It’s of great importance to know how certain foods affect HSP’s body. So, we’ve made a list of those 10 foods to avoid, to help you out.
In the following list of foods to avoid, we’ve listed the main effects on an HSP’s body.
Definition of Henoch-Schönlein Purpura
Henoch-Schönlein purpura (HSP) is a condition where there is inflammation of blood vessels. It is one of a family of conditions called vasculitis.
The names of some of the various types of vasculitis are microscopic polyarteritis, Wegener’s granulomatosis, Henoch-Schönlein purpura, and polyarteritis nodosa.
Causes of HSP
The cause is immunological. That is, the white blood cells and antibodies (natural defences) that are present to fight off infection are damaging the body by mistake.
The body’s defences against infection are very powerful and many diseases are due to their overactivities such as asthma, rheumatoid arthritis, and diabetes in young people.
In HSP, blood vessels, in particular, are damaged. Doctors do not understand fully why this happens and the condition is quite rare. HSP with kidney involvement affects 5-10 people per million population per year.
The trigger that starts HSP varies from person to person. Sometimes it is a ‘flu-like infection’, sometimes it appears to be an operation or a bacterial infection.
The condition is commoner in the spring and autumn than in the summer and is commoner in younger people, unlike other types of vasculitis which are commoner in older people.
Symptoms of HSP
These are variable and almost every case is different from each other. Often the only symptom is a feeling of tiredness and general ill-health.
Blood vessels in all parts of the body can be affected; here are some of the commoner symptoms:-
- Skin: small blood vessels in the skin can become damaged by HSP, causing them to burst, causing a rash with small red blotches. This is most commonly seen on the lower legs and the buttocks.
- Kidneys: the specialised small blood vessels in the kidney which filter blood to make urine seem especially sensitive. The damage to the kidney can cause blood to appear in the urine as well as kidney failure in severe cases.
- Joints: inflammation around the joints can cause pain and stiffness.
- Other parts of the Body: abdominal (tummy) pain is quite common in HSP, and although almost every part of the body may be affected in some cases of HSP, the majority of cases are restricted to the skin, kidneys, joints, and tummy.
Treatment
In some cases, especially if there is no involvement of the kidneys, the condition may go away on its own without the use of drugs other than simple painkillers if the joints are inflamed.
Steroid (prednisolone) treatment is required in some cases.
The easiest way to see if there is kidney involvement in HSP is to test the urine for blood with a dipstick. If this is negative, the kidneys are unlikely to be involved.
If it is positive, blood tests to measure the function of the kidneys will give an indication as to the severity of involvement. If there is a suspicion of severe kidney involvement, a kidney biopsy may be advised.
If there is kidney involvement, treatment may be advised with a combination of steroids (prednisolone) and cyclophosphamide.
These are both powerful drugs that reduce the activity of the immune system, reducing the activity of HSP. High doses of these drugs are normally given for the first 3-6 months after which doses are reduced to maintenance levels.
Some treatment is needed for at least 2 years.
These drugs can cause serious side effects and very careful monitoring is required for the sake of safety. The main side effect is infection.
There is a risk of severe urine infection or pneumonia during the first few months of treatment and any fevers or possible infection should be reported urgently to your doctor.
Dos
Unfortunately, it seems there is nothing you can do in your lifestyle or diet that will stop you from getting HSP. Similarly, there is little you can do that would prevent you from getting a relapse.
However, what you do still makes an enormous difference to your health:-
- Remember to take your medication at the times prescribed. Doctors often change the doses of tablets, so make sure you know exactly what has been advised. If in doubt about the dosage of tablets, ’phone up your Doctor and check.
- Report possible complications of treatment such as symptoms of infection at an early stage.
- Take regular exercise. People with HSP lose a lot of muscle strength during illness. Ask for advice about sensible regular exercise.
- Eat well. You will probably lose some bodyweight with HSP in its early stages. Even if you have a weight problem, this weight loss is usually a bad thing, because it is your muscle and not your fat that is lost. Please take advice from the renal dietitians about regulating your diet properly.
Long-Term Outlook
Most people with HSP recover completely and do not get problems with their health in the future. A few people get recurrent attacks of rash and joint pain, sometimes with kidney involvement.
These may merit treatment with steroids but may settle down over a period of a couple of years.
Occasionally there seems to be more severe damage of the kidneys, either with large amounts of protein in the urine, or a reduced level of kidney function on blood tests.
If this happens, the blood pressure should be treated intensively, and further consideration will be given to the possible value of steroids in protecting the kidneys against severe long-term damage.
However, this circumstance is rare, and many people have perfectly normal long-term kidney function, even if they have low levels of protein in the urine.
Supportive Management
Treatment of IgAV is primarily supportive and includes ensuring adequate hydration and monitoring for abdominal and kidney complications.
For minor complaints of arthritis, edema, fever, or malaise, symptomatic treatment is advised, including the use of acetaminophen, the elevation of swollen extremities, eating a bland diet, and adequate hydration.
All unnecessary drugs should be discontinued if a drug-related etiology is suspected.
Most patients with self-limited cases can be safely discharged home with close follow-up by the primary physician.
The decision for or against hospital admission depends on the physician’s customary practice and individual preference.
Admission to the hospital is recommended for control of abdominal pain or vomiting, monitoring of kidney function, confirmation of a doubted diagnosis, and observation and monitoring.
Patients with kidney involvement require close attention to their fluid balance, electrolyte status, and use of antihypertensives (if indicated).
A study examining prevention and treatment of kidney disease in patients with IgAV revealed no significant difference in the risk of persistent kidney disease at 6 months and 12 months in children given prednisone for 14-28 days upon presentation in comparison with placebo or supportive treatment.
Also, no significant difference was noted in the risk of persistent kidney disease in children given cyclophosphamide compared with supportive treatment and with cyclosporine compared with methylprednisolone.
Standard Therapies
Therapy
If individuals are thought to have HSP as the result of an allergic reaction, they must strictly avoid the offending substance (e.g., food or drug).
When evidence of streptococcal infection is present, antibiotic therapy is prescribed. Mild childhood cases of the disease often improve spontaneously with advancing age.
There is no specific treatment, however, in most patients, the disease has a limited course and the outlook for recovery is good.
If non-steroid anti-inflammatories fail to relieve symptoms, some patients may be treated with glucocorticoid (steroid) drugs such as prednisone.
These drugs may be useful to help control acute abdominal and joint pain. In some cases, swelling of soft tissues (angioedema) may be helped with steroid drugs.
Dapsone may be prescribed when prednisone is contraindicated or fails to relieve symptoms. The use of steroids to treat this disorder remains a matter of controversy in the medical literature.
Some research indicates that steroids do not shorten the length of the illness or reduce the frequency or recurrence of symptoms.
Other studies indicate that early steroid treatment may help to reduce the risk of kidney damage.
Patients with HSP who have advanced kidney disease and renal failure will probably benefit from mechanical cleansing of the waste products from the blood (hemodialysis).
Aggressive and supportive care may be necessary during an acute kidney crisis. Some patients with severe kidney disease have undergone kidney transplantation.
However, the disease can recur in the transplanted kidney. Another treatment is symptomatic and supportive.
Investigational Therapies
Experimental treatment with a combination drug therapy of anticoagulants (i.e., heparin and acenocoumarol), corticosteroids, and immunosuppressants has been tested on adults with severe cases of HSP.
Further studies are needed to determine the long-term safety and effectiveness of this form of therapy for the treatment of this disorder.
Plasmapheresis as a means of removing unwanted substances (toxins, metabolic substances, and plasma parts) from the blood has also been tried experimentally.
Blood is removed from the patient, and blood cells are separated from plasma. The patient’s plasma is then replaced with other human plasma and the blood is transfused back into the patient.
This therapy is still under investigation to analyze side effects and effectiveness. More research is needed before plasmapheresis can be recommended for use in all but the most severe cases of HSP.
Intravenous immunoglobulin (IVIG) has been used on an experimental basis to treat some children with severe abdominal pain associated with HSP.
Further research is needed to determine the long-term safety and effectiveness of immunoglobulins for the treatment of this disorder.
Diet and Sensible Eating for Vasculitis Patients
A healthy diet is important for vasculitis patients, especially for those who are struggling with food intake.
Healthy eating will, by definition, help anyone who has diabetes or who has gained weight and wants to do all they can nutritionally to stave off infection and disease long term.
Some vasculitis patients will require a special diet and this will be arranged via the hospital dietician. It is important to adhere to this regime.
For those with kidney involvement, you may find the kidney care cookbook “Rediscovering Food and Flavours” from Kidney Research UK helpful.
This cookbook was created by TV Chef Lawrence Keogh, Head Chef at Roast and BBC’s Saturday Kitchen along with Renal Dietician, Diane Green.
The book contains 16 recipes. It is now available free of charge from local Dieticians for patients who need to control their diet due to chronic kidney disease. It can be downloaded at Kidney Research UK
If you do not need a special diet, you should aim to cut down on starchy foods – bread, potatoes, rice, and pasta, replacing these with fresh fruit and vegetables.
You should also avoid processed food and grain-fed meat. The omega 3 fats in oily fish such as salmon, mackerel, trout, and sardines are beneficial in autoimmune disease.
Also, omega 3 can be found in flaxseed, walnuts, and green leafy vegetables.
Omega 3 fish oil supplements containing EPA and DHA can be helpful. However, it should be noted that these do react with some medication.
These, and other supplements, should not be taken without discussion with your doctor or nutritionist.
A sensible eating regime should be adopted especially for those patients taking steroids. This will help control weight gain.
Excessive dieting is not recommended for vasculitis patients. Also, when taking steroids there is an increased risk of developing osteoporosis.
Increased calcium in the diet can help prevent osteoporosis from developing. Eating broccoli, yogurt, skimmed milk, and tinned sardines are recommended.
Where the drug regime allows the drinking of alcohol this should only be in moderation. There are some immune-suppressant drugs where drinking alcohol is contraindicated.
Your doctor will discuss this with you if it is relevant in your case.