Allergic vasculitis

Synonyms for allergic vasculitis are vasculitis hyperergica cutis, leukocytoclastic vasculitis, arteriolitis allergica cutis, and necrotizing angiitis. 

The hemorrhagic type is the commonest and conforms to the classical picture of Schonlein-Henoch purpura. The main feature of the condition are petechial haemorrhages, ranging from pinhead- to coin-size and appearing preferentially on dependent parts of the body. Urticarial lesions may accompany the purpura. In severe cases there are also vesicular, bullous, and ulcerating lesions. 

In the rarer papulonecrotic type the predominant feature are inflammatory nodules which have central necrosis and leave depressed scars when they finally heal. 

The third variant is characterized by urticarial, papulohemorrhagic, and nodular lesions in conjunction. 

In their review, Scherer and Wolff (1979) list various groups of drugs which have been recognized as causes. The list includes insulin, penicillins, hydantoins, phenothiazines, sulfonamides, phenobutazone, and quinine (Paschoud 1966). 

---

Hypersensitivity reactions Anaphylactic reactions and other allergic reactions have been reported. Cutaneous allergic reactions and serious cases of allergic vasculitis, often with purpura (bruises and red patches), of the extremities and extracutaneous P.1215... 

Adverse effects include hypoglycemia, temporary visual impairment, gastrointestinal disturbances. Rarely leucopenia, haemolytic anaemia. Occasionally allergic or pseudoaUergic reactions like itching, urticaria or rashes. In isolated cases allergic vasculitis, photosensitivity or a decrease in serum sodium may occur. 

Adverse drug reactions can be classified simply according to their onset or severity. ADRs are occasionally classified as acute/ subacute/ or latent. Acute events are those observed within 60 minutes after the administration of a medication and include anaphylactic shock/ severe bronchoconstrictioii/ and nausea or vomiting (17). Subacute reactions occur within 1 to 24 hours and include maculopapular rasly serum sicknesS/ allergic vasculitiS/ and antibiotic-associated diarrhea or colitis. Latent reactions require 2 or more days to become apparent and include eczematous eruptions/ organ toxicity/ and tardive dyskinesia. 

Allergic vasculitis e.g. sulphonamides, NSAIDs, thiazides, chlorpropamide, phenytoin, penicillin, retinoids... 

In 1988 the Federal German Health Authorities issued a warning about fixed combinations of the thiazide bemetizide and triamterene that they could cause allergic vasculitis (2). Thiazides can occasionally cause allergic vasculitis and it is not clear on what basis the combination might be more likely to cause the same problem. 

Anonymous. Bemetizide/triamterene warning of allergic vasculitis. WHO Drug Inform 1988 2 148. 

Allergic vasculitis has been reported in association with various NSAIDs, and has been attributed to celecoxib (129,130), including one case with a fatal outcome (131). 

Jordan KM, Edwards CJ, Arden NK. Allergic vasculitis associated with celecoxib. Rheumatology (Oxford) 2002 41(12) 1453-5. 

Schneider F, Meziani F, Chartier C, Alt M, Jaeger A. Fatal allergic vasculitis associated with celecoxib. Lancet 2002 359(9309) 852-3. 

In a patient who developed an allergic vasculitis affecting the skin during long-term treatment with hydrochlorothiazide the findings suggested that immediate (Type I) hypersensitivity may be involved in the induction of vasculitis (29). 

Grunwald MH, Halevy S, Livni E. Allergic vasculitis induces by hydrochlorothiazide confirmation by mast cell degranulation test. 

Late reactions can present as allergic vasculitis (characterized by damage to the blood vessels and skin), pupura pigmentosa (a discoloration of the skin). 

Table 14. Drugs frequently involved in allergic vasculitis. (Van Arsdel 1978 Parker 1980)...

Mayer RL (1955) Group sensitization to compounds of quinone structure and its biological basis role of these substances in cancer. Prog Allergy 4 79 Me Combs RP (1965) Systemic allergic vasculitis. JAMA 194 1059 Me Combs RP, Patterson JF, Mac Mahon HE (1956) Syndromes associated with allergic vasculitis. N Engl J Med 255 251... 

The form of purpura noted under the first heading is dealt with in the section on allergic vasculitis. Drug-induced thrombocytopenic purpure is of allergic na-... 

Fries and Hirschfeld (1977) observed purpura based on allergic vasculitis with arthritis at normal thrombocyte values and intact coagulation factors after cotrimoxazole in a 71-year-old man. 

---