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TOPIC: Allergies that Cause ITP

Allergies that Cause ITP 6 years 4 months ago #29246

  • John
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If you google "Allergies and ITP", one of the links that comes up is this:

www.ehow.com/how-does_5497601_allergies-cause-itp.html

Now I don't know who wrote this, but to me this makes a ton of sense. I look back at my ITP experience and I say yeah, that is the way it works. Some may disagree with this interpretation, but I have enough experience to understand my ITP condition and relationship with my allergies or intolerance's.

I quote:

Relationship to Allergies
In the case of allergies, the immune system mistakes benign substances such as pollen or cat dander as a pathogen seeking to infect or harm the human body. The immune system responds by producing an excess of antibodies, or cells designed to destroy the invader. B cells are produced as well. Their function is to designate the invader which the antibodies are to attack. As the number of allergens entering the human body increases, the immune system increases production of both antibodies and B cells to a degree where both become redundant. At this point, it's possible for the B cells to begin designating "friendly" cells for destruction; such is the case with ITP. It should be noted that this is different than the sudden release of antibodies as experienced during anaphylactic shock, in that the number of antibodies slowly increases over time.

Does Any One Allergy Cause ITP?
No one allergy causes ITP. It is important to understand that allergies are cumulative. Your body may ignore one allergen, and the same for two. But the third might trigger an allergic response such as itchy eyes and nasal congestion. A fourth could worsen the allergic response so badly as to produce seizures, and so on. The proposed cause of ITP is that the threshold of allergic response in your body is slowly exceeded, and then surpassed by a significant margin. To that end, a person might be allergic to cat dander, pollen, wheat gluten, mold and dust mites. She can come into contact with four of these allergens with only a mild reaction, but the fifth could exceed the proposed threshold and cause ITP.


So to my history. I had a severe reaction to penicillin when I was in mid-high school. My face blew up and I was unrecognizable. Thus being very allergic to penicillin, I've never taken the stuff since. And at a young age I learned what its like when things go awry with your immune system.

I have dust allergies that I never took seriously but do today. For example I swept up the garage (without a dust mask) recently after some renovation work. I broke out immediately with hives on my chest. I also needed to crawl in the attic for several days to improve the insulation. Despite using a dust mask, I noticed I bruised easily not long after.

I am very sensitive to strong oxidants like chlorine and bromine. I learned a long time ago to avoid heavily chlorinated public swim pools. Everytime I go for a swim in our pool (where I control the chlorine level very tightly using an ozone system as primary treatment), I still sneeze persistently after being in the pool water. And hot tubs are definitely out (the bromine levels are usually very high and you are stewed in it)! I once worked in industrial settings with hypochlorite, so my sensitivity to such oxidants probably dates back almost 30 years. In fact I am sure that my working with such chemicals caused my first ITP symptoms to appear back then.

Now I realized last year that I have a gluten intolerance. I was never aware of the problem before, but it definitely was causing a lot of inflammation in my gut. Even now, if I have a little gluten somehow in a food, I will feel my stomach tighten within the hour.

As the article points out, it is not one particular allergy or factor that will cause ITP outright, but some combination that will ramp your immune system to the point of no return (ie. full blown ITP symptoms and subsequent platelet crash). And once you are in that situation, it takes a lot to cycle down your immune system.

IMO, anyone with ITP must be very self-aware and understand what environmental factors (ie. which cause allergic reactions) can be at play.

cheers,

john
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Allergies that Cause ITP 6 years 4 months ago #29257

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When I click on the authors name to the article, I have to question his scientific or medical knowledge.

John Albers has been a freelance writer since 2007. He's successfully published articles in the "American Psychological Association Journal" and online at Garden Guides, Title Goes Here, Mindflights Magazine and many others. He's currently expanding into creative writing and quickly gaining ground. John holds dual Bachelor of Arts degrees from the University of Central Florida in English literature and psychology.


He may be right, but it's not a fact we can state as the research is ongoing. The ITP experts from the Las Vegas ITP Convention talked about the research on T-cells, B-cell, and immunity and the leading theory was a non-related trigger like a virus or allergy. Many of us may have stories that could lead to this conclusion and on the other hand it might only be that once you have one autoimmune condition, your likely to have more.
"I am an old man and have known a great many troubles, but most of them have never happened.\" — Mark Twain\\\\\\"Worry is a misuse of the imagination.\" — Dan Zadra

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Allergies that Cause ITP 6 years 4 months ago #29262

  • Ann
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Several facts in the article are wrong. Haemophilia, he says is the result of few platelets, and we know that's not right. Haemophilia is a lack of factor VIII or less commonly another factor. Also he says that in ITP there is no problem producing platelets, which is not true. ITP is generally a production and a destruction problem.

The study by the UK ITP Support Association into food sensitivities and ITP hasn't so far come up with any connection but the study is ongoing and they may find something eventually.

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Allergies that Cause ITP 6 years 4 months ago #29267

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As I said, I was not sure of the author's medical authority. What I liked is how John Albers wrote it in lay person's terms that makes sense to me.

No study will likely find the connection between allergies and ITP, or at least it will take a very long time IMO. Once your immune system is in full fight mode, producing antibodies that will target good cells for destruction (ie. platelets), you are heading for or are in a full fledged ITP crisis. Nothing will seem to work for you other than the lines of treatment offered by a hematologist (ie. IVIG, prednisone, etc.). There is no measured direct cause and effect that can be studied for ITP. It is a combination of factors that leads you to getting ITP. What makes ITP so complex is that the factors will vary from person to person, thus establishing a link will be very difficult. Its no surprise then that we have not unequivocally found the cause of ITP.

Once you are beset by severe ITP symptoms, any link to your allergies or food intolerances will be completely overwhelmed by the mechanisms of ITP. Your immune system is raging. And it can persist a long time unless you deal with the underlying causes.

I'm not a medical expert of any kind. I am a chemical engineer who was trained to solve problems throughout my career. There are answers and ways to deal with ITP outside of what is offered by the medical community. I have lived it and experienced success as chronicled in another thread.

I knew there would be objections to the interpretation presented in this article. But I think there is something important to understand here based on my long experience with ITP.

cheers,

john

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Allergies that Cause ITP 6 years 4 months ago #29271

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John, we're not saying that your conclusions don't have merit. I think they do and they align with some of my own experiences with overall well being and allergies. The stories and alternative medicine portions of this site are incredible.

What I want to do is caution new comers who will read this article that there are lots of sites that claim to be Medical Knowledge sources that can state things as if they were facts and/or not present disclaimers. Most good articles will have links or citations to what research is available. It's healthy that those of us who have been around awhile present both perspectives so the anxious new people are aware.
"I am an old man and have known a great many troubles, but most of them have never happened.\" — Mark Twain\\\\\\"Worry is a misuse of the imagination.\" — Dan Zadra

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Allergies that Cause ITP 4 years 5 months ago #44121

  • ant1862
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OMG!..my wife and I have been thinking that our sons allergies have been causing his ITP for years, but the hemo docs all keep saying no!...so we went to some allergy specialists, and they said yes it is possible, but they have no records of it...probably because ITP simple isn't studied enough....but now because of this im going to take the allergy thing more serious & see how I can calm his allergies down, thanks much.

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Allergies that Cause ITP 4 years 5 months ago #44134

  • John
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Hi Ant,

It likely won't be just allergies that are promoting your son's ITP condition. There might be other undetected issues as well. I do believe that it is usually a combination of factors that lead to the development of ITP conditions. And I would suggest that your son might also have a predisposition (ie. for example my mother always bruised really easily and so did I when I was a kid).

But at the end of the day it is your immune system and how it responds to different stimulus and allergens that can really cause big issues. Pls check out the article (by Ed Conley) that is pinned at the top of this forum for things to consider.

And if you are not making any progress and want to avoid the drug therapies, homeopathy is worth a go with the right practitioner.

And the most important thing is that for your son to see a real change in his ITP condition and immune system response, it takes time to have various changes take effect. So going gluten free, using probiotics, discovering and eliminating various allergens all require some time before real lasting benefits can be expected. At least that is my experience.

GL.

cheers,

john

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Allergies that Cause ITP 4 years 4 months ago #44707

  • LadyNole
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John,

I am glad I came across your post. My doctors did extensive digging into my background and life after I was diagnosed with ITP. I had every test under the sun, then my profession came into question. I was around many dangerous chemicals and exhaust fumes from diesel and gasoline trucks/vehicles for hours every day, 6 days a week. My doctors believe that is what set my immune system off and caused the development of my ITP. Unfortunately, there is nothing they can do to "cure" me so now I am extremely aware of what I am surrounded by and what is in my soap, shampoo, toothpaste, etc.

I'm glad someone else sees a correlation between chemical exposure and ITP. Have you connected with anyone else who had come to the same conclusion? In my case, most people end up with cancer. I am praying that I will only have to face ITP for the rest of my life.
FSU Alum, using the unconquered spirit to beat ITP.

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Allergies that Cause ITP 4 years 4 months ago #44745

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Hi LadyNole,

I think it is the fact that I have had ITP so long, that I am aware of environmental factors, and yes they can cause problems. I can't recall someone saying something specific about this cause and effect relationship with chemical exposure.

Chlorine to me is something that can put me over the edge. What I mean by this is that enough factors (allergens, inflammation, etc.) are present to stimulate my immune system to the point that I begin to show an ITP response (excessive bruising, petechiae, etc.). So in my mind it is not just the chemical exposure in of itself, but it is likely the last straw before your immune system starts to ramp up, and if unchecked, you are heading for an ITP event of some kind. And why do some develop ITP and others don't? That I would leave to genetics.

I am thinking back to when things started to go really wrong in early 2011. After nearly 20 years of ITP and a successful splenectomy, I never expected anything like this. No doubt I had lingering issues leading into this period, but I remember that I was at my dentist and she insisted on having some old fillings replaced, the ones with silver mercury fillings. I think proper precautions were not taken and I ingested some mercury. Just this alone I believe could have set me off. However, at the time I was already starting to not feel right (no apparent ITP symptoms though), and some time after this dental work I started having severe ITP symptoms. It took me the better part of two years to recover completely from this.

So environmental factors are very important and should not be ignored if you have ITP.

cheers,

john

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Allergies that Cause ITP 3 years 5 months ago #51501

  • garylouisville
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Don't want to comment on the specific posts but as far as the subject line goes I can say that I have been in remission for 15 years now by doing allergy shots. It worked for me.

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Allergies that Cause ITP 3 years 5 months ago #51548

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Hey Gary,

Great to hear from you and thanks for piping in. I look back and I think this thread's topic is fundamental for most ITPers. This idea of inflammation issues (allergies/intolerances) ramping up our immune system is core to our ITP. When we see hematolgists and GPs treat very hard with corticosteroids and very hard drugs, what are they doing? Simply trying to ramp down the immune system. But if you are unaware/ or do not understand this mechanism, you will be lost as most people are. Hard to see it if you have not been down this long road as we have (and seen the other side of the tunnel). I take a potent probiotic daily and I find this helps with modulating any immune reactions (like something as simple as dust).

I am doing incredibly well. 2011 is but a dot in my rearview mirror and I will update on my next medical. For the record. :)

cheers,
john

BTW I should add that I am definitely allergic to chlorine. I can tolerate various levels of chlorine in our backyard pool now and I often handle it (with gloves) to treat the pool. Something I would have not thought possible a few years ago. How do I know chlorine is an issue? My nose is very irritated and I sneeze frequently immediately after the fact. This often happens after swimming in the pool with elevated chlorine levels.

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Allergies that Cause ITP 3 years 5 months ago #51550

  • garylouisville
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You actually brought up something that I hadn't totally considered myself, even though I knew it. I always assumed that since my allergy shot treatment works for my ITP that it was related to fall pollens and molds since I was mildly allergic to several of them and I would have ITP relapses every fall. But, I am also mildly allergic to several other things that are in my shots as well, such as dust mites, animal dander, etc. Since my allergy symptoms were so very mild it took me listening to friends and relatives several years before I would even acknowledge that I might even have allergies.

Anyway, what I was trying to say is that you are 100% right that whatever the triggers are for any autoimmune disease, they are often cummulative. Just one is often not responsible. A lot of this probably also has to do with a genetic predisposition. You may never come down with a particular autoimmune disease unless the right trigger or triggers present themselves (this could also include viruses or just about anything, not necessarily allergens). You might come across trigger one and nothing happens. Trigger two nothing happens. Maybe even trigger three nothing happens. But present triggers 1-4 all at once and whammo - an autoimmune disease starts.

What probiotic do you take? There is a lot of research going on now about various bacteria all over and in the body and their effects on many aspects of the body, including inflammation, which seems to be a component to many autoimmune diseases.

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Allergies that Cause ITP 3 years 5 months ago #51552

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Gary,

Yes the cumulative effect of many factors I think is key. I think allergies play a big role and I also never considered myself as having many allergies. I started to pay more attention and realized there were many which included something as simple as dust (and whatever might be in it).

I take Udo's Choice Super Plus probiotic (25 billion viable cells). It has to be refrigerated.

cheers,
john

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Allergies that Cause ITP 3 years 5 months ago #51553

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Gary, John and all- This is very interesting information. Thanks for sharing your personal research and recovery!

Gary, you mentioned (in another post)you avoid histamine causing foods- what specifically?

I notice sometimes I am itchy in my mouth and throat when I eat almonds, walnuts, bananas, avocados. I suppose that is an allergic reaction. I eat them anyway mixed with other foods to avoid the itching, but thinking perhaps I should not.

I am thinking about changing my diet but don't know where to start. I have quit sugar for the most part and feel much better. It hasn't affected my ITP but I am motivated to try some other kind of food elimination. If nothing else, perhaps my overall health and energy will improve.

I have always had allergies- cats, pollen, hay fever. I break out when I touch some plants, spruce, evergreen trees. Do you think going to an allergist is a good first step? I haven't been to one since I was six- was told I had dust and mold allergies. Thanks!

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Allergies that Cause ITP 3 years 5 months ago #51554

  • garylouisville
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When I first discovered my histamine intolerance problem I avoided high histamine foods. You can find lists on the internet as there can be many. My worst was pizza, tomato sauces recipes, cheddar cheese, chocolate, fruits, and fruit juices. Of course there were others. Certain nuts, bananas, and avocados can be high in histamines. At first I eliminated these things from my diet but then I discovered the enzyme DAO, which I buy from Swanson. You can't buy it in stores. There is another product which is called Histame which not only has DAO but Vit C as well. The DAO helps metabolize dietary histamines. Bodies normally have DAO but if you are deficient in it then you can have this histamine intolerance problem. I put the DAO to the test one day by taking several capsules before ingesting a high histamine meal and not a thing happened! Now I take DAO regularly with every meal and at other times when needed and have zero problems. I do try to avoid eating too much histamine and have forever eliminated orange juice from my diet but overall I do eat almost anything I want now.

I think going to an allergist is a great first step. Let them do the skin prick test on your back. Don't settle for the blood test to look for allergies. I believe that to be highly inaccurate and an almost total waste of time. They need to look for physical reactions, not what some computer spits out from a blood test. I started out on this route but found none of it actually helped out my ITP, until I started doing the allergy shots. The shots desensitized your immune system's reaction to the allergens. They start out with very miniscule doses to get your body used to the allergens and increase the dosages regularly until you have built up a full desenitization to the allergens. It was a few months after beginning the shots where my ITP disappeared and has never come back. I still get the allergy shots to this day. Every once in a while my allergist tries telling me I don't need the shots anymore but I have read that if you stop, eventually your allergies will return and I don't need to rock the boat after 15 years. Good luck if you decide to do it.
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Allergies that Cause ITP 2 years 3 months ago #56844

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Its NOT rocket science. Its common sense science. B)

www.ncbi.nlm.nih.gov/pubmed/25580738

NB posting paper because things can disappear from the original link given.

Association of primary immune thrombocytopenia and common allergic diseases among children

Ming-Ru Chiang, Chang-Ching Wei, Chin-Shin Muo, Lin-Shien Fu, Tsai-Chung Li & Chia-Hung Kao
Affiliations Corresponding author
Pediatric Research (2015) 77, 597–601 doi:10.1038/pr.2015.6
Received 11 April 2014 Accepted 08 October 2014
Accepted article preview online 12 January 2015 Advance online publication 04 February 2015

Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information

Background:
Growing evidence has revealed a link between autoimmune and allergic diseases. However, few studies have assessed the relationship between allergic diseases and primary immune thrombocytopenia (ITP), an autoimmune disease frequently occurring in children. This population-based case–control study investigated the association between common allergic diseases and the subsequent risk of developing ITP during childhood.

Methods:
This study investigated 1,203 children younger than 18 y of age who were diagnosed with ITP between 1998 and 2008, as well as 4,812 frequency-matched controls. The odds ratios of the association between ITP and preexisting allergic diseases were calculated.

Results:
Children with every type of allergic disease examined in this study (except asthma) exhibited an increased risk of developing ITP; the lowest adjusted odds ratio (aOR) was 1.39 for allergic conjunctivitis (95% confidence interval (CI) = 1.09–1.79), whereas the greatest aOR was 1.84 for allergic rhinitis (95% CI = 1.49–2.27). The aORs increased with the number of concurrent allergic diseases to 2.89 (95% CI = 1.98–4.22) for children with at least three allergic diseases.

Conclusion:
Children with atopic diathesis have a greater risk of subsequently developing ITP. The fundamental determinants of this relationship warrant further study.

Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia with normal bone marrow and the absence of other causes of thrombocytopenia (1,2). Antiplatelet antibodies secreted by autoreactive B lymphocytes resulting in platelet destruction through the reticuloendothelial system were described as the primary immunological defect in ITP. ITP was reported as a type-1 T-cell (Th1)-predominant disease, and activated platelet-specific autoreactive T cells that drive the generation of platelet reactive autoantibodies by B cells are present in ITP. In contrast to ITP, allergic disorders are considered type-2 T-cell (Th2)-related immune responses with chronic inflammation at sites of persistent or repetitive exposure to allergens. Allergic conjunctivitis (AC), allergic rhinitis (AR), atopic dermatitis (AD), asthma, and urticaria are frequently observed organ-specific allergic diseases involving IgE-mediated inflammation, and increasing epidemiological evidence has indicated a potential link between Th2-related allergic diseases and Th1-related autoimmune diseases (3,4,5). However, the relationship between pre-existing allergic diseases and ITP risk remains unclear. Therefore, in this nationwide population-based case–control study, we investigated the relationship between common allergic diseases and subsequent risk of developing ITP in children.

Results
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
We selected 1,203 children younger than 18 y of age with ITP diagnosis as well as 4,812 controls. The proportion of girls and boys was nearly equal (49.5 vs. 50.5%), and the average age was 6.18 y (SD = 5.20) in the ITP group. No significant differences were observed in the urbanization of residential area between the ITP children and controls. However, a history of allergies, including AR (17.2 vs. 8.96%), AC (8.98 vs. 5.36%), asthma (8.65 vs. 5.24%), AD (6.98 vs. 3.66%), and urticaria (4.16 vs. 2.41%), was more common in the ITP children than in the controls (Table 1).

Table 1: Demographics between primary immune thrombocytopenia (ITP) and non-ITP controls
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The children with AR exhibited the highest risk of developing ITP (OR = 1.84; 95% CI = 1.49–2.27), followed by those with AD (OR = 1.66; 95% CI = 1.25–2.21) and AC (OR = 1.39; 95% CI = 1.09–1.79) (Table 2). Compared with the children with no allergic disease, the risk increased with the number of allergic diseases from 1.94 to 2.89 (P < 0.0001). Both sexes exhibited the same trend, except for boys with AC.

Table 2: The association between primary immune thrombocytopenia and single or multiple allergic diseases by sex
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Table 3 shows the association between allergic disease and ITP among the age groups. The children with AR exhibited a higher risk of developing ITP at ages younger than 2 y compared with children of the same age without AR. The children aged 1–2 and 6–11 y have a higher risk of developing AD. The 6–11-y-old children with urticaria had a 22% increased odds for ITP compared with the corresponding age group of controls without urticaria (95% CI = 1.22–4.01).

Table 3: The association between primary immune thrombocytopenia and allergic disease by age group
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Table 4 presents the joint effect of ITP among ITP-associated allergic diseases. The top five risk factors of ITP (in descending order) were combinations of AR, AD, and urticaria (OR = 5.88; 95% CI = 1.57–22.0); AC, AR, and urticaria (OR = 4.90; 95% CI = 1.41–17.0); AC and urticaria (OR = 4.20; 95% CI = 1.40–12.6); AC, AR, and AD (OR = 4.03; 95% CI = 1.35–12.0); and AR and AD (OR = 3.61; 95% CI = 2.05–6.36), after accounting for age, sex, and parental occupation.

Table 4: Joint effect of the association between primary immune thrombocytopenia (ITP) and allergic disease
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Table 5 shows the incidence rate and relative risk of allergic diseases in the children with ITP compared with the non-ITP controls. The children with ITP consistently exhibited increased incidence rates and risks for all five allergic diseases, except urticaria.

Table 5: Incidence and hazard ratio for different allergic disease compared to comparison
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Discussion
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
Based on our review of the literature, this is the first large-scale study to evaluate the link between typical allergic diseases and ITP. The findings reveal that most of the allergic diseases investigated in this study, including AR, AD, urticaria, and AC, were consistently associated with an increased risk of developing ITP both before and after the occurrence of allergic diseases. In addition, the risk of developing ITP increased with the number of concurrent allergic diseases, indicating that a higher burden of clinically evident allergic disease is associated with a higher prevalence of ITP.

AR presented the greatest risk of subsequent ITP development; the patients with AR had an 84% increased risk of subsequently developing ITP, and this observation was consistent among patients older than 3 y. The children with AD were at an increased risk of ITP, particularly those younger than 2 y, possibly because AD onset typically occurs in the first year of life, and is the first step in the allergic march (6,7,8); as children age, allergic diseases progress from AD to AR, and asthma has classically been observed in some patients (6,7,8). However, in this study, we observed no association between ITP and asthma, potentially because the mean age of the onset of asthma among children in Taiwan (7.24 y) follows the mean age of the onset of ITP (6.18 y) (9).

Previous studies have proposed that an imbalance in Th1/Th2 explains the development of Th2-mediated allergic diseases (3,4,5). However, the proposed Th1/Th2 paradigm appears unable to fully explain the increasing incidence of concurrent Th1-mediated autoimmune diseases. Recent studies have posited a link between allergies and autoimmune diseases (10,11,12), and some studies have provided evidence of a relationship between allergies and ITP development. First, environmental factors such as viral or bacterial infection influence the development of allergic and autoimmune diseases (13). Second, previous studies have shown that FcγRIIb, a low-affinity IgG Fc receptor, plays a role in both allergic and autoimmune diseases, such as ITP. Intravenous immunoglobulin has been a standard treatment for ITP (1,14); intravenous immunoglobulin functions by competitively inhibiting Fc-receptor binding sites and the activation of FcγRIIb (15). Several studies have shown that intravenous immunoglobulin is also effective in treating refractory asthma, AR, and AD (16,17,18). FcγRIIb has been plays a role in nasal eosinophilia in AR (19), and FcγRIIIa gene polymorphisms play a role in the pathogenesis of ITP and atopic disease (20,21). Monoclonal antibodies against FcγRIIIa have been shown to be effective in improving thrombocytopenia in ITP (22,23). Third, elevated Th2 cytokines (IL-4, IL-10) have been observed in patients with ITP (24). Fourth, decreased regulatory T (Treg) cells exhibiting impaired function have been observed in ITP patients (25,26,27,28,29,30,31). The dysfunction of Treg cells plays a role in both autoimmune disease and allergic diseases (32,33,34,35). These studies have indicated an association between the pathogenesis of ITP and allergic disease, and thus support our finding that children with allergic diseases have a greater subsequent risk of developing ITP (and vice versa). Thus, typical environmental triggers, genetic factors, and immunological aberrancies might contribute to the development of both disorders.

This study has a number of strengths. First, it robustly demonstrates the relationship between atopic diathesis and the risk of childhood ITP by using a high number of study patients. Second, we analyzed the effects not only of a specific type of allergic disease, but of numerous typical allergic diseases. Third, this study is a population-based study involving physician-diagnosed atopic diseases, which minimizes selection and recall bias. Fourth, we accounted for potentially confounding factors, including age, sex, and parental occupation.

Several limitations were encountered while conducting this study. This was a cross-sectional study, and the causality between allergic diseases and ITP could not be established. However, this study clearly demonstrates an association between allergic diseases and increased risk of ITP in a high number of patients. Another limitation was a lack of data on genetic and environmental factors that might have affected the risk of developing ITP and atopic diathesis. Ethnic influence was not considered in this study because most of Taiwan’s population is of ethnic Chinese origin; thus, the results of this study might not be generalizable to other populations.

The findings of this study indicate that the onset of allergic diseases is associated with an increased risk of subsequent ITP. Furthermore, the risk of ITP was consistently associated with a number of comorbid allergic diseases. Future investigations on the environmental and genetic factors and common immunological aberrancies related to allergies and ITP are warranted.

Methods
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
Data Source
The National Health Insurance Research Database (NHIRD), maintained by the National Health Research Institutes, is population-based data set derived from claims data from Taiwan’s National Health Insurance program, a mandatory-enrollment single-payment system established in 1995, now covering more than 99% of Taiwan’s population (36). This database contains all medical claims and information of insurants, thus providing a sufficient sample size to pursue the objectives of this study. To ensure the accuracy of disease diagnosis, Taiwan’s National Health Insurance Bureau randomly reviews medical charts of one in every 100 ambulatory claims and one in every 20 inpatient claims. The high validity of the diagnostic data from the NHIRD has been reported previously (37,38). The children data set (age < 18 y) was derived from the NHIRD and is also maintained by the National Health Research Institutes. The children data set contains 50% of children in the NHIRD, randomly selected from the children population from 1996 to 2008. Diseases are coded based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Because of personal electronic data privacy regulations, the insurants’ records are encrypted before being released to researchers; thus, informed consent was not required in this study. Although the identification information was scrambled, this study also received approval from the Institutional Review Board at China Medical University Hospital (CMU-REC-101-012).

Study Patients
We enrolled children whose ITP was newly diagnosed between 1999 and 2008 as the ITP group. ITP was defined as ICD-9-CM Code 287.3, excluding Evan’s syndrome (ICD-9-CM 287.32) and congenital and hereditary thrombocytopenic purpura (ICD-9-CM 287.33). To increase the likelihood of capturing a valid diagnosis of ITP, at least three claims coded in any diagnosis field as an inpatient or ambulatory claim for ITP within 12 mo were inclusion criteria for this study. The ITP diagnosis date was defined as the index date. Controls (the non-ITP group) were selected from the children without ITP before the entry date. Controls were frequency-matched to the case group according to age and sex at a ratio of 4:1.

Definition of Variables and Comorbidities
We grouped urbanization into seven levels based on research by Liu (38), where Level 1 was considered as the highest urbanization level. Because there were few children in Levels 5 to 7, we combined these cases with Level 4. Comorbidities, including AC (ICD-9-CM 372.05, 372.10 and 372.14), AR (ICD-9-CM 477), asthma (ICD-9-CM 493), AD (ICD-9-CM 691.8), and urticaria (ICD-9-CM 708.0 and 708.9), were considered where at least one inpatient claim record or two ambulatory claims were present in any diagnosis field with respective ICD-9-CM codes. Furthermore, comorbidities were considered only in cases where diagnosis was made before the index date. The sum of allergic diseases was counted as the number of comorbidities.

Statistical Analysis
χ2 and t-tests were performed to test for differences in the baseline characteristics between the two groups. Unconditional logistic regression was used to estimate the ORs and 95% CIs to evaluate the association between each allergic disease, the number of allergic diseases, and ITP. Multivariable logistic regression was used to manually account for the effects of age, sex, and comorbidities. We also estimated and compared the sex- and age-specific risk of developing ITP for both groups. For further analysis, we assessed the association between ITP and ITP-associated allergic diseases, including AC, AR, AD, and urticaria. We also performed a cohort analysis on the incidence rate and relative risk of allergic diseases in children with ITP compared with the non-ITP controls to investigate a causative link between allergic diseases and the onset of ITP, or a common pathway between these disorders. This retrospective cohort study involved 843 patients (aged < 18 y) whose ITP was newly diagnosed between 2000 and 2007 as the ITP cohort. The baseline was set as the date of ITP diagnosis. For each child with ITP, we randomly selected four non-ITP children matched by sex, age (within 1-y intervals), urbanization of residential area, parental occupation, and baseline year. Children with pre-existing allergic diseases were excluded from both cohorts. Hazard ratios and 95% CIs were calculated using multivariable Cox proportional hazard regression models (with the non-ITP control cohort as the reference group) to assess the association between ITP and the risk of developing allergic diseases. SAS Version 9.3 (SAS Institute, Carey, NC) was used for the data analysis, and statistical significance was defined as a two-tailed t-test value of 0.05.

Statement of Financial Support
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
This study was partially supported by the Bureau of Health Promotion, Taiwan Ministry of Health Welfare, R.O.C. (Taiwan) (DOH99-HP-1205); study project grants (DMR-103-018 and DMR-103-020) from China Medical University Hospital, Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW103-TDU-B-212-113002); Health and welfare surcharge of tobacco products, China Medical University Hospital Cancer Research Center of Excellence (MOHW104-TD-B-111-03, Taiwan); and the International Research-Intensive Centers of Excellence, Taiwan (I-RiCE) (NSC101-2911-I-002-303). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of this manuscript. No additional external funding was received for this study.

Disclosure
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
The authors have no financial relationships relevant to this article to disclose.

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Acknowledgments
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
Ming-Ru Chiang and Chang-Ching Wei contributed equally to the conceptualization and design of the study, as well as drafting and approving the final version of the manuscript. Chin-Shin Muo, Lin-Shien Fu, and Tsai-Chung Li conducted the initial analysis, reviewed and revised the manuscript, and approved the final manuscript. Chia-Hung Kao coordinated and supervised the data collection process and critically reviewed the manuscript, and approved the final manuscript.

Author information
Abstract• Results• Discussion• Methods• Statement of Financial Support• Disclosure• References• Acknowledgments• Author information
Primary authors
The first two authors contributed equally to this work.
Ming-Ru Chiang & Chang-Ching Wei
Affiliations
Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
Ming-Ru Chiang & Lin-Shien Fu
Department of Nephrology, Children’s Hospital, China Medical University Hospital, Taichung, Taiwan
Chang-Ching Wei
College of Medicine, China Medical University, Taichung, Taiwan
Chang-Ching Wei
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
Chin-Shin Muo
Department of Public Health, China Medical University, Taichung, Taiwan
Tsai-Chung Li
Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
Chia-Hung Kao
Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Chia-Hung Kao
Corresponding author
Correspondence to: Chia-Hung Kao

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Allergies that Cause ITP 2 years 1 month ago #57892

  • mdallas
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Not sure if this thread is still active... but my daughter was first diagnosed with ITP three years ago at the age of 2-years old. She had repeated relapses - always triggered by a bad virus. Only 2 relapses resulted in platelet drops low enough to send her to the hospital for IVIG. She had been in remission since that age of 4. She will be 6-years old this summer - so that's nearly 2 years of no platelet level drops. Her remission began around the time our dog passed away. She had several viruses during her remission and never once relapsed. Two weeks ago we adopted a new dog. And she got a stomach virus and to my shock... she relapsed. Platelets dropped... not low enough for treatment... but she had bruising and petechiae. CBC is this week to make sure she bounced back. Of course, I am linking her relapse to our new pet. Doctor says there is no way to know for sure but exposure to the pet could have heightened her immune response and predisposed her to a relapse. Am I crazy to think we need to find a new home for our rescue dog? I would gladly do it if it would prevent her from the ups and downs of ITP. Any advice or insight from anyone with ITP experience?

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Allergies that Cause ITP 2 years 1 month ago #57893

  • Hal9000
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LOL, if you want to be called crazy, you'll need a better story.
In my humble opinion, your suspicion is very appropriate. Although, if she has other allergies, or her numbers vary a lot, it would be more compelling. Curious though. Is it the IVIG that brings her into remission, or ?

Whatever happens, it would be a good to post back the progress/outcome for the benefit of other readers in the future to gain from your experience.

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Allergies that Cause ITP 2 years 1 month ago #57898

  • garylouisville
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Is it possible to remove the dog from the environment for a month or two without getting rid of it to see if it makes a difference? Also, allergy shots are what keeps my ITP under control. Maybe she could be tested for pet allergens and take allergy shots for that to see if it helps. It takes a a few months for the shots to build up immunity in the system so don't get discouraged if you don't see immediate results, assuming that is the problem.

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Allergies that Cause ITP 2 years 1 month ago #57906

  • juliannesmom
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My daughter was diagnosed with ITP about a year after we moved from an older home (the only one she'd known) to a newer home, on a wooded lot, in a new town. She was in a private school, and that didn't change with the move. We only lived there two years before we moved again, to another older home, twenty miles away. After the second move, she began to improve, and eventually entered remission. Her school, friends and their houses, pets, church, activities, and all other things remained the same. Just a change of home and neighborhood, and a few miles. She'd had eczema all along, but the ITP was new after the first move. I've often wondered if she had an allergy to the carpet, or, perhaps, the trees in the yard, that triggered the ITP.
Norma

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Allergies that Cause ITP 2 years 1 month ago #57968

  • John
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Hi juliannesmom,
You mention that your daughter has eczema. Eczema is an autoimmune disorder. Read the link provided and I quote:
"WHAT CAUSES ECZEMA?
Scientists are fairly sure the primary cause is a genetic issue, but we’re largely unsure what exactly causes eczema. The important point to understand is that it’s an autoimmune condition, meaning the immune system is overactive and misfiring, mistaking its own tissue for perceived pathogens and attacking itself. It can be worsened with exposure to environmental factors such as pollen or pet dander/fur, and/or internal factors such as irregular stress hormone (cortisol) levels."
Now the point of this is that your daughters ITP is essentially the same thing. It is an autoimmune condition and typically there is an underlying overactive immune system at play. I have hammered away at this idea since since I started this thread years ago. It is essential to understanding ITP.
www.maryvancenc.com/healing-eczema-from-within/
cheers,
john

NB Read the opening post of this thread. It describes how an overactive immune system can lead to an ITP response. If you can figure out enough of the allergens involved and mitigate them, you should be able to improve your daughter's condition. GL.

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Allergies that Cause ITP 2 years 1 month ago #57975

  • Sandi
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John:
I had eczema as a child (and into my 20's) and so did two of my children. One of those children also has an autoimmune disorder. I do think that children with eczema and/or asthma are more prone to acquire other autoimmune disorders as time goes on.

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Allergies that Cause ITP 2 years 1 month ago #57999

  • John
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Hi Sandi,
That is the basic conclusion of the study I posted further up this thread.


Results:
Children with every type of allergic disease examined in this study (except asthma) exhibited an increased risk of developing ITP; the lowest adjusted odds ratio (aOR) was 1.39 for allergic conjunctivitis (95% confidence interval (CI) = 1.09–1.79), whereas the greatest aOR was 1.84 for allergic rhinitis (95% CI = 1.49–2.27). The aORs increased with the number of concurrent allergic diseases to 2.89 (95% CI = 1.98–4.22) for children with at least three allergic diseases.

Conclusion:
Children with atopic diathesis have a greater risk of subsequently developing ITP. The fundamental determinants of this relationship warrant further study.


Hope you are well.
cheers,
john

NB - In medicine and allied fields, diathesis (from Greek διάθεσις) is a hereditary or constitutional predisposition to a disease or other disorder.[1]
Atopic diathesis is a predisposition to develop one or more of hay fever, allergic rhinitis, bronchial asthma, or atopic dermatitis. source: Wikipedia[2]

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Allergies that Cause ITP 1 year 9 months ago #59267

  • thomaskm
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  • Male 66 Diag. April 2017 in ER with Petechiae from knees to toes 4 oral cheek blood blisters 3000 count. 3-IVIG rescues, 4, 4 day 40mg Dexamethadrone blasts. Best read 217,000 5/24/17 On weekly Nplate maintenance
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Newly diagnosed Good Friday 4/14/2017 when a three week old rash on my lower legs and feet was joined by oral blood blisters that sent me scurrying to the ER with a 3000 count. 3 IVIG rescues and I am finishing my 4th Dexy pulse today. I left the hospital with a 105. Since I have not scored higher than 124 and had dipped twice below 50. Praise the Lord today I had A 217 !! 66 years old and now this. I began to take stock on how I may have arrived with ITP.
FACTOR 1. I had/have an abscessed tooth.
2. I had a severe frozen painful shoulder for 4 months that therapy made worse (Dexy fixed that!).
3. It was suggested I try to reduce overall inflammation by rubbing frankincense oil on my feet, I did.
4. My property was invaded by deer ticks, I bought super strength Permethrin insecticide and used on
my outside work pants and shirt sleeves profusely.
5. I was taking 1000mg niacin for HDL as I am allergic to statins. Niacin toxicity is mentioned often with ITP
6. The cat gets brushed 4-5 times a day.
7. Not feeling well = dusty house.
8. Huge property to mow with hundreds of trees, gardens, and fruit blossoms.
9. Above average alcohol consumption as our local wineries celebrated the end of winter as did I.

I firmly believe I fell to ITP as a result of all the above colliding in late March when my rash appeared. All but the cat has been eliminated in hopes Rituxan is not in my future, I barely tolerate IVIG my max titrate rate is 300, and my wife barely tolerates me on steroid blasts. 4 days x 40mg. After blast #2 Dexy revealed a 95% blocked artery and I had an emergency middle of the night stent procedure for. My Hematologist listens, but repeats idiopathic and shrugs. However today's 217 was offset with some really low other blood factors so something is amiss. Based on what I have gathered above from memory I have no trouble believing allergens, toxins, and lifestyle can contribute to ITP onset.

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Allergies that Cause ITP 1 year 9 months ago #59269

  • poseymint
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Hi Thomaskm~ Thank you for sharing your story. Very interesting! I totally believe allergies, stress, eating, everything "lifestyle" can trigger ITP. Also it is known that viruses, vaccines and drugs can also be a trigger. I had a lot of allergies as a child; hay fever, pollen, dust, cats all that. Plus sensitive skin- allergic reactions if I touch certain trees, plants. So my immune system over-reacts easily, and I see how I am prone to auto-immune issues. I've had ITP for 8 years diagnosed, and at least two years before that. Have no idea what my original trigger was.

Glad you got some good out of Dexy! My joint pain goes away when I'm on prednisone, but unfortunately comes back with a vengeance when I taper off. But one thing I've noticed is: I've been off sugar- all candy, cookies, desserty sweets for 2 years and my joint pain is overall much much less. good luck with whatever your next step is- and keep us posted!

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Allergies that Cause ITP 1 year 9 months ago #59270

  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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Thomas - Yes, all of those things or one of those things could have triggered ITP. You had a lot going on. The pesticide is a definite concern...very toxic. If you took an antibiotic for the tooth, that could also have contributed to it. There is no way to know for sure, hence the 'idiopathic' part. Your counts are responding well to treatments....that's great!

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