| ObjectivesThis study aims to study the value of Montelukast in clinical treatment of children with allergic pupura by applying Montelukast to children with allergic purpura and observing the subsequent alleviation of the rash and the change of blood-related indicators.Methods1.Study population:42 cases with allergic purpura treated in our hospital from September to December 2003 were chosen, among which 25 were male and 17 female, aging from 2.5 to 14 years old. Of all the cases,17 happened in winter,12 in spring,9 in autumn and 4 in summer. The 42 cases were divided into a test group of 22 cases and a control group of 20 cases. There were no significant statistical differences(P> 0.05) between the age, gender, course of the disease, cause and clinical symptoms of the disease in the two groups, and therefore they were comparable.2.specimen collection and lab examination:all patients were given blood test, urine test and stool examination after their admission into the hospital. Every morning before any meal and drink,5～10ml blood was drawn from all patients, which was not given any anticoagulation treatment but stored at 4℃for an hour. When the blood became coagulant, lab examinations of the liver function, immunoglobulin, ESR, ASO, compliments and C reactive protein were performed.3.methods:treatment of the control group:the control group was given conventional comprehensive treatment.(1) bed rest during the acute stage, avoidance of second contact and withdrawal of suspicious food and drugs for cases with clear allergen, anti-infective treatment for cases with significant infection, spasmolytic treatment for cases with stomachache, and liquid food or no food for cases with gastrointestinal blooding.(2) all cases were given anti-allergic treatment, i.e. Cimetidine 20～40mg/kg.d, first intravenously dripped in two doses with glucose solution, and then changed to 15～20mg/kg.d in three doses with oral calcium after 1～2 weeks.(3)for cases with stomachache, hemorrhage of digestive tract and arthralgia, Prednisone 1～2mg/kg.d was prescribed to be taken orally in several doses every day, and when the symptoms were relieved, Prednisone was taken every other day in smaller doses. This usually took 2～3 weeks. (4) anti-platelet aggregant drug Dipyridamole 3～5mg/kg.d was prescribed to be taken orally in doses. (5) herbal medicine for better blood circulation. With other prescriptions the same, anti-allergic drugs for the control group was substituted by Yu Lu Sterling for the test group (Singulair, by Merck Sharp & Dohme),4mg/d for patients 2-6 years of age, and 5mg/d for patients 6～14 years of age, which was taken daily before sleep. When conditions were under control, only Yu Lu Sterling was used.Results1. The effective rate of the test group (95.5%) was superior to that of the control group (80.0%), yet the comparative difference between the two groups was of no statistical significance (P>0.05). However, the apparent improvement rate of the test group (72.3%) was markedly higher than that of the control group (40.0%), and the difference was of statistical significance (P< 0.05).2. comparison of time for rash alleviation:rash alleviated after 11.42±3.71 days of treatment for the test group, and 14.36±5.05 days for the control group. This difference was of statistical significance (P< 0.05).3. comparison of rash recurrence:rash recurred to 9 cases in the test group and 18 cases in the control group. The effectiveness of treatment for the test group was markedly superior to that for the control group, and the difference was of statistical significance (P< 0.05).4. comparison of other clinical manifestations:the possibility of arthragra, stomachache and vomiting and the remission rate of cases with kidney damage after 2 weeks'and 4 weeks'treatment showed no significant difference(P>0.05).ConclusionThe competitive combination of LTs receptor antagonist Montelukast and LTs receptors can suppress the vasculitic reaction of allergic purpura during the acute stage, shorten the time for the alleviation of allergic purpura rash, and reduce the chance of its recurrence. The critical role of Montelukast in the prophylaxis and treatment of other allergic illness needs further research. |
