PURPURA, ALLERGIC

(Anaphylactoid Purpura; Henoch-Schönlein Purpura)

 Basic information

description

Allergic purpura is an allergic disorder involving sudden bleeding into the skin. It can also involve the joints (usually knees, ankles, hips, wrists, and elbows); the gastrointestinal tract; kidneys; and the skin of the legs, thighs, and abdomen. It usually affects children ages 2 to 11, most often boys. Adults are rarely affected.

FREQUENT SIGNS & SYMPTOMS

• Headache, fever, and loss of appetite may occur first.
• Itching, red skin rash that seems to be just beneath the skin surface. The rash usually consists of large hives with small bruises or blood spots in the centers. The rash is most often on the legs, thighs, and lower abdomen, but it may be scattered over the body. The rash turns a bruised, purple color. (That is why the name purpura is given to the disorder.).
• Joint pain and swelling at the knees, ankles, hips, wrists, or elbows.
• Cramping stomach (abdominal) pain and vomiting.
• Blood in urine or stools.

causes

Purpura is probably an autoimmune reaction in the inflamed small blood vessels in the body. The allergic trigger is not known. Attacks often follow an upper respiratory infection or the use of some drugs.

risk increases with

• Recent illness such as cold or flu. Both viral and bacterial infections have preceded allergic purpura.
• Use of certain drugs. These include antibiotics, such as penicillin and ampicillin, and some vaccines, such as typhoid, measles, yellow fever, and cholera.
• Bee stings, some chemical toxins, cold exposure, and food allergies have also preceded allergic purpura.

PREVENTIVE MEASURES

No specific preventive measures. Avoid any of the risk factors where possible.

expected outcomes

Most children recover completely. Mild cases may last a few days. Usually, recovery takes 1 to 4 weeks. In about 50% of cases, the disorder will recur.

possible complications

• Kidney damage. It may occur years later.
• The disorder can cause complications in almost every organ system. These include gastrointestinal, cardiovascular (heart and blood vessels), and the lungs.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam and ask questions about the symptoms. Medical tests may include blood and urine studies. X-rays or CT testing may be done to assess complications.
• Most patients require hospital care. This is important to help watch for, and prevent, complications.
• Treatment involves discontinuing any drugs or trigger factors that could be the cause, along with supportive therapy to relieve symptoms.
• At home, use warm soaks to relieve joint pain.

medications

• There is no specific drug to treat the disorder. Drugs to reduce inflammation (such as ibuprofen or naproxen) or to treat an infection may be prescribed.
• In some cases, corticosteroids may be prescribed.

activity

When fever and pain are gone, the child may gradually resume normal activities as strength and well-being will allow.

diet

Eat a normal, well-balanced diet.

 notify our office if

• Your child has symptoms of allergic purpura.
• The following symptoms occur after treatment:
  • Increased abdominal pain.
  • Blood in the stool or black, tarry stools.
  • New bleeding under the skin.
  • Blood in the urine.

Special Notes: