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Hypersensitivity (Allergic) Vasculitis

What is hypersensitivity vasculitis?

Vasculitis is inflammation of blood vessels. It can damage blood vessels by thickening, scarring, and weakening the vessel walls. There are many different types of vasculitis. Some are acute and last a short time, while others can be chronic. Hypersensitivity vasculitis is also known as leukocytoclastic vasculitis. It is typically an acute condition that causes inflammation of small blood vessels. It’s marked by inflammation and redness of the skin that occurs when you come in contact with a reactive substance. About 10 percent of cases of hypersensitivity vasculitis go on to become chronic or reoccurring.

The condition involves the appearance of red spots on the skin, most commonly, palpable purpura. Palpable purpura are raised spots that are often red but may darken to a purple color. However, many other types of rashes can also occur.

Conditions that can cause this skin inflammation include:

  • medications
  • infections
  • cancer
  • any substance that you might have an allergic reaction to

Most hypersensitivity vasculitis is caused by drug reaction. It can also occur alongside certain infections or viruses. In some cases, the exact cause cannot be identified.

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Triggers

Triggers for a hypersensitivity vasculitis reaction

Hypersensitivity vasculitis is commonly triggered by a reaction to a drug. Common drugs linked to hypersensitivity vasculitis include:

Chronic bacterial infections or viruses can also cause this type of vasculitis. These include HIV, hepatitis B, and hepatitis C. People with autoimmune disorders such as lupus, rheumatoid arthritis, Sjogren’s syndrome, and inflammatory bowel disease can also experience this condition. It can also affect individuals with cancer.

Symptoms

Recognizing the symptoms of hypersensitivity vasculitis

The word “vasculitis” relates to blood vessel inflammation and damage. This inflammation and damage causes palpable purpura, the main sign of vasculitis.

These spots may appear purple or red. You’ll most likely find them on your legs, buttocks, and torso. You might also develop blisters or hives on your skin. Hives are potentially itchy bumps that appear on the skin as a result of an allergic reaction.

Less common symptoms and signs you might experience include:

  • joint pain
  • enlarged lymph nodes (glands that help remove bacteria from the bloodstream)
  • kidney inflammation (in rare cases)
  • mild fever

When drug interaction is the cause, symptoms typically appear within seven to 10 days of exposure. Some people may experience symptoms as early as two days after taking certain medications.

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Diagnosis

How is it diagnosed?

A traditional way of diagnosing hypersensitivity vasculitis is determining whether you meet at least three of the five following criteria set forth by the American College of Rheumatology:

  • You are older than 16 years of age.
  • You have a skin rash with palpable purpura.
  • You have a skin rash that is maculopapular (contains both flat and raised spots).
  • You used a drug before developing a skin rash.
  • A biopsy of your skin rash showed that you have white blood cells surrounding your blood vessels.

However, not all experts agree that these are the only criteria necessary to consider when diagnosing this condition. Half of the time organs such as the kidneys, gastrointestinal tract, lungs, heart, and nervous system can also be involved.

Typically, to aid in your diagnosis, your doctor will:

  • evaluate your symptoms and ask about drug, medication, and infection history
  • review your medical history and perform a physical exam
  • take a tissue sample, or biopsy, of your rash
  • send the sample to a lab where it will be analyzed for evidence of inflammation surrounding blood vessels
  • order a variety of blood tests, such as a complete blood count, kidney and liver function tests, and an erythrocyte sedimentation rate (ESR) to measure the degree of whole-body inflammation

Diagnosis and treatment will depend on the cause of your vasculitis and whether infection or inflammation of other organs is present.

Treatment

What are my treatment options?

There is no cure for hypersensitivity vasculitis itself. The main goal of treatment will be to relieve your symptoms. In mild cases, no specific treatment is required.

Talk to your doctor about the medications that you’re taking. This information can help determine the potential cause for your vasculitis. If your problem is traced back to a medication that you are currently taking, the doctor will probably advise you to stop taking it. However, you shouldn’t stop taking any medications without your doctor’s recommendation. Your symptoms should go away within several weeks of stopping the offending medication.

You may be prescribed anti-inflammatory medications, especially if you have joint pain. Typically, nonsteroidal anti-inflammatory drugs like naproxen or ibuprofen are used. If mild anti-inflammatory medications fail to relieve symptoms, your doctor may also prescribe corticosteroids. Corticosteroids are drugs that suppress your immune system and reduce inflammation. Corticosteroids do have a number of side effects, especially when taken for a long period of time. These include weight gain, sudden mood swings, and acne.

If you have more a severe case that involves significant inflammation or involvement of other organs besides the skin, you may need to be hospitalized for more intensive treatment.

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Complications

Complications

Depending on the severity of your vasculitis, you may have some scarring as a result of the inflammation. This is caused by permanently damaged blood vessels.

Less commonly, inflammation of the kidneys and other organs can occur in people with hypersensitivity vasculitis. Most people don’t notice symptoms of organ inflammation. Blood and urine tests can help determine which organs may be involved and the severity of the inflammation.

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Outlook

Outlook

It’s possible for hypersensitivity vasculitis to come back if you are exposed to the offending drug, infection, or object. Avoiding your known allergens will help decrease your chances of having hypersensitivity vasculitis again.

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