avoid eating unclean food, avoid parasitic infections.
Diet: Choose light, less stimulating and easy-to-digest foods, and avoid allergy-causing foods.
Daily life: Regular work and rest, pay attention to rest, appropriate exercise, enhance physical fitness. Pay attention to the timely increase or decrease of clothing, indoor ventilation at regular intervals.
Adjust your mood to relieve tension and anxiety.
Regular work and rest, combine work and rest, appropriate physical exercise, to enhance physical fitness.