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Afr Health Sci. 2013 March; 13(1): 94–99.

doi:  10.4314/ahs.v13i1.26

PMCID: PMC3645106

Henoch Schonlein Purpura in children: clinical analysis of 120 cases

O Chen,^1,2 XB Zhu,¹ P Ren,⁵ YB Wang,³ RP Sun,¹ and DE Wei⁴

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Abstract

Background

Henoch Schonlein Purpura (HSP) is a systemic vasculitic disease which is common in children. It is very important to understand the clinical features of this disease for doctors and nurses.

Objectives

To study the clinical characteristics of HSP in children.

Methods

Collect the clinical data of the HSP children, and analyze the clinical characteristics of these HSP patients.

Results

The ratio of M:F was 1.9:1. The mean age was 6.6 ± 1.6 years. The typical onset seasons were spring, winter and autumn. Infection and food allergy were the main etiological factors. The first symptom was skin purpura and these purpura mainly concentrated the lower extremities and buttocks. The dominant digestive clinical features were abdominal pains and vomiting. The knee joint and ankle joint were most frequently affected. The typical kidney symptoms were microscopic hematuria and albuminuria. An increased ESR was reported in 68 patients (56.7%). Serum C3 decreased in 13 cases (10.8%). ASO titer was higher in 57 children (47.5%).

Conclusion

There were gender, season and area differences for the HSP patients. The etiological factors were diverse. HSP patients could have various clinical symptoms and rare complications.

Keywords: Henoch Schonlein Purpura, Children

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What's new in the diagnosis and management of food allergy in children?

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Current Review  Open Access

|    Asia Pac Allergy. 2013 Apr;3(2):88-95. English. Published online 2013 April 26.  http://dx.doi.org/10.5415/apallergy.2013.3.2.88  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. What's new in the diagnosis and management of food allergy in children? Paul J Turner,1,2 and Dianne E Campbell2,3 1Imperial College London, London, SW7 2AZ, United Kingdom. 2Discipline of Paediatric and Child Health, The University of Sydney, Sydney, NSW 2006, Australia. 3Children's Hospital at Westmead, Sydney, NSW 2145, Australia.  Correspondence: Dianne E Campbell. Department of Allergy and Clinical Immunology, Level 3, Children's Hospital Westmead, Sydney, NSW 2145, Australia. Tel: +61-2-9845-3420, Fax: +61-2-9845-3389, Email:Diannec3@chw.edu.au  Received March 09, 2013; Accepted March 17, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract This article reviews the recent advances in the diagnosis and management of IgE mediated food allergy in children. It will encompass the emerging technology of component testing; moves to standardization of the allergy food challenge; permissive diets which allow for inclusion of extensively heated food allergens with allergen avoidance; and strategies for accelerating tolerance and food desensitization including the use of adjuvants for specific tolerance induction. Keywords: Child, Food, Allergy, Diagnosis.

Clinical evaluation of pediatric anaphylaxis and the necessity for multiple doses of epinephrine

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Original Article  Open Access

|    Asia Pac Allergy. 2013 Apr;3(2):106-114. English. Published online 2013 April 26.  http://dx.doi.org/10.5415/apallergy.2013.3.2.106  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Clinical evaluation of pediatric anaphylaxis and the necessity for multiple doses of epinephrine Naoyuki Inoue, and Asuka Yamamoto Department of Pediatrics, Inagi Municipal Hospital, 1171 Omaru, Inagi, Tokyo 206-2801, Japan.  Correspondence: Naoyuki Inoue. Department of Pediatrics, Inagi Municipal Hospital, 1171 Omaru, Inagi, Tokyo 206-2801, Japan. Tel: +81-42-377-0931, Fax: +81-42-377-1156, Email: nao2014272@yahoo.co.jp  Received January 08, 2013; Accepted March 25, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background Epinephrine administered intramuscularly is the treatment of choice for anaphylaxis, and more than 1 dose is occasionally required. Objective To determine clinical background of anaphylaxis for improving the treatment, management, and prognosis of anaphylaxis. Methods Children who had satisfied the diagnostic criteria for anaphylaxis according to the National Institute of Allergy and Infectious Disease Food Allergy and Anaphylaxis Network were selected from our hospital from April 1, 2009 to March 31, 2012. Results We analyzed 61 patients from the ages of 2 months to 14 years who satisfied the diagnostic criteria for anaphylaxis. Parents of 32 children (52.5%) reported that they had been administered single dose of epinephrine, and 3 children (4.9%) reported receiving multiple doses of epinephrine. The latter group experienced syncope more often (p = 0.049) than the former and suffered more often from comorbid allergic diseases (p = 0.043) that included either bronchial asthma, allergic rhinitis, or atopic dermatitis. Two (3.3%) children experienced biphasic reactions. Patients who experienced a biphasic reaction were more likely to have experienced syncope (p = 0.033), vomiting (p = 0.02), and administration of multiple doses of epinephrine (p = 0.0016). Conclusion Our findings lead us to recommend that children receiving more than 1 injection of epinephrine should be observed for 24 hours, because it seems that children with requiring more than 1 injection of epinephrine might be have biphasic reactions. Keywords: Epinephrine, Children, Biphasic anaphylaxis, Anaphylaxis.

Chronic cough hypersensitivity syndrome: a series of 12 reviews covering the various aspects of this problem

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Chronic cough hypersensitivity syndrome

Chronic cough remains a clinical problem that most clinicians, whether in general or hospital practice, 

are bound to encounter in their professional lives. The new emerging concept of chronic cough being considered 

as a cough hypersensitivity syndrome may help scientists and clinicians to better understand and treat it. 

At the Seventh International Cough Symposium held in London in July 2013 and supported by Imperial College 

London and by unrestricted educational grants from Proctor Gamble and GSK, many aspects of the cough 

hypersensitivity syndrome were discussed and we have been fortunate to assemble a series of 12 reviews covering 

the various aspects of this problem. The first article focuses on personal reminicenses of Professor John Widdicombe

 who devoted his latter years to understanding the physiology and neural pathways of cough.

Collection published: 6 March 2013

Last updated: 2 May 2013

	Review    Summary of papers presented at the 2012 seventh international cough symposium Peter V Dicpinigaitis, Giovanni A Fontana, Lu-Yuan Lee, Milos TatarCough 2013, 9:13 (2 May 2013) Abstract | Provisional PDF | PubMed
	Review    The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes Jaclyn A Smith, Lesley A HoughtonCough 2013, 9:12 (16 April 2013) Abstract | Full text | PDF | ePUB | PubMed
	Review    The difficult coughing child: prolonged acute cough in children Michael D Shields, Surendran ThavagnanamCough 2013, 9:11 (10 April 2013) Abstract | Full text | PDF | ePUB | PubMed
	Review    Cough, sarcoidosis and idiopathic pulmonary fibrosis: raw nerves and bad vibrations Nicholas Kim HarrisonCough 2013, 9:9 (6 March 2013) Abstract | Full text | PDF | ePUB | PubMed
	Review    Molecular signaling and targets from itch: lessons for cough Pamela Colleen LaVinka, Xingzhong DongCough 2013, 9:8 (6 March 2013) Abstract | Full text | PDF | ePUB | PubMed
	Review    Sensorimotor circuitry involved in the higher brain control of coughing Stuart B Mazzone, Alice E McGovern, Seung-Kwon Yang, Ariel Woo, Simon Phipps, Ayaka Ando, Jennifer Leech, Michael J FarrellCough 2013, 9:7 (6 March 2013) Abstract | Full text | PDF | PubMed
	Review    John Widdicombe’s contribution to respiratory physiology and cough: reminiscences Kian Fan Chung, Jay A Nadel, Giovanni FontanaCough 2013, 9:6 (6 March 2013) Abstract | Full text | PDF | PubMed

Review Article

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Direct and indirect comparison of the efficacy and safety of adalimumab, etanercept, infliximab and golimumab in psoriatic arthritis

1. S. Fénix-Caballero PharmaD^1,*, 
2. E. J. Alegre-del Rey PharmaD¹, 
3. R. Castaño-Lara PharmaD², 
4. F. Puigventós-Latorre PharmaD³, 
5. J. M Borrero-Rubio PharmaD¹,
6. J. F. López-Vallejo PharmaD¹

Article first published online: 17 APR 2013

DOI: 10.1111/jcpt.12045

© 2013 John Wiley & Sons Ltd

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Journal of Clinical Pharmacy and Therapeutics

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Keywords:

• adalimumab;
• etanercept;
• golimumab;
• infliximab;
• psoriatic arthritis;
• therapeutic equivalent

Summary

What is known and Objective

Psoriatic arthritis is an autoimmune disease characterized by chronic inflammation of the skin and joints. Anti-TNF drugs reduce the severity of the disease in the long term. This study compares the efficacy and safety of adalimumab, etanercept, infliximab and golimumab in patients with psoriatic arthritis.

Methods

Direct comparison was based on a literature search of drug comparison studies, whereas indirect treatment comparison was based on phase III clinical trials with biological agents, involving similar populations and durations, and with the same outcome. ACR50 was taken as primary outcome for comparison, whereas ACR20 and ACR70 were used as secondary outcomes. Indirect comparisons were made using infliximab as the reference drug and the Bucher method. In calculating δ (the maximum acceptable difference as a clinical criterion of equivalence), use was made of half of the absolute risk reduction obtained in the meta-analysis of the clinical trials included in the indirect comparison (ARR 32%; δ: 16%). The four anti-TNF drugs were also compared in relation to the secondary outcomes and adverse effects.

Results and Discussion

Reported direct and indirect comparisons of the four drugs did not include golimumab, and did not yield conclusive results. Four clinical trials – one for each drug studied – were identified. The estimated differences for the primary outcome, ACR50, between infliximab and the other drugs were adalimumab (ARR 4%, 95% CI −9·5 to 17·5), etanercept (ARR 4%, 95% CI −10·5 to 18·5) and golimumab (ARR 9%, 95% CI −5·4 to 23·4). Likewise, there were no relevant differences between the drugs in relation to the secondary efficacy outcomes, except for etanercept, which was less effective in ACR70 response. For adverse reactions, there were also no significant differences except for injection site, reactions which were more frequent with etanercept, with a mean difference of 26% relative to infliximab.

What is new and Conclusion

No significant differences were found in ACR50 responses to the four drugs after 24 weeks. Injection-site reactions were more common with etanercept, but this was insufficient to invalidate the inference that clinically the four drugs can be regarded as clinically equivalent for the treatment of psoriatic arthritis.

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