Is there a crossroad between infections, genetics, and Henoch–Schönlein purpura?

Rigante, Donato; Castellazzi, Luca; Bosco, Annalisa; Esposito, Susanna

doi:10.1016/j.autrev.2013.04.003

Cited by 111 publications

(91 citation statements)

References 67 publications

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“…The abovementioned study corroborates our finding showing that the Th2 environment contributes to the development of autoimmune T1 diseases such as HSP, suggesting that the Th1/Th2 paradigm is oversimplified. Dysregulated immune responses to environmental stimuli and a genetic predisposition or gene interactions may contribute to both allergic and autoimmune diseases (37). Therefore, immunogenetic or early-life environmental factors may all contribute to the development of allergy and HSP.…”

Section: Hsp In Allergic Diseasesmentioning

confidence: 99%

Association between allergic diseases and risks of HSP and HSP nephritis: a population-based study

et al. 2015

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Background: Some allergic inflammation-associated mediators have been reported in acute stage of HenochSchönlein purpura (HSP). However, the association of children with allergic diseases and their subsequent risks of HSP and HSP nephritis remain unknown. Methods: In this study, we included 2,240 children with HSP diagnosed between 2000 and 2008 as well as 8,960 non-HSP controls matched for age, sex, and level of urbanization. The odds ratios (ORs) of HSP were calculated with respect to associations with pre-existing allergic diseases. results: Children with allergic diseases had an increased subsequent risk of HSP; the lowest adjusted OR (aOR) was 1.33 for allergic conjunctivitis (95% confidence interval (CI): 1.17-1.52) and the highest was 1.68 for asthma (95% CI: 1.48-1.91). The aOR increased to 2.03 (95% CI: 1.80-2.31) in children with at least two allergic diseases. Children who visited medical institutes more often per year for associated allergic diseases had an increased risk of HSP. Of the 2,240 children with HSP, 249 (11%) had HSP nephritis and 45.8% of those with nephritis had history of any allergic disease. conclusion: Atopic children had an increased subsequent risk of HSP but not an increased risk of HSP nephritis. h enoch-Schönlein purpura (HSP) is a common systemic small vessel vasculitis that primarily affects children and is characterized by nonthrombocytopenic purpura, abdominal pain and bleeding, arthritis, and renal involvement. Although the clinical course of HSP is generally benign and self-limited (1), renal function impairment, bowel perforation, and central nerve system involvement are rare but cause severe morbidity and long-term complication which need more aggressive treatment (1-3). HSP with renal involvement, HSP nephritis, has been reported to occur in 20-50% of the patients with HSP, and the long-term outcome of HSP depends primarily on the extent of renal involvement (4-7). The manifestations of HSP nephritis vary from asymptomatic hematuria and/or proteinuria to nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis (4-7). To date, the exact etiology and pathogenesis of HSP are unknown. However, HSP is regarded as a specific immune-mediated inflammation induced by environmental factors, such as infections and seasonal variation (1,8). Some inflammatory mediators, including tumor necrosis factor (TNF)-α, interleukin-6, IL-8, transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF), and cysteinyl leukotrienes, have been reported to be higher in children with acute HSP than in healthy controls (9-11). Cysteinyl leukotrienes are potent inflammatory mediators which contribute to asthma (12). Elevated Th2-mediated biological markers such as elevated serum IgE, serum eosinophil cationic protein (ECP), and urinary leukotriene E4 levels were found in acute stage of HSP (10-13). The onset of HSP has been reported after exposure to drug or food allergens, vaccines, and insect bites (14-16). In our clinical experience, some children with HS...

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Section: Hsp In Allergic Diseasesmentioning

confidence: 99%

Association between allergic diseases and risks of HSP and HSP nephritis: a population-based study

et al. 2015

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“…Among the etiological factors rarely mentioned is Moraxella catarhalis. Most cases are caused by bacteria Streptococcus pyogenes, Haemophilus influenzae, or Staphylococcus aureus [17] and viruses (e.g., adenoviruses, Epstein-Barr virus, or parvovirus) [18] . The drugs of choice are still glucocorticoids which reduce the risks of developing complications.…”

Section: Discussionmentioning

confidence: 99%

Henoch-Schönlein purpura

Zdanowska¹,

Owczarczyk‐Saczonek²,

Placek³

2016

J Surg Dermatol

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Henoch-Schönlein purpura (HSP) is an acute, systemic vasculitis which usually occurs in young adults and children. The skin involvement may lead to the manifestation of symptoms associated with vasculitis in intestines, kidneys, and the central nervous system. The incidence of bowel perforation in course of HSP is very seldom and it occurs about 10 days after the appearance of the first symptoms. We present a 23-year-old male patient with jejunal intussusception in the course of HSP. The patient was operated urgently with resection of part of the small intestine. Adults rarely suffer from the occurrence of abdominal pain and fever, but sometimes they require careful monitoring and surgical intervention because misdiagnosis can be life threatening.

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“…Neben Streptokokken wurde auch eine Vielzahl anderer bakterieller und viraler Infektionen als Trigger vermutet. Auch im Rahmen einer Erkrankung mit Protozoen wurde das Auftreten einer Purpura Schönlein-Henoch-Vaskulitis berichtet [7].…”

Section: Definitionunclassified

Purpura Schönlein-Henoch im Kindesalter

Pöhl

2014

Monatsschr Kinderheilkd

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Diese Fortbildungseinheit steht Ihnen als e.CME und e.Tutorial in der Springer Medizin e.Akademie zur Verfügung. -e.CME: kostenfreie Teilnahme im Rahmen des jeweiligen Zeitschriftenabonnements -e.Tutorial: Teilnahme im Rahmen des e.Med-Abonnements ZertifizierungDiese Fortbildungseinheit ist mit 3 CMEPunkten zertifiziert von der Landesärzte-kammer Hessen und der Nord rheinischen Akademie für Ärztliche Fort-und Weiterbildung und damit auch für andere Ärzte-kammern anerkennungsfähig. Hinweis für Leser aus ÖsterreichGemäß dem Diplom-Fortbildungs-Programm (DFP) der Österreichischen Ärzte-kammer werden die in der e.Akademie erworbenen CME-Punkte hierfür 1:1 als fachspezifische Fortbildung anerkannt. ZusammenfassungDie Purpura Schönlein-Henoch ist die häufigste Vaskulitis des Kindesalters mit einem Altersgipfel im Vorschulalter. Die leukozytoklastische Vaskulitis wird durch Ablagerung IgA enthaltender (IgA: Immunglobulin A) Immunkomplexe in den Wänden der kleinen Gefäße verursacht. Die klinischen Hauptmanifestationen sind eine tastbare Purpura vorrangig an der unteren Extremität, eine Arthritis oder Arthralgie und abdominelle Schmerzen. Die Langzeitprognose wird vom Ausmaß der Nierenbeteiligung bestimmt, die zu persistierender renaler Entzündungsaktivität und einer chronischen Nierenschädigung führen kann. Eine Purpura Schönlein-Henoch-Nephritis kann bis zu 6 Monate nach Erkrankungsbeginn auftreten, sodass auch bei rückläufigen extrarenalen Symptomen wiederholte Urinuntersuchungen über 6 Monate erfolgen sollten. Bei ausgeprägten abdominellen Schmerzen sind orale Kortikosteroide indiziert. Trotz schlechter Evidenzlage wird eine klinisch oder histologisch schwerwiegende Glomerulonephritis oft mit ACE-Hemmern (ACE: "angiotensin converting enzyme") und Immunsuppression behandelt.

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Is there a crossroad between infections, genetics, and Henoch–Schönlein purpura?

Cited by 111 publications

References 67 publications

Association between allergic diseases and risks of HSP and HSP nephritis: a population-based study

Association between allergic diseases and risks of HSP and HSP nephritis: a population-based study

Henoch-Schönlein purpura

Purpura Schönlein-Henoch im Kindesalter

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