Hypersensitivity vasculitis in children
- David Cabral, MBBS, FRCPC
David Cabral, MBBS, FRCPC
- Clinical Professor of Pediatrics, Head, Division of Rheumatology, Department of Pediatrics
- University of British Columbia
- Kimberly Morishita, MD, MHSc, FRCPC
Kimberly Morishita, MD, MHSc, FRCPC
- Clinical Assistant Professor of Pediatrics
- Division of Rheumatology, Department of Pediatrics
- University of British Columbia
The term "hypersensitivity vasculitis" refers to a vasculitis of small blood vessels of the skin that is secondary to an immune response or hypersensitivity reaction to an often unidentifiable exogenous substance. Names often used interchangeably, but controversially, have included drug-induced vasculitis, cutaneous leukocytoclastic vasculitis, cutaneous small-vessel vasculitis, serum sickness, and allergic vasculitis. Over time, the term "hypersensitivity vasculitis" has become less commonly used since it is not included in either the 1994 or the 2012 Chapel Hill Consensus Conference Nomenclature for systemic vasculitis [1,2]. Under this nomenclature system, hypersensitivity vasculitis may be more appropriately categorized as cutaneous arteritis (when isolated to the skin) or under other categories of systemic vasculitis, such as "vasculitis associated with probable etiology" when a triggering agent (eg, infection or drug) can be identified. (See "Vasculitis in children: Classification and incidence".)
Serum sickness and serum sickness-like reactions share clinical and pathologic features with hypersensitivity vasculitis; however, many cases do not have actual vascular inflammation. Serum sickness and serum sickness-like disorders are presented separately. (See "Serum sickness and serum sickness-like reactions".)
Hypersensitivity vasculitis in children, including the clinical features, diagnosis, and treatment, is reviewed here.
There are no pediatric-specific classification criteria for hypersensitivity vasculitis . All available systems are based upon adult data. The most commonly used system is that of the American College of Rheumatology (ACR)  (see 'Drugs' below). Children were explicitly excluded when the ACR criteria were proposed in 1990 due to the lack of pediatric data. In the absence of clearly superior alternatives, the ACR criteria are nonetheless commonly used in children.
The ACR criteria for hypersensitivity vasculitis are as follows:
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- CLINICAL MANIFESTATIONS
- LABORATORY FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Henoch-Schönlein purpura (IgA vasculitis) (HSP [IgAV])
- Malignancy-associated vasculitis
- Systemic vasculitides
- Other rheumatic diseases
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS