Quincke's edema: symptoms and treatment. Quincke's edema is an insidious and deadly fast pathology that can suffocate, damage the brain and kill. Is angioedema dangerous?

According to historical data, Quincke's edema was first described in 1576 by Marcello Donati. However, the term angioedema was introduced in 1882 by Henrik Quincke, whose name this condition still bears.

However, it was only in 1964 that chemicals that provoked the development of a pathological reaction were identified. Since then, the possibility of targeted pathogenetic treatment has emerged.

Quincke's edema - what is it?

Quincke's edema is one of the most difficult problems of allergology - this is explained by the high prevalence of this pathology. Thus, its frequency in combination with is 49% among all allergic reactions, and isolated angioedema is observed in 11% of cases.

Quincke's edema photo 1

Moreover, the highest prevalence is observed in people of working age. It is worth noting that in 2% of cases, angioedema can be hereditary, associated with a certain pathological complement reaction (a certain part of the immune system that normally protects a person from pathogenic microorganisms).

Quincke's edema is a condition in which swelling of the skin and subcutaneous fat is observed. At the same time, this can be combined with swelling of the mucous membranes. Therefore, the respiratory, urinary, digestive and nervous system, which leads to the appearance of corresponding symptoms (see photo).

Quincke's edema is characterized by some features of symptoms:

Sudden onset (sometimes identifying the causative agent is not so easy);
Development of swelling in the lower layers of the skin layer itself and fatty tissue;
The predominance of pain with minimal itching;
Frequent involvement in pathological process mucous membranes;
Slow resolution of swelling - within 72 hours, compared to hives blisters, which resolve quickly.

Clinical signs of angioedema appear after contact with allergens; various substances can play their role ( see the list at the bottom of the article ).

However, regardless of the causative factor, allergic edema and urticaria develop due to increased production of histamine in the body. This is confirmed by the following facts:

The appearance of characteristic skin reactions when histamine is administered;
Proven release of granules from mast cells (macrophages);
Increased release of histamine in some forms of urticaria;
Clinically proven to be effective antihistamines.

Symptoms of Quincke's edema, photo

swelling and skin manifestations

Allergic angioedema can be of 2 main types:

Acute – suddenly appears when causative factors enter the body;
Acutely relapsing, when at least 3 clinical relapses are observed within 3 to 6 months.

Symptoms of Quinet's edema have the following features:

Most often, the lesion is asymmetric;
Color: pale pink or no different from skin color;
Rare detection of itching, more often there is pain and a burning sensation;
It takes more than 24 hours for clinical manifestations to subside;
The favorite localization is tissues rich in water - the periorbital zone, hairy part heads, tongue, pharynx, hands, genitals, feet (dorsal surface). However, swelling can appear anywhere;
Skin manifestations can be combined with swelling of the mucous membranes of any organ and joints.

Quincke's edema, photo, tongue - a very dangerous condition

Symptoms in adults with Quincke's edema in the larynx, as a variant of angioedema, are life-threatening. Death occurs due to suffocation.

For swelling of the larynx characteristic first signs include cough and hoarse voice, as it develops, noisy breathing and symptoms of suffocation appear.

With swelling of the mucous membrane of the stomach and intestines, characteristic symptoms- nausea, vomiting, spasmodic abdominal pain.

In some cases, rare forms of Quincke's edema may occur, their symptoms:

1) Recurrent, combined with hypereosinophilia. In this condition, the number of eosinophils is several times higher than the norm for a given age period, and leukocytes and the level of antibodies directed against the endothelium (the inner lining of blood vessels) are also increased.

Clinically determined elevated temperature up to 40°C and allergic skin rash.

2) A hereditary form of angioedema, which is transmitted in an autosomal dominant manner. Swelling occurs occasionally various localizations. This disease is characterized by a genetic deficiency of a protein that inhibits complement activation.

The disease first appears before the age of 20 years. Before this period clinical symptoms are missing. The main danger of the hereditary form is the increased risk of death, which is observed in 35% of patients. Therefore, all relatives are subject to examination.

3) The acquired form of angioedema is more common in elderly patients and is associated with lymphoproliferative diseases, systemic lupus erythematosus and viral hepatitis.

Hereditary forms Allergies can be of three main types:

The first type is observed in 85% of cases. The causative mutation occurs spontaneously, so in relatives the genotype, as a rule, remains normal;
The second type is less common - in 15% of cases. It is associated with high concentration complement activators due to the fact that it is not consumed;
The third type is observed only in women, because the disease is X-linked. This form has been described recently.

The hereditary form of angioedema is characterized by the following features:

Frequent association with chronic infection;
Recurrent appearance of edema;
Frequently recurring abdominal pain, combined with nausea and vomiting (they can be the cause of unnecessary surgical interventions);
Reduced content of the C4 fraction of complement (an important diagnostic sign, because when it normal values the likelihood of a hereditary form is minimal);
No itching;
Frequent development of laryngeal edema with involvement of the tongue in the edematous syndrome;
Urticaria is rarely observed;
Exacerbations recur with varying frequency. For some patients – once a week, for others – once a year.

Quincke's edema in children - features

signs of Quincke's edema in children, photos

The symptoms of Quincke's edema in children are somewhat different from adults - this requires extreme care from parents. The appearance of any suspicious symptoms should be a reason to consult a doctor.

Features of edema in childhood are:

Possibility of manifestation on any part of the body, and not just on hydrophilic ones (containing a large amount of water);
Frequent appearance of skin rashes of the type;
Excited state;
Fever, loss of consciousness;
Abdominal pain, nausea and vomiting.

Very often, Quincke's edema in a child is accompanied by damage to the larynx. This is fraught with fatal suffocation if help is not provided in time.

First aid for Quincke's edema includes the following measures:

Mandatory call for an ambulance with a description of the situation;
Stop the entry of the allergen into the body;
When an insect bites, apply an ice pack to this place, and above the bite site, apply a pressure bandage to prevent further entry of the allergen into the bloodstream;
Gastric lavage and intake of activated charcoal if swelling is associated with food;
Ensure the flow of oxygen into the room (open the windows);
Give any antihistamine. However, if there is swelling of the mucous membrane digestive tract its absorption is impaired, so intravenous or intramuscular injection(this is done by emergency doctors).

If a person’s Quincke’s edema recurs, then he already has specially prepared syringes with adrenaline and a hormonal drug. They are produced by the pharmaceutical industry.

Treatment of Quincke's edema, drugs

The primary direction in the treatment of angioedema and anaphylactic shock is occupied by second-generation antihistamines. Their effectiveness is due to the suppression of histamine synthesis and its action with receptors. An additional effect is anti-inflammatory.

Representatives of first generation antihistamines are:

Diphenhydramine;
Tavegil;
Pipolfen;
Suprastin;
Fenistil;
Diazolin;
Fenkarol.

However, second generation drugs for the treatment of Quincke's edema are preferable, these include:

Claritin;
Zyrtec;
Telfast;
Erius.

Symptoms and treatment of Quincke's edema directly depend on nutrition - therefore it is recommended hypoallergenic diet. Its main principles are:

Total exclusion is high allergenic products(coffee, chocolate, eggs, cocoa, fruits, vegetables and berries that are orange and red);
Complete exclusion of allergens, causing swelling Quincke;
Adequate replacement of excluded products to meet human needs for energy and nutrients;
A gradual expansion of the diet with the introduction of prohibited foods in small doses and assessment of individual tolerance;
Spicy and extractive substances are prohibited - broths, canned food, smoked meats, pickles, etc.;
Products containing nutritional supplements(marmalade, marshmallows, marshmallows, cakes, etc.);
Salt, flour products and butter are limited;
Light-colored fruits and berries are allowed;
Rice, buckwheat, pearl barley cereals are allowed;
Fermented milk products are consumed;
You can eat turkey and rabbit meat;
Vegetable oils are allowed;
Food should be steamed or boiled;
Cereals and potatoes should be pre-soaked for 18 hours before cooking;
The first water when cooking meat should be drained.

Complications

The most dangerous complication Quincke's edema is swelling of the larynx, leading to asphyxia. As a result, acute respiratory failure can be fatal if not treated promptly. Other complications of angioedema include:

Spicy abdominal syndrome, simulating surgical pathology of the abdominal organs;
Acute allergic cystitis, leading to acute urinary retention;
Minière's syndrome with swelling of the mucous membrane inner ear(this is a state of manifestation of dizziness and tinnitus);
Combination of edema with urticaria.

Causes of Quincke's edema - common allergens

Among food products greatest danger represent: fish, egg, milk, chicken, beef, apples, nuts, pork, honey, carrots, stone fruits
citrus fruits, melon, smoked meats, various food additives and soy products.

Medicines can also be strong allergens. In this regard, the greatest danger is posed by:

penicillins from the beta-lactam group;
cephalosporins;
non-steroids, especially aspirin;
B-vitamins;
angiotensin enzyme blockers;
X-ray contrast agents;
insulin.

The venom of bees, wasps and hornets also has strong allergenic properties. Some infections are comparable in strength to it:

Hepatitis C and B, HIV infection;
Diseases associated with Epstein-Barr and Coxsackie virus;
Herpetic infection;
Helicobacter pylori diseases;
Infectious mononucleosis;
Intestinal dysbiosis;
Chronic bacterial and fungal conditions.

Sjogren's syndrome, lupus erythematosus, thyroiditis;
Rheumatoid arthritis;
Giardiasis;
Trichomoniasis, amoebiasis;
Malaria and others.

Among physical factors There are also provocateurs of allergic reactions:

Increased sun exposure;
Warm or cold;
Vibrational influences.

Prevention

The only one preventive measure is to avoid contact with a possible allergen. Therefore it is required thorough examination see an allergist to identify the causative factor.

Such patients should be careful in their diet and lifestyle in general.

Quincke's edema is a condition that occurs in acute form pathological condition, which occurs against the background of a false or true allergic reaction. more often observed in people who are prone to allergies. At the same time, the possibility of the appearance of a similar pathology in those who first encountered a particular allergen, which caused an unusual reaction of the body, cannot be ruled out. The development of this pathology can pose a threat to human life.

What is Quincke's edema

In most cases, allergic edema causes fluid accumulation in the skin, fatty tissue and mucous membranes. Most intensively affected soft fabrics faces. Swelling is especially visible in the lips, cheeks, tongue and eyelids. In more rare cases, rapid swelling of the respiratory tract, gastrointestinal tract and genitourinary system is observed. In this case, Quincke's syndrome is extremely dangerous, because it can cause asphyxia in the shortest possible time.

The mechanism of development of such a pathology as allergic Quincke's edema has not yet been fully studied. It is believed that the problem lies in the penetration of the allergen into the human body. This leads to the launch of histamine production. This substance is always present in large quantities in body tissues, but its release is observed only under certain pathological conditions.

When an allergen enters the body, the immune system malfunctions. This causes the release of this substance. Histamine leads to rapid swelling of soft tissues. In addition, this substance can greatly thicken the blood.

Causes

The main reason for the appearance of angioedema lies in the penetration of an allergen into the human body, which can be:

food product;
dust;
plant pollen;
medicinal product;
insect poison, etc.

Factors contributing to the appearance of such a pathological condition as Quincke's syndrome include: ACE inhibitors and angiotensin receptor antagonists

In addition, genetically determined edema is common. In this case, the development of hereditary angioedema is observed in several representatives of the same family. This disorder is caused by a mutation in the Hageman factor gene. There is a high probability of a similar problem occurring in women who have increased production of bradykinin and its delayed destruction due to the low activity of ACE-estrogens.

Often the factors contributing to the appearance of this pathology are combined, so it is often not possible to accurately determine the cause of the problem.

Symptoms

Signs of angioedema may persist for several minutes or hours, and then gradually subside. There are a number of manifestations that indicate the development of this disorder. The first symptoms of the disease appear suddenly and increase rapidly. Soft tissues swell in just 5-15 minutes. The presence of this form of edema may be indicated by:

enlargement of eyelids, lips, cheeks, tongue, feet and hands;
pain on palpation of the affected areas;
redness;
skin itching;
burning;
breathing problems;
mucous discharge from the nose.

Small particles may appear skin rash. In some patients, this pathological condition is accompanied by the appearance of signs of general intoxication. Patients have complaints about general weakness, headaches and nausea. Possible increase in body temperature.

The degree of danger of this condition depends on the severity of the allergic reaction. If, asphyxia may develop. Often the appearance of edema is accompanied by anaphylactic shock.

What does angioedema look like?

Increasing changes in the patient's skin and facial shape often frighten those around him. The eyelids become so swollen that the patient is unable to see or can see through the remaining small slits. This is an extremely important feature of the development of edema.

Swelling of the lips is often observed. They greatly increase in size and become disproportionate to the face. The cheeks and chin may increase several times. Due to increasing changes, the skin acquires a red tint. The development of Quincke syndrome disfigures a person beyond recognition in a matter of minutes.

Diagnostics

If signs of development of this pathological condition appear, it is necessary to call ambulance. Often the patient is hospitalized in a hospital due to the risk of respiratory failure and the development of anaphylactic shock. Initial examination carried out by emergency doctors.

Before the doctors arrive, you need to reassure the patient as much as possible. Swelling caused by allergic reactions often causes shock in patients. If possible, the allergen should be removed. The patient should be seated and a pillow placed under his back.

To reduce the rate at which swelling increases, apply a cold compress to your face or wipe it with cold water. If possible, you need to give a Prednisolone injection. IN severe cases In case of laryngeal edema, the administration of Adrenaline is required.

How to treat Quincke's edema

Emergency doctors who arrive on a call often immediately give the patient sorbents to stabilize the condition and quickly remove the allergen from the body. In addition, as part of emergency care, the use of antiallergic drugs and Prednisolone injections is indicated. The main effects of the drug are aimed at reducing swelling caused by an allergic reaction and preventing the development of anaphylaxis and shock. This hormonal drug Therefore, it is used with extreme caution.

After relief of the edematous syndrome, the efforts of doctors are aimed at stabilizing the condition and preventing reappearance Problems.

Drug treatment

Within further treatment Patients are individually selected medications for Quincke's edema. First of all, the patient needs a potent antihistamine. In addition, drugs belonging to the following groups are prescribed:

corticosteroids;
ACE inhibitors;
sorbents;
hormonal.

To quickly remove fluid, diuretics are often prescribed. In some cases, the use of agents that help reduce vascular permeability is justified. In the presence of urticaria, ointments and gels with antihistamine properties are prescribed. In severe cases, the patient is given Ephedrine and Adrenaline and resuscitation measures. Often, if there are breathing problems, a tracheotomy procedure is performed.

Treatment at home

Considering that this pathological condition poses a danger to the patient’s life, it is impossible to refuse the help of doctors and carry out drug treatment at home. Acute period an allergic reaction should be eliminated under medical supervision. After being discharged home, the person needs to avoid exposure to allergens. It is advisable to use hypoallergenic bedding and wear clothes made from natural fibers.

In addition, you should exclude from your diet all foods that are food allergens. You should avoid walking if the flowering period of plants to which you are allergic has begun. You must take medications prescribed by your doctor. Such precautions are necessary, because after an acute allergic reaction, the human body is still for a long time remains sensitized, which increases the risk of recurrence of this pathological condition.

Consequences

Most dangerous consequence the development of Quincke syndrome is a fatal outcome caused by anaphylactic shock or asphyxia. Such cases are especially common in children. In milder situations, the edematous processes caused by the syndrome negatively affect the condition of the skin, which leads to faster aging. In addition, such an allergic reaction is associated with high risk development of disorders of the cardiovascular system.

This condition can develop at any age. About 10% of people have experienced this condition at least once in their lives.

Causes of swelling

Angioedema is based on an immediate allergic reaction. Tissue swelling is associated with increased vascular permeability caused by the release of mediators (histamine, prostaglandins, leukotrienes, cytokines, etc.) from sensitized mast cells and basophils upon their contact with.

Such an allergen can be food products(peanuts, chocolate, milk, exotic fruits, etc.), inhaled pollen or dust allergens, as well as medications.

In addition, the cause of Quincke's edema can be exposure to various physical factors, such as cold, bright sunlight and etc.

Symptoms of Quincke's edema

Quincke's edema is usually observed in areas with loose tissue - lips, eyelids, cheeks, oral mucosa, scrotum. It has a dense nature (the surface of the skin is not pressed when pressed on it) due to high content protein in edematous fluid.

After lasting from several hours to 2-3 days, the swelling then goes away without a trace. Particularly dangerous is Quincke's edema in the larynx (occurs in 30% of cases of Quincke's edema). In this case, first there is hoarseness of the voice, “barking”, then difficulty breathing with shortness of breath increases. The complexion acquires a bluish tint, then suddenly turns pale. In the absence of rational therapy, patients may die from suffocation.

Diagnostics

The diagnosis is established by clinical picture. This condition requires mandatory hospitalization and adequate treatment in a hospital setting.

What can you do (first aid for Quincke's edema)

At the slightest suspicion of the development of Quincke's edema, you should immediately call an ambulance. The situation can change within a matter of seconds and the slightest delay is dangerous for the patient’s life. Next, it is necessary to eliminate the allergen that caused such a reaction, help the victim take a comfortable position and give antihistamines.

What can a doctor do?

Depending on the location of the swelling, the doctor’s actions will differ. In any case, the introduction of potent drugs is required. A patient with laryngeal edema needs urgent hospitalization in the department intensive care or resuscitation.

Prevention

Quincke's edema usually occurs suddenly, and it is not possible to prevent its development. If you have ever had a similar allergic reaction, you should avoid contact with the allergen that caused it.

Patients who have previously suffered from angioedema must have a card with them indicating their allergen. If the allergen was a drug, do not forget to report this during subsequent visits to the doctor.

Quincke's edema is a diffuse or suddenly limited swelling of the mucous membranes, fascia and fatty tissue. Otherwise, Quincke's edema is called "acute angioedema" or "giant urticaria."

This disease occurs in both children and adults, but young people, and especially women, are most susceptible. Teenagers and the elderly suffer from this disease less often. The most dangerous thing about this disease is that those symptoms that are characteristic of Quincke's disease appear regardless of age, very often lead to conditions in which death is possible if the person is not treated in time emergency assistance.

Quincke's edema is the action of allergic reactions that contribute to the production large quantity histamine mediator. This is what causes inflammation to begin. circulatory system person. Doctors divide Quincke's edema into two types:

1. Edema is hereditary, it is an extremely rare genetic disease;

2. Acquired, the reasons for the development of this type of disease will be given below.

Quincke's edema develops in a very short period of time (from 60 seconds to 60 minutes). In each individual case, everything depends on the type of pathogen and the characteristics of the organism. In most cases, Quincke manifests itself in soft form, but there are also more severe cases. If the disease is severe, swelling of the throat and tongue appears, and the airways become blocked. I think it is clear to everyone that these manifestations can seriously threaten a person’s life.

It is necessary to know the symptoms of Quincke, because the disease is very serious. Having the necessary information will give you the opportunity to promptly notice the onset of swelling and call emergency help. The symptoms that appear are not always the same, but generally the following picture can be observed:

Swelling of the skin. The onset of edema is manifested by the sudden appearance of a small swelling on the skin of the face, arms and legs, usually pink in color.

Quincke's edema in the photo
- discomfort is felt in the affected areas, those parts of the body where the swelling appears are itchy, and sometimes a burning sensation and pain may be observed;

Sometimes a swelling appears that resembles nettle burns. Typically, the rash appears in the part of the body where hair grows. It can be not only the head, but also the arms and even the legs.

In extremely rare cases, it can lead to hoarseness, a feeling of tightness in the throat (lump in the throat) and difficulty breathing.

Antigens lead to severe swelling and intense release of biogenic compounds. Also, some foods, pollen, dust, medications, and some natural irritants: bright sunlight or cold can also be an allergen. As you can see, dozens of irritants can be the cause, which is why edema is very dangerous, not only for children, but also for adults. One of the most common reasons are: powders, air fresheners, etc. It should be noted that the manifestation of symptoms of the disease (the appearance of edema) may not begin immediately, but after 72 hours.

Acute, painless, swelling of the deep layers of the skin and subcutaneous tissue or mucous membranes, due to increased vascular permeability. In some cases, it can lead to complete closure of the airways and death.

The disease was first described in 1882 German doctor and explorer Heinrich Quincke.
More than 90% of all cases of Quincke's edema and emergency visits medical care associated with the use of medications, especially ACE inhibitors (captopril, enalapril).
Quincke's edema can be of several types:
- Hereditary angioedema
- Acquired angioedema
- Quincke's edema associated with allergic reactions (usually urticaria)
- Quincke's edema associated with taking medications (more often in the elderly with ACE inhibitors)
- Quincke's edema of unknown cause (idiopathic)

Hereditary angioedema a rare disease that develops in only 1 person out of 150 thousand people. It was first described in 1888 in five generations of members American family. The onset of episodes of the disease is most often recorded at the age of 7-15 years. All patients with hereditary angioedema have a tendency to develop autoimmune diseases(systemic lupus erythematosus, autoimmune thyroiditis, etc.). The disease is transmitted in an autosomal dominant manner and the chance of having a child in a couple in which one parent is sick is 50%.
Cases acquired angioedema quite rare, only 50 cases of the disease were described during the period 1997-2008. The disease most often develops in people over 50 years of age.
The incidence of angioedema associated with the use of ACE inhibitors is 1-2 cases per 1 thousand population.

To understand the cause and mechanism of hereditary angioedema, it is necessary to disassemble one of the components of the immune system. We will talk about the compliment system. The complement system is important component both innate and acquired immunity, consisting of a complex of protein structures.

The complement system is involved in the implementation of the immune response and is designed to protect the body from the action of foreign agents. In addition, the complement system is involved in inflammatory and allergic reactions. Activation of the complement system leads to the release of specific immune cells(basophils, mast cells) biologically active substances(bradykinin, histamine, etc.), which in turn stimulates the inflammatory and allergic reaction.

All this is accompanied by dilation of blood vessels, an increase in their permeability to blood components, a decrease in blood pressure, and the appearance of various rashes and swelling. The complement system is regulated by specific enzymes, one of these enzymes is the C1 inhibitor. The quantity and quality of which determines the development of Quincke's edema. It has been scientifically proven that the lack of C1 inhibitor is the main cause of the development of hereditary and acquired Quincke's edema. Based on its function, the C1 inhibitor must inhibit and control complement activation. When it is not enough, uncontrolled activation of the compliment occurs and from specific cells (mast cells, basophils), a massive release of biologically active substances is carried out that trigger the mechanisms of an allergic reaction (bradykinin, serotonin, histamine, etc.). The main cause of edema is bradykinin and histamine, which dilate blood vessels and increase vascular permeability to the liquid component of the blood.

In the case of allergic Quincke's edema, the development mechanism is similar to an anaphylactic reaction. cm.

Mechanism of development of anaphylaxis

Edema occurs in the deep layers, subcutaneous fatty tissue and mucous membranes as a result of dilation of blood vessels (venules) and an increase in their permeability to the liquid component of the blood. As a result, interstitial fluid accumulates in the tissues, which causes swelling. The dilation of blood vessels and an increase in their permeability occurs as a result of the release of biologically active substances (bradykinin, histamine, etc.) according to the mechanisms described above (the complement system, the mechanism of development of anaphylaxis).

It is worth noting that the development process of Quincke's edema and urticaria are similar. Only with urticaria does vasodilation occur in the superficial layers of the skin.

Stress emotional and physical
Infectious diseases
Injury
Surgical interventions, including dental procedures
Menstrual cycle
Pregnancy
Taking contraceptives containing estrogens

The following diseases contribute to the manifestation of acquired angioedema:

Chronic lymphocytic leukemia
Non-Hodgkin's lymphoma
Lymphosarcoma
Myeloma
Primary cryoglobulinemia
Lymphocytic lymphoma
Waldenström's macroglobulinemia

All these diseases contribute to a decrease in the level of C1 inhibitor and increase the possibility of uncontrolled activation of complement with the release of biologically active substances.

In angioedema associated with the use of ACE inhibitors, the development of the disease is based on a decrease in the level of a specific enzyme (angiotensin II), which in turn leads to an increase in the level of bradykin. And accordingly this leads to swelling. ACE inhibitors (captopril, enalapril), drugs mainly used to control blood pressure. Symptoms of Quincke's edema do not appear immediately after using such medications. In most cases (70-100%), they appear during the first week of treatment with these drugs.

Causes of allergic Quincke's edema cm.

Causes of anaphylaxis

Precursors of Quincke's edema: tingling, burning in the area of edema. U

35% of patients experience pink or red skin on the trunk or extremities before or during swelling.

In order to understand the symptoms of Quincke's edema, you need to understand that the appearance of symptoms and their characteristics vary depending on the type of edema. So Quincke's edema with anaphylactic shock or other allergic reaction will differ from an episode of hereditary or acquired angioedema. Let's consider the symptoms separately for each type of Quincke's edema.

Type of edema	Symptoms
Type of edema	Onset and duration of swelling	Place of appearance	Characteristics of edema	Peculiarities
Allergic Quincke's Edema	From a few minutes to an hour. Usually in 5-30 minutes. The process resolves after a few hours or 2-3 days.	Most often the area of the face and neck (lips, eyelids, cheeks), lower and upper limbs, genitals. Swelling can occur in any part of the body.	The swelling is dense and does not form a pit after pressure. The swelling is pale or slightly red.	In most cases, it is accompanied by hives and itchy rashes.
Quincke's edema is hereditary and acquired, as well as associated with taking ACE inhibitors,	Swelling in most cases develops within 2-3 hours and disappears in 2-3 days, but in some patients it can be present for up to 1 week.	Swelling most often appears in the eyes, lips, tongue, and genitals, but can appear in any part of the body.	The swelling is often pale, tense, there is no itching or redness, and there is no pit left after pressure.	Not accompanied by urticaria.
Quincke's edema without found causes	See allergic angioedema			Urticaria occurs in 50% of cases

Symptoms of Quincke's edema depending on the location of occurrence

Do I need to call an ambulance?

An ambulance should be called in any case of Quincke's edema. Especially if this is the first episode.

Indications for hospitalization:

Swelling of the tongue
Difficulty breathing caused by swelling of the airways.
Intestinal swelling (symptoms: abdominal pain, diarrhea, vomiting).
No or insignificant effect from treatment at home.

How can I help before the ambulance arrives?

Clear the airways
Check for breathing
Check pulse and blood pressure
If necessary, perform cardiopulmonary resuscitation. see First aid for anaphylactic shock.
Administer medications

The tactics of drug treatment for non-allergic Quincke's edema and allergic edema are slightly different. Considering the fact that non-allergic angioedema reacts poorly to basic medications (adrenaline, antihistamines, glucocorticoids) are used to treat acute allergic reactions. However, as practice shows, it is better to start with these medications, especially if a case of Quincke's edema is detected for the first time and its exact cause has not yet been determined.

The drugs are administered in a certain sequence. At the beginning, adrenaline is always administered, then hormones and antihistamines. However, if the allergic reaction is not so pronounced, the introduction of hormones and antihistamines is sufficient.

Adrenalin

At the first symptoms of Quincke's edema, you should administer

adrenalin. This is the drug of choice for all life-threatening allergic reactions.

Where to inject adrenaline? Usually on prehospital stage the drug is administered intramuscularly. The best place for the injection of adrenaline, this is the middle third of the outer surface of the thigh. The peculiarities of blood circulation in this area allow the drug to quickly spread throughout the body and begin to act. However, adrenaline can also be injected into other parts of the body, for example, into the deltoid muscle of the shoulder, gluteal muscle etc. It is worth noting that in emergency situations when swelling occurs in the neck and tongue, adrenaline is injected into the trachea or under the tongue. If necessary and possible, adrenaline is administered intravenously.

How much should I enter? Usually in such situations there is a standard dose for adults of 0.3-0.5 ml of a 0.1% solution of adrenaline, for children 0.01 mg/kg of weight on average 0.1-0.3 ml of a 0.1% solution. If there is no effect, the administration can be repeated every 10-15 minutes.

Currently, there are special devices for convenient administration of adrenaline, in which the dose is strictly defined and dosed. Such devices are the EpiPen syringe pen and the Allerjet audio instruction device. In the USA and European countries, such devices are worn by everyone suffering from anaphylactic reactions and, if necessary, they can independently administer adrenaline.

Main effects of the drug: Reduces the release of allergic reaction substances (histamine, bradykinin, etc.), increases arterial pressure, eliminates spasms in the bronchi, increases the efficiency of the heart.

Hormonal drugs

Used to treat an allergic reaction the following drugs: dexamethasone, prednisolone, hydrocortisone.

Where to enter? Before the ambulance arrives, you can administer medications intramuscularly, into the same gluteal area, but if possible intravenously. If it is not possible to administer it with a syringe, it is possible to simply pour the contents of the ampoule under the tongue. There are veins under the tongue through which the drug is well and quickly absorbed. The effect when the drug is administered under the tongue occurs much faster than when administered intramuscularly, even intravenously. Since when hit medicine it immediately spreads into the sublingual veins, bypassing the hepatic barrier.

How much should I enter?

Dexamethasone from 8 to 32 mg, in one ampoule 4 mg, 1 tablet 0.5 mg.
Prednisolone from 60-150 mg, in one ampoule 30 mg, 1 tablet 5 mg.

Medicines also exist in tablets, but the speed of onset of effect is much lower than with the above methods of administration (IM and IV). If necessary, hormones can be taken in tablet form in the indicated doses.

Main effects of the drugs: relieve inflammation, swelling, itching, increase blood pressure, stop the release of substances that cause allergic reactions, help eliminate bronchospasm and improve heart function.

Antihistamines

The drugs that block H1 receptors are mainly used (loratadine, cetirizine, clemastine, suprastin). However, it has been proven that the antiallergic effect is enhanced by a combination of H1 and H2 histamine blockers. H2 receptor blockers include: famotidine, ranitidine, etc.

Where to enter? It is better to administer the drug intramuscularly, however, the drugs will also work in tablet form, but with a later onset of effect.

How much should I enter? Suprastin – 2 ml-2%; in tablets 50 mg;

Clemastine – 1 ml – 0.1%;

Cetirizine - 20 mg;

Loratadine – 10 mg;

Famotidine – 20-40 mg;

Ranitidine – 150-300 mg;

Main effects of the drugs: eliminate swelling, itching, redness, stop the release of substances that trigger an allergic reaction (histamine, bradykinin, etc.).

Medicines used for non-allergic Quincke's edema knitted with a decrease in the level of C1 inhibitor (hereditary, acquired Quincke's edema)

Drugs that are usually administered during hospitalization:

Purified C1 inhibitor concentrate, administered intravenously, is used in Europe and the USA. Not yet used in the Russian Federation.
In the absence of a C1 inhibitor concentrate. Fresh frozen plasma 250-300 ml is administered, which contains sufficient quantity C1 inhibitor. However, in some cases, its use may increase the exacerbation of Quincke's edema.

Drugs that can be administered independently before the ambulance arrives:

Aminocaproic acid 7-10 g per day orally until the exacerbation completely stops. If possible, place a dropper in a dose of 100-200 ml.
Effects: the drug has antiallergic activity, neutralizes the effect of biologically active allergy substances (badikinin, kaleikrein, etc.), reduces vascular permeability, which helps eliminate edema.
Male sex hormone preparations(androgens): danazol, stanazol, methyltestosterone.

Doses: danazol 800 mg per day; Stanazolol 4-5 mg per day, taken orally or intramuscularly; Methyltestosterone 10-25 mg per day, route of administration, under the tongue.

Effects: These drugs enhance the production of C1 inhibitor, thereby increasing its concentration in the blood, which eliminates the main mechanism for the development of the disease.

Contraindications: pregnancy, lactation, childhood, prostate cancer. In children, aminocaproic acid is used together with androgens.

In case of laryngeal edema, complete closure of the airways is possible, in which drug treatment is not always effective. In this case, a puncture or cut into the cricothyroid ligament (cricothyriotomy) can be performed to save life. see How to ensure airway patency during laryngeal edema?

Depending on the severity and nature of the edema, the patient is sent to the appropriate department. For example, a patient will be sent to the intensive care unit in case of severe anaphylactic shock. If there is swelling of the larynx, this may be in the ENT department or the same intensive care unit. In case of Quincke's edema moderate severity Not life-threatening, the patient is undergoing treatment in the allergy department or regular therapeutic department.

What is the treatment?For allergic Quincke's edema As part of the anaphylactic reaction, the drugs of choice are adrenaline, glucocorticoid hormones, and antihistamines. In addition, detoxification therapy is carried out by intravenous administration special solutions (reoplyuglyukin, ringer lactate, saline solution, etc.). When food allergen enterosorbents are used (activated carbon, enterosgel, white coal and etc.). It is also carried out symptomatic therapy depending on the symptoms that arise, namely in case of difficulty breathing, medications that relieve bronchial spasms and dilate the airways (euphilin, salbutamol, etc.) are used.

For non-allergic Quincke's edema(hereditary, acquired Quincke's edema), accompanied by a decrease in the concentration of C1 inhibitor in the blood, treatment tactics are somewhat different. In this case, adrenaline, hormones, and antihistamines are not the first choice drugs, since their effectiveness in these types of Quincke's edema is not so high.

The first choice drugs are those that increase the missing enzyme (C1 inhibitor) in the blood. These include:

Purified C1 inhibitor concentrate;
Fresh frozen plasma;
Male sex hormone preparations: danazol, stanazolol;
Antifibrinolytic drugs: aminocaproic acid, tranexamic acid.

In case of severe swelling of the larynx and complete closure of the airway, an incision is made in the cricothyroid ligament and a special tube is installed for an alternative route of breathing (tracheostomy). In severe cases, they are transferred to an artificial respiration apparatus.

The length of hospital stay depends on the severity of the disease. On average, when treated in a therapeutic department, the patient's stay in the hospital is 5-7 days.

Quincke's edema is a type of immediate allergic reaction to external irritants. This disease is dangerous; its onset is sudden and leads to extensive swelling of the skin, attacks of suffocation and increased blood pressure. The irritant role is played by both food products or medications, and the influence of external physical factors (sun, wind, cold). If symptoms of the disease appear, you should immediately contact a medical facility. If the disease is ignored, the consequences of edema lead to a deterioration in the body's condition and even death. To answer the question of how long angioedema lasts, it is necessary to understand the types of the disease.

For the development of edema, a few minutes are enough from the time the allergen enters the body. There have been cases where swelling occurred after a few hours.

The disorder is easy to identify: the patient experiences extensive swelling of the skin. Often the disease affects the facial skin and neck, and damage to the mucous membrane of the body is possible. When the disease becomes more complicated, swelling spreads to the brain. It's threatening further development neurological disorders.

The duration of the disease varies depending on complications:

With normal swelling, the effects of the disease last for several days. The period increases to one week in case of complications. If the disease has not affected important parts of the body (the brain and the mucous membrane of the respiratory tract), then the swelling goes away without a trace. The transfer of Quincke's edema leads to a recurrence of the disease in the future. After an illness, the body may experience acute rejection of other allergens.
Swelling of the larynx lasts from 2-3 days to several weeks. Complications of laryngeal edema lead to progression of the disease. How quickly the disease makes itself known is determined by the patient’s body’s reaction to various allergens. Disease respiratory system lead to attacks of suffocation, difficulty breathing, and dry cough. Delayed treatment laryngeal edema creates the basis for the occurrence of chronic diseases of the respiratory system.
Swelling of the gastric mucosa lasts for one week. The consequences appear in the form acute pain, disturbances in appetite and body condition, and the appearance of symptoms of peritonitis. After 7-8 days, the patient’s condition improves, nutrition and intestinal motility normalize. After some time, the attack may recur. After the disease has passed, the patient should undergo a full examination gastrointestinal tract to determine possible consequences.

With angioedema, it is better not to delay contacting a doctor. Sometimes failure to seek help in a timely manner leads to death.

Damage to the urogenital system by Quincke's disease leads to urine retention and pain during urination. Swelling may appear in the genital area. Under medical supervision and acceptance medicines, the disease goes away after 2-4 days. With complicated edema of the urogenital system, the illness time increases to 7 days.
The longest and most dangerous is swelling on the face. Lobes of the brain may be affected. Patients exhibit symptoms unpleasant consequences: dizziness, nausea or vomiting, headaches. Some patients experienced disease progression within 6 weeks. Ignoring facial symptoms leads to irreparable damage to the body or death. With proper medical examination and medication, attacks can be eliminated in 7-10 days.

Quincke's disease is inherited and is chronic. Some medical institutions provide the opportunity to take tests that will help identify the allergen. After a reaction to the allergen appears, the patient must stop all contact with it in the future.

Quincke's edema can vary in duration. The duration of the disease is influenced by the following factors:

An area of the body or specific organs that is affected by disease.
Conducting a medical examination, and taking tests if necessary.
Taking prescribed medications that remove negative consequences of edema.

Proper treatment and medical examination, will reduce the progression of the disease and relieve Quincke's edema. Periodic preventive maintenance reduces the possibility of the disease occurring.

There are many causes of swelling and even more possible reasons. However, one of the most serious manifestations of swelling is Quincke's edema, which is also called angioedema. In this case, the person is very quickly exposed to this disease and it is necessary to provide assistance as quickly as possible, otherwise there is even a possibility of death. Now we will understand what can cause this complex type of edema, how it develops, and what methods exist for its elimination and treatment.

Before we begin to consider how angioedema occurs, the ways of its development, the symptoms of this disease and methods of combating it, it is worth talking about what it is.

So, the essence of the disease is that in a short period of time a person’s soft tissues, mucous membrane and skin are affected. Outwardly, it looks like a strong increase or swelling of certain areas of the skin, and it is very difficult to confuse angioedema with something else.

The causative agent of this disease in most cases is an allergen that has entered the body, that is, a reaction to a specific pathogen is observed. In this case, the body’s reaction is such that when the transferred allergen is activated, the human body reacts increased emissions histamine into blood vessels.

Most often, this pathology occurs in the face, neck and upper parts torso. For these reasons, there is a high risk of swelling of the upper respiratory tract and complete blockage of breathing. Needless to say, in such cases, urgent qualified care and hospitalization are necessary.

You have received a general idea of this pathology with the occurrence of severe swelling, and it’s time to talk about the reasons for such a reaction of the body. Doctors around the world are convinced that angioedema has two development mechanisms:

Allergic;
Pseudo-allergic;

In the first case, as mentioned above, the activator is the allergen and the body’s violent hypersensitivity to this pathogen (this scenario occurs most often). At the same time, substances produced by the body itself enter the blood in large volumes, due to which the permeability of blood vessels increases.

Blood passes through the walls of blood vessels and enters the soft tissues, then there is an increase in the intercellular distance and a general expansion of body tissues, as well as skin epithelium. Outwardly, it looks and is characterized precisely as swelling.

There are many reasons for allergic edema:

Hypersensitivity to any food product;
Reaction to chemicals;
Flowering plants;
Medications;
Insect bites;
Animal fur, etc.

Pseudoallergic angioedema is a congenital pathology in the human body, which manifests itself as a mutation of the compliment system ( separate species proteins responsible for the reactions of the immune system to individual factors).

In this case, the activator is not a third-party allergen. The body can erroneously react to any manifestations, such as heat or cold, physical damage or stress. In other words, angioedema can begin spontaneously when the compliment system is erroneously activated.

When angioedema occurs, all symptoms appear very quickly, sometimes the time from the onset of the reaction to its apogee does not exceed 2-3 minutes. Of course, the individual characteristics of the human body come into force here, however, the picture of the development of pathology in all people is approximately the same.

At the same time, it is quite easy to recognize such swelling; first of all, the reaction begins with the swelling of the eyelids, lips, and tongue. Further, the reaction goes deeper than the oral cavity, affecting soft sky, tonsils and airways. The affected outer areas of the skin increase in size by 2-3 times, and the eyes may become completely swollen.

In some cases, one might say atypical, Quincke's edema affects the genitals; in such situations, the swelling affects the labia in women and the scrotum in men.

The entire reaction is painless, you can only feel the pressure on the affected areas increasing with every second, a tingling sensation. In this case, the skin acquires a slightly pale tint, and upon palpation no traces or pits remain.

Other symptoms include the following:

Hoarseness in the voice;
Difficulty breathing;
Cough;
Vomiting.

Everything happens because the tongue and organs of the upper respiratory tract swell, the risk increases every minute and there is a high probability of asphyxia (suffocation).

With Quincke's edema, the victim is almost always overcome by a feeling of anxiety or even hysteria. The first thing to do in such cases is to try to calm the person and immediately call an ambulance. However, there are a number of activities that should not be carried out before help arrives; their use is necessary:

Give the patient any antihistamine. This action will slow down the allergic reaction and allow at least a little relief of swelling. In this case, you need to pay attention to the age and weight category of the victim, so as not to get an overdose.

There are times when antihistamines are not at hand, then any vasoconstrictor drugs will do, for example, nasal drops with the desired effect. You need to drop them into your nose, dilute them with water and try to wet your throat and mouth with them.
IN mandatory Free the patient from restrictive clothing and jewelry. You need to remove all chains from your neck, unfasten the top buttons, loosen your tie and belt on your trousers. All this can hinder respiratory process in this and without that difficult situation. It is also worth opening the windows to let more fresh air into the room.
If the causative agent of Quincke's edema is known, the patient should be protected from it as quickly as possible However, if the reaction was caused by some product (eaten or drunk), and the swelling has already become critical, in no case try to cleanse the stomach by inducing vomiting, this may worsen the situation.

Remember, this pathology appears unexpectedly and develops very quickly, sometimes in a matter of minutes. You must do everything to wait for the arrival of doctors who will be able to provide emergency care and hospitalize the patient with subsequent treatment measures.

Usually, after angioedema forms and a person is hospitalized, doctors take a number of actions to reduce the intensity of swelling and restoration processes body. In such situations, antihistamines are prescribed for some time to suppress allergies.

Further, treatment can be individual, it all depends on the cause of Quincke's edema. In any case, the reasons for activating the process are established. After this, some are prescribed drugs to reduce vascular permeability, others are recommended to periodically take a course preventive measures, remove all possible allergy triggers from the diet, etc. In any case, treatment should be prescribed by an experienced specialist and compliance with it is very important.

healthy the immune system and the absence of allergic reactions are closely related. From this article you will learn everything about what Quincke's edema is, what are the symptoms and treatment of this condition, the reasons why it occurs and the signs to which it is important to respond in time.

What is Quincke's Edema

Quincke's edema is a rapidly developing deep swelling of the tissues of the skin, mucous membranes and subcutaneous tissue. This condition can be dangerous, as there are known cases when the airways closed and the person died.

The likelihood of edema does not depend on gender: The disease appears equally often in both men and women. A relatively rare disease. Most often, the diagnosis of Quincke's edema is found in adults over 50 years of age.

Note! If a child has suffered from such a phenomenon, parents should be especially careful, since Quincke's Edema can lead to serious consequences.

During their lifetime, approximately 20% of the adult population of the planet experiences Quincke's edema at least once. Among all cases of the disease, in 25% the pathology is non-hereditary, in 30% the disease is acquired over time.

Reasons for the development of edema

The causes of Quincke's edema are varied. A review of the existing classification will help to understand why this condition occurs.

There are the following types of Quincke's edema:

allergic;
hereditary;
drug;
idiopathic.

Having examined these varieties in more detail, it will become clear what the causes of Quincke's edema occur.

Features of allergic edema

Allergic edema occurs as a result of an immune reaction of antibodies to an external antibody. The following factors can provoke a reaction:

insect bites;
consumption of certain foods;
use of certain medications;
use of inappropriate perfumes;
use of household chemicals;
inhalation of plant pollen;
smell of animal food.

The allergic reaction develops rapidly and can recur. In response to antibody penetration, inflammatory mediators are released, which ultimately leads to increased vascular permeability. As a result, rapid development of edema begins.

Even people who do not have true edema may experience Quincke's edema. The condition can develop as a response to hypersensitivity to certain substances.

Features of the hereditary form of the disease

Oddly enough, the tendency to develop Quincke's edema is transmitted genetically. If one of the parents in a married couple has this pathology, the probability of having a child with the disease is 50%.

Congenital Quincke's Edema develops against the background of a mutation of special proteins that are responsible for normal immune reactions and are intensely activated in response to the penetration of a potentially dangerous substance.

At hereditary form Diseases can be caused by various factors, even minor ones mechanical damage or contact with chemical. If first aid is not provided, death is possible. Edema can be focal, that is, concentrated in only one place on the body, or it can be diffuse.

Features of medicinal Quincke's Edema

Angioedema may occur as a result of taking certain pills. The condition is often accompanied and usually identified in the elderly.

It is the application medical supplies becomes the most common provocateur of the formation of Quincke's edema. As practice shows, this condition is caused by the use of “”, “” and even “Chlorhexidine”. Many medications contain a warning in the manufacturer's instructions that there is a risk of developing Quincke's edema.

What does idiopathic form mean?

If the doctor talks about idiopathic Quincke's Edema, it means that the causes of the problem cannot be determined. It is difficult to exclude factors that can provoke the condition, since it is not possible to determine what becomes a stimulant of a dangerous phenomenon.

Symptoms of Quincke's Edema

To prevent possible complications and even the death of the patient, emergency assistance must be provided. It is important to understand how this condition manifests itself and what the first alarming symptoms are.

The first signs of approaching edema are itching, hyperemia, burning and tingling in the area where the pathological condition will develop.

Important! The size of the edema increases rapidly; the condition can arise in just a few minutes.

The localization of edema, as a rule, is where subcutaneous fatty tissue is well developed. It could be:

larynx;
language;
sky;
throat;
eyelid

The most dangerous is swelling of the tongue and airways, as breathing becomes impossible and the person may die. Severe exacerbations are possible with the development of edema of the brain, genitourinary and digestive systems.

When localizing Quincke's edema in respiratory tract the symptoms are as follows:

difficulty breathing;
sore throat;
barking cough;
cyanosis of the skin;
fainting.

When swelling is localized on the face, the following may occur:

eyelids visually enlarge;
cheeks become swollen;
the upper lip swells sharply;
my eyes are swollen.

If problems affect the brain, neurological disorders, complaints of seizures, and pathology in genitourinary system there will be difficulty passing urine. If swelling occurs in the intestines, dyspepsia may occur, including diarrhea, bloating and pain.

In the photo you can see what the face of a person with Quincke's edema looks like. If the condition is not treated at the stage when the tumor has just appeared, negative consequences are possible.

Treatment of the condition

About treatment folk remedies with Quincke's edema we are not even talking about it. If the swelling is not eliminated quickly, death occurs. In this case, no tests or examinations are performed for diagnosis. Help must be provided immediately, and the diagnosis is obvious from external signs.

The algorithm of actions for the development of Quincke's edema is as follows:

calling an ambulance;
avoiding further contact with the allergen;
human provision alkaline drinking(if he can drink);
providing access to fresh air;
loosening of clothing around the neck or belt around the waist.

To relieve Quincke's edema, it is necessary to carry out drug therapy. Even if this is treatment at home and before the ambulance arrives, such measures can save a person’s life.

The recipe is as follows:

administration of adrenaline;
hormones;
antihistamines.

You can relieve an attack using the methods described above. Epinephrine is usually administered for allergic conditions that are life-threatening. To cure a person, the substance is injected into the gluteal, femoral, brachialis muscle or under the tongue. It is better that the injection is made as close as possible to the swelling area.

Hormones are administered either intramuscularly or intravenously. It could be:

"Dexamethasone";
"Prednisolone";
"Hydrocortisone."

Note! Injecting hormones under the tongue is more effective because it works faster.

Among the antihistamines used:

Most drugs are contraindicated during pregnancy, oncological tumors and children. Therefore, when edema develops in these categories of the population, cooperation with medical representatives is strictly necessary.

Prevention

Since it is impossible to cure Quincke's edema once and for all, with the help of simple folk ways You can provide yourself with prevention:

avoid contact with suspected allergens;
monitor your diet;
take medications with caution;
During the flowering period, follow a diet to reduce the load on the immune system.

You can save a person’s life if you notice the symptoms of Quincke’s edema in a timely manner and provide quality assistance. Calling an ambulance is mandatory in all episodes of the disease.

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