Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study.
BACKGROUND
Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population.


METHODS
An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record.


RESULTS
During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0).


CONCLUSIONS
This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.
Department of Woman and Child Health, University of Padua, Padua, Italy.
Liviana
L
Da Dalt
Pediatric Department, Treviso Hospital, Treviso, Italy.
Claudia
C
Zerbinati
Pediatric Department, Treviso Hospital, Treviso, Italy.
Maria Stefania
MS
Strafella
Giannina Gaslini Children Hospital, Genoa, Italy.
Salvatore
S
Renna
Giannina Gaslini Children Hospital, Genoa, Italy.
Laura
L
Riceputi
Giannina Gaslini Children Hospital, Genoa, Italy.
Pasquale
P
Di Pietro
Giannina Gaslini Children Hospital, Genoa, Italy.
Paola
P
Barabino
Department of Woman and Child Health, University of Padua, Padua, Italy.
Stefania
S
Scanferla
Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Umberto
U
Raucci
Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy.
Nadia
N
Mores
Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy.
Adele
A
Compagnone
National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy.
Roberto
R
Da Cas
National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy. francesca.menniti@iss.it.
Francesca
F
Menniti-Ippolito
D000293:Adolescent; D017677:Age Distribution; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011695:IgA Vasculitis / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D007558:Italy; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000009:adverse effects*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D015203:Reproducibility of Results; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric
D022542:Measles-Mumps-Rubella Vaccine; D004364:Pharmaceutical Preparations
Adverse drug reaction; Children; Henoch-Schönlein purpura; Vaccine