Subjects
From January to June 2021, 72 children with HSP hospitalized in the department of Traditional Chinese Medicine, Beijing Children's Hospital were enrolled. All children were diagnosed according to the HSP diagnostic criteria formulated by the European anti rheumatism alliance and the European Society of pediatric rheumatology in 2006.5
These patients were divided into the following two groups by whether take animal protein diet: animal protein group (32 patients received animal protein diet programs) and plant protein group (40 patients received plant protein diet programs). Vitamin C were used for intravenous drip injection, and sodium hydrocortisone succinate (2 mg/kg/day, 2 times/day) were given according to whether the patients had abdominal pain and the amount was gradually reduced after the symptoms disappeared. The drug was stopped after 7–10 days, and the symptoms were treated. At the same time, diet was restricted or guide dietary was followed. Children of the two groups were followed up and dietary survey by telephone every 3 days was performed at 8 weeks after discharge.
Conventional restricted diet programs
All patients in two groups received the following conventional diet restriction scheme in this study:
1. It was forbidden to eat raw, cold, hard and other stimulating food or drinks. Three meals a day included porridge, noodles, steamed bread, rice and some salt and oil. Patients were advised to drink warm boiled water.
2. A small amount of one kind of vegetable was added first after discharge, and no new rash appeared 3 days later, then another vegetable was added. Generally, the vegetables were added in the following orders, such as green vegetable, cabbage, tomato, potato, cucumber, and reduce the consumption of vegetables that are difficult to chew, such as broccoli and cauliflower.
3. A small amount of fruits can also be added in the following order such as banana, apple, watermelon, peach, and reduce the consumption of mango, peach and other allergic fruits. The interval between the two kinds of fruits must be > 3 days.
4. In the process of adding food, when skin rash, abdominal pain and other repeated symptoms occurred, it was necessary to stop eating the added food and restart after the situation was considered to be stable.
Plant protein group
1. Bean products were added first after discharge, such as soy-bean milk, tofu, gluten, etc. And no new rash appeared 3 days later, another bean product was added.
2. Animal protein is prohibited during follow-up observation, like fish, shrimp, meat, eggs, milk, etc.
Animal protein group
1. The meats were added first after discharge in the following orders, and no new rash appeared 5 days later, then another meat was added. Generally, the meats were added in the following orders: lean pork, chicken, ducks, and reduce the consumption of fish, shrimp, beef and mutton.
2. After adding meats without new rash for 2 weeks, a small amount of eggs could be added. After adding eggs without repeated rash for 1 week, a small amount of milk could be added in the food. 3. Bean products rich in plant protein is prohibited during follow-up observation.
Record clinical data
The clinical data of the children were collected, including general data, times of skin rash recurrence, the incidence of HSP recurrence, and the incidence of renal lesions.6 The daily protein intake of the children was recorded by questionnaireand followed up for 8 weeks after discharge.
1. Repeated rashes: purpura-like rashes appeared again in batches after the previous rashes were eliminated and cleared.
2. Recurrence of HSP: the children diagnosed as HSP with purpura-like rashes again at least 1 month after the disappearance of the rash; hematuria and/or proteinuria occurred during follow-up. 3. No clinical symptoms of HSP after cure to the end of the follow-up period were determined as non-recurrence.