Notes in the treatment of allergic capillary inflammation

Allergic vasculitis is an autoimmune disorder that causes small blood vessels in the skin, joints, intestines, and kidneys to become inflamed and bleed. This condition is most common in children aged 2 to 6.

Allergic vasculitis also known as Henoch-Schonlein purpura or IgA vasculitis.
The general rule of the treatment of allergic conjunctivitis is to always ensure the daily amount of water and electrolytes. During treatment, the patient should be monitored for urine abnormalities.
If the patient has symptoms such as: severe abdominal pain, gastrointestinal bleeding or acute kidney failure... they need to be hospitalized, to prevent life-threatening complications.
Supportive treatment
Supportive treatment for allergic conjunctivitis includes ensuring adequate hydration and monitoring for abdominal and renal complications.
If the patient complains of arthritis pain, swelling, fever or discomfort, the doctor may prescribe acetaminophen to relieve pain, elevate the leg when lying down, and eat a low-salt diet. All unnecessary medications should not be used unless a drug-related cause has been ruled out.

Supportive therapies
Pain relievers
Effective pain control is a goal in treatment and care for a good quality of life for patients with vasculitis. In particular, pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can reduce discomfort caused by inflammation in joints and soft tissues. These drugs are usually effective but do not worsen the purpura. Even so, the dosage of these drugs should also be cautious in patients with renal impairment.
Corticosteroids
Clinicians often use corticosteroids to treat subcutaneous edema and nephritis in allergic capillary inflammation. In addition, corticosteroids also help improve symptoms of joint pain in patients. In addition, a number of studies have now shown preliminary results that the use of steroids can help prevent or treat complications of allergic capillary inflammation in the kidney.
Other drugs
Complementary or alternative steroid regimens may include the following:
Azathioprine Cyclophosphamide Cyclosporine Dipyridamole Immune Globulin Angiotensin-converting enzyme Inhibitors Angiotensin receptor blockers Danazol Fish oil Alternative Plasma
Plasma exchange has been shown to be effective in acute flares of capillary inflammation when steroid-resistant.
In a number of studies in children, where corticosteroid therapy is warranted, it has been shown to be safe and highly effective without immunosuppressive therapy.

Surgical intervention
Surgery can be performed to treat severe intestinal ischemia. Delay may result in bowel perforation, generalized peritonitis and sepsis, and septic shock.
Besides, kidney transplant can also be indicated in patients with severe kidney damage, progressing to end-stage chronic kidney disease requiring kidney replacement. However, the risk of kidney damage due to antibodies in allergic vasculitis can still occur in the newly transplanted kidney.
Multi-specialty coordination
Because allergic capillary disease is a disease that damages multiple organs, the comprehensive treatment process for the patient requires multi-specialist coordination. Accordingly, consultation with the following specialists may be helpful in diagnosis, treatment and long-term follow-up:
Gastrointestinal Dermatology, in particular as an aid in determining whether Indication for dialysis or kidney replacement in general or not Rheumatoid, autoimmune Cardiovascular Finally, the role of the attending physician is also very important in accessing and initial management when a patient is hospitalized because acute flare-ups or organ complications. In this context, quick, correct intervention decisions and accurate specialist coordination are partly to help maintain the patient's life.
Long-term monitoring
In all patients, monitoring of urine and blood pressure to assess renal function is a daily practice, and should be maintained for up to 6 months after diagnosis. disease or after exacerbations and discharge from the hospital. This should be followed even if the initial urinalysis results are normal.
When the patient has progressed to end-stage chronic renal failure, the indications for kidney replacement with long-term hemodialysis should be carried out and maintained until a compatible kidney is available for transplantation. However, the risk of repeat renal failure in a transplanted kidney is completely unavoidable in the setting of allergic vasculitis.
For children who have shown symptoms of kidney injury in the acute phase and continue to have hematuria or a positive proteinuria test, should be checked every 3-6 months for renal failure or increased Hypertension can develop up to 10 years after disease onset.
Finally, the use of NSAIDs can be indicated in the control of pain caused by inflammatory reactions, edema of joints, soft tissues; however, due to the risk of Reye's syndrome, the use of NSAIDs should be individualized.
Long-term complications
Kidney damage in allergic vasculitis may progress to end-stage chronic kidney disease. At this time, a kidney transplant is one of the options for renal replacement therapy. However, the risk of complications of kidney transplant injury due to vasculitis after kidney transplantation is very frequent. Also, in one study, the risk of graft loss after 10 years of follow-up was 7.5%.
In summary, allergic conjunctivitis is considered a systemic disease and the treatment of allergic vasculitis requires comprehensive, multi-specialist coordination. Although there is no specific treatment, this disease has the ability to self-resolve or can still be effectively controlled if the patient receives proper supportive treatment, close monitoring and proactively prevents complications. long-term evidence.
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Reference source: emedicine.medscape.com; mayoclinic.org