Allergic Purpura in Children: Treatment and Management Insights

Pediatric Purpura

My daughter is currently three and a half years old and has always been healthy.
About two weeks ago, she caught a cold, which has not yet resolved.
On the fourth day of her cold, she developed petechiae on her lower extremities.
On the tenth and eleventh days, she experienced temporary joint pain in her lower limbs, making it difficult for her to walk.
On the twelfth day, she had petechiae behind both ears, and on the thirteenth day, she developed diffuse petechiae on her left hand.
The purpura typically resolves on its own within about a day.
On the eleventh day, we took her to Kaohsiung Medical University Hospital for blood tests, and she was prescribed Prednisolone.
The joint pain subsided, and her condition has been good since then, with no recurrence of the previous symptoms.
However, the test results indicated that she has allergic purpura, and she needs to take medication long-term, which could be for several years.
Long-term medication can be a physical and mental burden for a child.
I would like to ask if it is truly impossible to cure this condition.
My daughter is currently very active, and her symptoms have resolved; is it still necessary for her to continue taking medication? If the symptoms disappear and we stop the medication, will a subsequent viral infection lead to more severe consequences? Or can we simply provide supportive treatment as we did previously and expect her to recover? I would appreciate your response to these questions.
Thank you.

Xiao Zhen, 30~39 year old female. Ask Date: 2000/10/03

Dr. Zhou Zuyou reply Pediatrics

Dear Parents,
Regarding your inquiry about Allergic Purpura, it is classified as an autoimmune disease that affects the blood vessels, commonly occurring in children aged 2 to 10 years.
It often presents with skin purpura about 7 to 10 days after a child has a cold, followed by symptoms such as abdominal pain (often colicky) and joint pain.
Approximately 40% of affected children may develop proteinuria or other renal symptoms.
The exact etiology of Allergic Purpura remains unclear, as the symptoms are consistent with vascular involvement.
Treatment should be symptomatic, and most patients experience symptom relief within 3 to 6 weeks.
The likelihood of recurrence is low, and there is no definitive report indicating that symptoms worsen with subsequent viral infections.
In terms of treatment, aside from the use of Aspirin, some immunosuppressants may be employed, and IVIG can be administered.
Corticosteroids are reserved for severe cases of vasculitis, acute segmental obstructive enteritis (ASOE), or renal sequelae.
Once symptoms improve, medications can be gradually tapered off.
Long-term medication is only necessary in cases of severe nephritis or nephrotic syndrome.

Whenever you have concerns, seeking assistance from an allergist or immunologist is your best option.
Sincerely,
Dr.
Chou Tzu-Yo, Pediatric Allergy Specialist, Tainan Hospital

Reply Date: 2000/10/03

More Info

Allergic purpura, also known as Henoch-Schönlein purpura (HSP), is a small-vessel vasculitis that primarily affects children. It is characterized by the presence of purpura (purple spots on the skin), often accompanied by joint pain, abdominal pain, and kidney involvement. The condition is usually triggered by an upper respiratory infection, which aligns with your daughter's recent history of illness.
In your daughter's case, the appearance of purpura and joint pain following a viral infection suggests that she may be experiencing HSP. The good news is that most children with HSP recover fully without long-term complications. The symptoms can be distressing, but they often resolve on their own over time.
The treatment for HSP typically focuses on managing symptoms. In cases where joint pain is significant, corticosteroids like Prednisolone are often prescribed to reduce inflammation and alleviate pain. It's important to note that while corticosteroids can help manage symptoms, they do not cure the underlying condition. The use of Prednisolone is generally short-term and is usually tapered off as symptoms improve.

Regarding your concerns about long-term medication use, it is true that prolonged use of corticosteroids can have side effects, including potential impacts on growth, immune function, and bone health. However, if your daughter is currently symptom-free and active, it may be possible to taper off the medication under the guidance of her healthcare provider.
It is crucial to have regular follow-ups with her pediatrician or a specialist to monitor her condition. If symptoms reappear after stopping medication, supportive care may be sufficient, and the healthcare team can provide guidance on managing any new symptoms that arise.
As for the possibility of recurrence, while HSP can recur, it is not common. If your daughter does experience another viral infection, it does not necessarily mean that her symptoms will return. Each case is unique, and her healthcare provider will be the best resource for personalized advice based on her medical history.

In summary, while allergic purpura can be concerning, most children recover well with appropriate management. Regular monitoring and communication with her healthcare team will be essential in ensuring her health and well-being. If you have further questions or concerns, do not hesitate to reach out to her doctor for clarification and support.

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