IgA vasculitis, IgAV, formerly known as Henoch-Schönlein purpura, HSP, is a common form of vascular disease in childhood. Annual child morbidity rate (6.1 ~ 55.9 ) per 100,000, with the highest annual prevalence among children aged 4-6 (703 per 100,000). The Asian population has a higher incidence and the black population has the lowest incidence]. The IgAV occurs mainly in the autumn, winter and spring, and is rare in the summer, with a male to female prevalence ratio of 1.1 to 1.5 = 1. In the 2012 ICMC classification criteria for vascular disease, it was recommended that the HSP be renamed IgAV, emphasizing the role of Iga-guided immune response in its development. In 2013, the Immunology Unit of the Chinese Medical Clinical Science Branch developed “Evident-based recommendations for the treatment of child allergies”, which has been instrumental in regulating the clinical treatment of children under the HSP. As a result of past disease designations, a number of clinical treatments were misdiagnosed. In 2022, the Immunology Unit of the China Medical Clinical Science Branch, the Editorial Board of the Chinese Paediatric Journal and the China Coalition for Children’s Rheumatizing Immunology invited the Centre for Evidence-based Medicine at the University of Lanzhou School of Basic Medicine to provide guidance on the use of updated classification designations, to follow the methodology and steps developed by the Evidence-Based Clinical Practice Guide and to update the “Guidelines for the diagnosis and treatment of IgA vascular disease among Chinese children” (hereinafter referred to as “the Guide”) for nearly one year, based on the latest research evidence, taking into account clinical practice in the country, with a view to further improving the normative and scientific nature of IgAV consultations and to guide clinical practice.
I. Clinical question 1: How to diagnose IgAV?
Recommendation 1: Recommended to use the final Ankara classification criteria endorsed in 2008 by the European Union against Rheumatism (EULAR), the International Experimental Organization for Childhood Rheumatism (PRINTO) and the European Society for Rheumatism in Children (PPRES), with attention to the identification of unusual cases (GPS).
Clinical question 2: Does the diagnosis of IgAV require abdominal ultrasound, abdominal X-ray and CT tests?
Recommendation 2: It is recommended that abdominal ultrasound, abdominal X-rays be used for the diagnosis of serious digestive tract complications (intestinal folding, intestinal piercing) at IgAV, and that CT tests (1C) be selected if the X-line or ultrasound examination is in doubt.
Clinical question 3: What are the adaptation certificates for the IgAV digestive endoscope examination?
Recommendation No. 3: Children suffering from IgAV are not recommended for regular indigestion endoscopy (GPS), IgAV for severe abdominal pain or internal bleeding (acute haemorrhage or repeated indigestion) or children suspected of IgAV need to be further diagnosed with the use of an indigestion endoscopy (2C).
Clinical question 4: What are the adaptation certificates for IgAV skin work?
Recommendation 4: It is recommended that a dermal biopsy be performed on children who are suspected of a disease or whose skin rash is unusual in order to assist in the diagnosis or exclusion of other pathologies (GPS).
Clinical question 5: What are the adaptation certificates for IgAV kidney examination?
Recommendation 5: The IgAV kidney test is used primarily for clinical evidence of evaluation of the extent of kidney damage and for counselling (GPS) for children with severe kidney problems.
Clinical question 6: What are the certificates for the adaptation of sugar cortex to IgAV?
Recommendation 6: Sugar cortex hormones are applied to IgAV ‘ s gastrointestinal tract suffering [serious abdominal pain and/or haemorrhage in the digestive tract] (1B), arthritis (2B), IgAV ‘ s kidney disease (GPS), severe rashes (rapid progress, haemorrhagic haemorrhagic rashes, ulcer rashes, etc.), vascular edema, testicularitis, encephalitis, pulmonary haemorrhage and other serious organs which suffer or endanger life (1C).
Clinical question 7: Is sugar cortex hormone effective in preventing repeated IgAV rashes?
Recommendation 7: Sugar cortex hormones do not prevent IgAV from repeating rashes and do not recommend the long-term use of sugar cortex hormones to prevent rashes from repeating (1C).
Clinical question 8: Are sugar cortex hormones effective in preventing kidney damage to IgAV?
Recommendation 8: Sugar cortex hormones do not prevent IgAV ‘ s kidney damage and the use of sugar cortex hormones is not recommended to prevent IgAV ‘ s kidney damage (1B).
Clinical question 9: What are the adaptation certificates for other immunosuppressants in IgAV?
Recommendation 9: It is recommended that IgAV severe gastrointestinal tract stress (2D) be used for high-dose sugar cortone hormone treatment or hormonal dependence (2D); cyclophosphate for pulmonary haemorrhage with severe IgAV, high-dose sugar cortex hormone treatment ineffective for severe digestive haemorrhage, cerebrovascular and other severe organovascular diseases (2D). IgAV Nephritis immunosuppressants are recommended for reference to the “Evident-Based Guidelines for the Treatment of Purple Nephritis (2016)” (GPS) developed by the Chinese Medical Clinical Science Group on Renal Medicine.
Clinical question 10: What are the IVIG ‘ s adaptation certificates in IgAV?
Recommendation 10: The IgAV severe gastrointestinal tract (2B), haemorrhagic haemorrhagic herpes (2D) and cerebrovascular disease (2D), which is recommended for use in sugar cortex hormonal treatment, which is ineffective or is forbidden.
Clinical question 11: Is plasma replacement for IgAV effective?
RECOMMENDED OBSERVATION 11: The IgAV treatment is inaccurate, and the IgAV treatment is not recommended for regular use (1C).
Clinical question 12: What are the pre-planned risk factors affecting IgAV?
Recommendation 12: IgAV ‘ s recent prognosis is mainly related to the severity of the digestive tracts and the major organs of the body (GPS); the proximate prognosis is mainly related to the severity of the kidneys (1B).
Clinical question 13: Is IgAV related to food allergies? Is there a need for anti-montamine or anti-allergy medication?
Recommendation 13: There is no evidence that food allergies are the cause of IgAV and no regular application of antitamines or allergies (GPS) is recommended.
Clinical question 14: What should IgAV take into account in its diet?
Recommendation No. 14: It is recommended that children with IgAV be careful to control their diet when their gastrointestinal tracts are exhausted, that children with light abdominal pain IgAV recommend the consumption of light, low slags easily digestive foods, and that those with severe abdominal pain, vomiting or haemorrhage in the digestive tract recommend a moratorium to provide nutritional support (GPS). Long limits on animal protein diet (1D) are not recommended.
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