Quincke's edema is characterized by. Causes, symptoms and treatment of angioedema. The state of the immune system and the mechanism of development of Quincke's edema

Content

One of the most severe manifestations of an allergic reaction is Quincke's edema. This condition was first described by the doctor Heinrich Quincke, and this pathology is named after him. Another medical name for this disease is angioedema. The disease occurs in only 2% of people who are susceptible to allergic reactions. The disease develops rapidly and requires urgent medical intervention. Due to reasons that are not fully understood, it occurs more often in women or children.

What is Quincke's edema

Angioedema of this type is characterized by local swelling of the skin, damage to the mucous membranes, subcutaneous tissue of a pseudo-allergic or allergic nature. As a rule, a reaction occurs on the cheeks, lips, eyelids, tongue, neck, and much less often it can appear on the mucous membranes, for example, of the genitourinary organs, gastrointestinal tract, and respiratory tract. In the latter case, air flow may be impaired, which poses a risk of asphyxia.

Symptoms

Quincke's disease has pronounced symptoms; they can persist from several minutes to several hours, in rare cases they do not go away for a day. Usually, all manifestations disappear without a trace, but in the chronic form of the pathology relapses occur. The main symptoms of Quincke's edema:

It develops very quickly and suddenly, within 5-20 minutes (in rare cases 1-2 hours).
Serious swelling of the subcutaneous tissue, mucous membranes to a dense, painless swelling occurs; it occurs on the cheeks, nose, tongue, lips, eyelids, mucous membranes of the mouth, tracheobronchial tract, larynx, inner ear, and sometimes affects the meninges, stomach, genitals, and intestines.
One of the characteristic signs of Quincke is the absence of pain, unpleasant sensations appear only upon palpation; there is a feeling of fullness, tissue tension, and density.
The typical location of swelling is on the upper body (face). Swelling of the larynx and trachea will be extremely dangerous for human life. This condition is a medical emergency.
In 20% of cases of Quincke syndrome, the pathology is not accompanied by itchy skin, but half of the patients experience urticaria, which is characterized by burning and blisters.
A general allergic reaction causes nasal congestion, lacrimation, itching of the conjunctiva, sneezing, fever, weakness, and headache.

Causes of Quincke's edema

To avoid a life-threatening condition, you need to know what causes allergic swelling. This may vary from person to person, but the most common risk factors include the following:

Classification

In medicine, Quincke syndrome, taking into account associated and main factors, is usually classified according to the following algorithm:

acute edema – symptoms persist for up to 45 days;
chronic – symptoms will last longer than 6 weeks with periodic relapses;
acquired - during the entire period of observation, this type was recorded only 50 times in people over 50 years of age;
hereditary angioedema – 1 case per 150 thousand patients is recorded;
swelling along with symptoms of urticaria;
isolated – without additional conditions.

Doctors always focus on two types of dangerous edema with similar external manifestations:

angioedema;
hereditary (non-allergic).

With the same symptoms of the disease, completely different factors become the cause of development. This situation often leads to an incorrect diagnosis, which is fraught with serious complications, the use of an incorrect emergency care regimen, and further therapy. It is very important at the stage of providing assistance to determine which type of pathology has developed in the patient.

Complications

If help is not provided to a person in time, Quincke syndrome can develop and cause serious complications. Here are the main consequences that can be caused by this pathology:

The most threatening complication may be swelling of the larynx; signs of acute respiratory failure will gradually increase. Symptoms of this complication will be a barking cough, hoarseness of the voice, and progressive difficulty breathing.
Swelling of the gastrointestinal mucosa can cause acute abdominal pathology. Acute abdominal pain, dyspeptic disorders, increased peristalsis, and in rare cases symptoms of peritonitis develop.
Swelling of the urogenital system may be accompanied by signs of acute cystitis, which causes urinary retention.
Dangerous complications can be caused by Quincke syndrome, which is localized on the face. The meninges may be involved in the process, and symptoms of meningeal diseases or labyrinthine systems may appear (manifested by signs of Meniere's syndrome). This swelling can be fatal without immediate medical attention.
Acute urticaria may be combined with Quincke's reaction.

Diagnostics

After overcoming the crisis and eliminating the threat to life, the following laboratory tests may be prescribed:

Measures the amount of total immunoglobulin (IgE) that reacts with the allergen and provokes the development of immediate allergic symptoms. An ICLA (immunochemiluminescent) study is carried out; the results show that the IgE value should normally be in the range of 1.31-165.3 IU/ml.
Tests to detect specific IgE, which help determine the root cause (allergens) that provoke immediate swelling. The effectiveness of allergy prevention and treatment depends on the result of this technique.
Determination of disorders in the complement system, analysis of function for the control and diagnosis of autoimmune diseases.

After recovery, several months later, when antibodies that respond to the allergen are present in the body, the following studies are carried out:

Skin allergy tests. A classic method in which the suspected allergen is applied to the surface of the skin. If a person is sensitive to this reagent, the skin will show mild inflammation around the site where the agent was applied.
Immunogram analysis or study of the immune system.
Search for systemic diseases, which often cause Quincke syndrome.
If there was pseudo-allergic edema, then it is necessary to examine the entire body, perform a wide range of tests (biochemical, bacteriological), do an ultrasound, and an x-ray of the organs.

Treatment of Quincke's edema

If a patient experiences swelling of the larynx, trachea or throat, he is immediately sent to a hospital for treatment. Treatment measures are carried out in two stages:

elimination of an allergic reaction;
eliminating symptoms, determining causes, prescribing treatment.

Emergency care during an acute period in the hospital is aimed at eliminating threatening symptoms and ensuring the normal functioning of vital functions if a state of shock is observed. Doctors must reduce the body's reaction to the allergen. If the described symptoms appear, you should definitely call an ambulance. The main measures that can be taken for Quincke therapy:

To prevent symptoms of suffocation and a dangerous drop in pressure, Epinephrine (Adrenaline) is administered intravenously, subcutaneously or intramuscularly in dosages according to the patient’s age. There should be a gap of at least 20 minutes between injections.
You can relieve swelling by injecting hormones in an age-appropriate dose according to the instructions (Dexamethasone, Prednisolone).
Intravenous administration of drugs against shock, to remove toxins from the body (Hemodez, Reopoliglyukin, 5% glucose solution).
Intramuscular, intravenous administration of antihistamines (Diphenhydramine, Suprastin).
To increase dangerously low blood pressure and restore blood volume, colloidal and saline solutions are infused through a dropper.
The patient is given diuretic medications (Mannitol solution, Lasix, Furosemide), which remove allergens and excess fluid from the body, and reduce swelling. Can be prescribed for high and normal blood pressure.
If bronchospasm is observed, then Dexamethasone with Eufillin is given intravenously.
A mask with pure oxygen is indicated if there is a pronounced deficiency in the blood, shallow, difficult breathing, wheezing, blue discoloration of the mucous membranes and skin.
Hemosorption is a method of actively removing allergens and toxins from the blood, which is passed through absorbent sorbents.

First aid for Quincke's edema

Allergic and idiopathic edema must be treated using different methods, but a person will not be able to independently determine the type of pathology. For this reason, you need to start therapy with medications that are effective in both forms of the disease (antihistamines, adrenaline, glucocorticoids). You must immediately call an ambulance and try to stop the spread of swelling. Emergency care for angioedema, which can be provided before the doctor arrives:

clear the airways;
check for breathing;
measure blood pressure, pulse;
if necessary, perform cardiopulmonary resuscitation (artificial respiration);
administer the medications described above.

Tablets

This pathology must be treated with medications that can block H1 receptors. These include the following drugs:

Lortadine;
Suprastin;
Citrisine.

To maximize the antihistamine effect of drugs, a complex of drugs is additionally prescribed to block H1 and H2. This group of medications includes:

Ranitidine;
Famotidine.

There are several forms of medications for treating angioedema; for maximum effect, intravenous solutions are usually prescribed. This is the fastest way to influence the allergen in the human body. If the cause of edema is known, for example, a chronic disease, or it does not threaten a person’s life, then tablet forms can be used. Their main difference is that the effect occurs a little later.

This is a powerful synthetic glucocortecosteroid, which contains adrenal hormones and their synthetic analogues. This medication is prescribed to control metabolic processes (carbohydrates, proteins, minerals). If there is a need to treat Quincke's reaction with Dexamethasone, the dosage should be selected correctly. This is done by a doctor on an individual basis, taking into account the patient’s condition and sensitivity to medications. The instructions for the drug indicate the following options for taking the drug:

A small dose of 2-6 mg is taken in the morning;
a large dose of 10-15 mg is taken 2-3 times per day;
after achieving the desired result, the dosage is reduced to 0.5-4.5 mg per day;
exit from the course of treatment is carried out smoothly;
if a child and not an adult is undergoing treatment, then the dose is calculated based on 0.083-0.33 mg of medication per 1 kg of weight.

Diet

Food allergens very often cause Quincke's reaction, so the diet must be selected very carefully. There are certain foods that are more likely to cause illness than others:

strawberries;
fish;
eggs;
seafood;
citrus;
strawberry;
nuts.

If food has become the cause of the pathology, then doctors sharply limit the diet, but such a diet cannot be maintained for a long time. The body must receive the full range of necessary substances, so fasting should not be prolonged. Products are introduced smoothly, usually from one type, for example:

The patient begins to consume semi-liquid mashed potatoes without adding oil. The serving is 100 g on an empty stomach, then 200 g 4 times a day.
When the body adapts to the need to fully digest food, other products are added to the potatoes in the same way. It is important that the dishes do not contain any additives (exclude butter, milk, fruits, vegetables).
Before introducing each product, a “provocation” is first carried out: on an empty stomach you need to eat 100 g of this dish.

There is a conventional order in which hypoallergenic products should be introduced. The plan for including additional dishes depends on the patient's dietary characteristics (identified dangerous foods). The following sequence is considered the most rational:

potato;
carrot;
dairy products;
bread (preferably stale);
cereals;
beef;
fish;
poultry meat;
eggs.

Consequences

When an acute condition passes after the development of pathology, a person may experience dyspepsia and abdominal pain for several days. If the urogenital system is affected, then there is acute urinary retention and symptoms of cystitis appear. The worst consequence of Quincke syndrome is death due to acute respiratory failure. With meningeal signs of pathology, the following are often noted:

vomit;
nausea;
dizziness.

Prognosis and prevention

The outcome of Quincke's pathology will depend on the degree of edema and the timeliness of emergency care. For example, in case of an allergic reaction in the larynx, in the absence of prompt therapeutic action, the outcome can be fatal. If the disease is recurrent and accompanied by urticaria for six months, then in 40% of patients the pathology will be observed for another 10 years, and in 50% a long-term remission occurs even without preventive treatment. The hereditary type of angioedema will recur throughout life.

Correctly selected preventive and supportive treatment will help to avoid relapse, which significantly reduces the likelihood of developing pathology or complications. Measures to prevent Quincke's reaction depend on the type of pathology:

If there is a history of allergic genesis, then it is important to follow a diet and exclude potentially dangerous medications.
If it is possible to recognize hereditary angioedema, then viral infections, injuries, taking ACE inhibitors, stressful situations, and estrogen-containing medications should be avoided.

Photo of angioedema

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Quincke's edema: symptoms, treatment and causes

Quincke's edema is an acute, suddenly developing severe disease that affects subcutaneous fatty tissue and mucous membranes. This pathology has several other names: acute angioedema, trophoneurotic edema, giant urticaria, angioedema.

It was first described by the German therapist Quincke in the 19th century. The basis for its development is an immediate allergic reaction with the release of biologically active substances: histamine, heparin, serotonin, etc. Under their influence, the permeability of the smallest vessels increases and therefore edema develops.

People of all age groups can get sick, but angioedema most often occurs in young women. In childhood and old age they get sick much less often.

What it is?

Quincke's edema is a reaction to various biological and chemical factors, often of an allergic nature. Manifestations of angioedema are enlargement of the face or part or limb. The disease is named after the German physician Heinrich Quincke, who first described it in 1882.

Causes

Quincke's edema can be allergic and pseudo-allergic.

Allergic Quincke's edema appears upon contact with an allergen. For an allergic reaction to develop, the body must already be sensitized - there has already been an encounter with the allergen, and the body has developed antibodies. When this allergen re-enters the site of contact, inflammation is caused: small vessels dilate, their permeability increases, and as a result, tissue swelling occurs.

Allergens can be:

Pollen.
Various insect bites.
Wool and animal waste products.
Cosmetics.
Food products (citrus fruits, chocolate, eggs, fish products, various berries).
Medications. The most common reaction is to antibiotics, painkillers, and vaccines. The reaction can range up to anaphylactic shock, especially if the drug is administered by injection. Vitamins and oral contraceptives rarely cause anaphylactic shock.

Pseudoallergic edema is a hereditary disease; patients have a pathology of the complement system. This system is responsible for triggering an allergic reaction. Normally, the reaction starts only when an allergen enters the body. And with pathology of the complement system, activation of inflammation also occurs from thermal or chemical exposure, in response to stress.

Symptoms of Quincke's edema

Quincke's edema is manifested by the occurrence of certain symptoms, this is the appearance of edema in places with developed subcutaneous tissue - on the lips, eyelids, cheeks, oral mucosa, genitals. The color of the skin does not change. There is no itching. In typical cases, it disappears without a trace after a few hours (up to 2-3 days). The swelling may spread to the lining of the larynx, which can cause difficulty breathing.

In this case, there is a hoarseness of the voice, a barking cough, difficulty breathing (first exhale, then inhale), noisy breathing, the face is hyperemic, then suddenly turns pale. Hypercapnic coma occurs and then death may occur. Nausea, vomiting, abdominal pain, and increased peristalsis are also noted.

Angioedema differs from ordinary urticaria only in the depth of skin damage. It should be noted that manifestations of urticaria and angioedema may occur simultaneously or alternate.

Complications

With Quincke's edema affecting any organ, especially if it is accompanied by intense manifestations of urticaria, anaphylactic shock can develop at lightning speed. This is an extremely life-threatening allergic reaction that spreads throughout the body. Manifests itself in the following symptoms:

generalized (widespread) itching;
swelling of the tissues of the pharynx, tongue, larynx;
nausea, vomiting, cramping abdominal pain, diarrhea;
convulsions, respiratory arrest, coma;
the appearance of urticaria (swelling and itchy red-pink spots, blisters);
lacrimation, sneezing, bronchospasm with excessive mucus production, blocking the flow of oxygen;
increased heart rate, drop in blood pressure, cardiac arrhythmia, increase in acute cardiovascular failure.

Incorrect treatment of hereditary angioedema also leads to fatal consequences for the patient.

What does Quincke's edema look like, photo

The photo below shows how the disease manifests itself in humans.

First aid

Quincke's edema develops very unpredictably and poses a threat to the patient's life. Therefore, the first thing to do is to call an ambulance, even if the condition is currently satisfactory and stable. And under no circumstances should you give in to panic. All actions must be quick and clear.

Before the emergency ambulance team arrives, you must:

Make the patient sit in a comfortable position and calm him down
Give an antihistamine (fenkarol, diazolin, diphenhydramine). Injectable forms of antihistamines are more effective, since it is possible that swelling of the gastrointestinal tract develops and the absorption of substances is impaired. In any case, you need to take 1 - 2 tablets of the drug if it is not possible to get an injection. The medicine will weaken the reaction and alleviate the condition until the ambulance arrives.
Limit contact with the allergen. When bitten by an insect (wasp, bee), the sting must be removed. If you cannot do this yourself, you need to wait for specialists to arrive.
Enterosgel or regular activated carbon can be used as sorbents.
Be sure to drink plenty of alkaline water (per 1000 ml of water, 1 g of soda, either Narzan or Borjomi). Drinking plenty of fluids helps remove the allergen from the body.
Provide good access to fresh air, remove objects that make breathing difficult.
To reduce swelling and itching, you can apply a cold compress, a heating pad with cold water, or ice to the swollen area.

In case of severe swelling, it is better not to take any measures on your own, so as not to provoke a worsening of the patient’s condition, and wait for an ambulance. The main thing is to do no harm.

Diagnostics

First of all, the doctor conducts an examination to familiarize himself with the existing symptoms. In addition, the reaction of edema to the administration of adrenaline must be taken into account.

The next stage is to establish the cause of the pathology. As a rule, it is enough to ask the patient about what allergic diseases are present in his or his immediate family history, what his body’s reaction is to eating various foods, taking (administering) medications, and contact with animals. Sometimes specific blood tests and allergy tests are required to detect the cause.

How to treat?

For allergic angioedema, which is part of an anaphylactic reaction, the drugs of choice for treating patients are adrenaline, glucocorticoid hormones, and antihistamines. In addition, detoxification therapy is carried out by intravenous administration of special solutions (reoplyuglyukin, ringer lactate, saline solution, etc.).

In the case of a food allergen, enterosorbents (activated carbon, enterosgel, white coal, etc.) are used. Symptomatic therapy is also carried out depending on the symptoms that have arisen, namely, in case of difficulty breathing, drugs that relieve bronchospasm and dilate the airways (euphilin, salbutamol, etc.) are used.

It makes sense to provide data on the latest trends in the field of antiallergic drugs, treatment of which is carried out in the acute period of Quincke's edema and between episodes of repeated angioedema.

First generation antihistamines: chloropyramine (suprastin), promethazine (pipolfen, diprazine), fenkarol (hifenadine), pheniramine (avil), dimethindene (fenistil), tavegil (clemastine), mebhydrolin (omeril, diazolin) act quickly (within 15-20 minutes). They are effective in relieving Quincke's edema, but cause drowsiness and prolong reaction time (contraindicated for drivers). Act on H-1 histamine receptors
The second generation blocks histamine receptors and stabilizes mast cells, from which histamine enters the bloodstream. Ketotifen (zaditen) effectively relieves spasm of the respiratory tract. Indicated when angioedema is combined with bronchial asthma or broncho-obstructive diseases.
Third-generation antihistamines do not depress the central nervous system, block histamine receptors and stabilize the mast cell wall: Loratadine (Clarisens, Claritin), Astemizole (Astelong, Hasmanal, Istalong), Semprex (acrivastine), Terfenadine (teridine, Trexil), Allergodil (acelastine), Zyrtec, Cetrin (cetirizine), Telfast (fexofenadine).

For non-allergic Quincke's edema (hereditary, acquired Quincke's edema), accompanied by a decrease in the concentration of C1 inhibitor in the blood, the 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.

Diet

Diet adherence is mandatory. In this case, it is necessary to completely exclude not only products that cause a direct allergic reaction, but also a cross one. The menu of an allergic patient should not contain products with synthetic additives, artificial colors, or histamines. At the same time, the diet should not be depleted by replacing allergenic foods with hypoallergenic ones that are similar in calorie content.

Products that can cause an allergic reaction:

fish and seafood, chicken, eggs, dairy products, cocoa, peanut butter and nuts themselves;
strawberries, tomatoes, spinach, grapes;
spices of different types, chocolate.

Very carefully, people prone to allergic reactions to foods should eat sauerkraut, cheese, rhubarb, legumes, fried and stewed meat and fish dishes, as well as broths. Drinking wine, even in small doses, is completely contraindicated.

Artificial food additives can also cause an allergic reaction: preservatives, dyes, flavors and taste stabilizers.

Prevention

Following certain rules will help prevent the development of soft tissue swelling:

eat right;
If you are prone to allergies, follow a gentle diet;
take vitamin complexes to strengthen the immune system;
avoid contact with foods and medications that cause allergies;
If you have allergic reactions to certain types of medications, be sure to notify your doctor;
When taking a new type of antibiotic, keep antihistamines on hand.

Forecast

The prognosis of the disease is favorable in most cases. The most dangerous for the patient is Quincke's edema localized in the larynx. In this case, only emergency medical care will help the patient avoid asphyxia. If breathing is significantly impaired, a tracheostomy is necessary.

Quincke's edema is a dangerous allergic reaction with severe symptoms. If first aid is provided incorrectly, the consequences can be very serious. Negative signs appear in the upper part of the body: the face, lips, neck swell, the lumen of the larynx often narrows, and there is a risk of suffocation. Some patients develop swelling of internal organs, which is life-threatening.

What allergens provoke an acute reaction? What to do if angioedema develops? How to provide first aid for Quincke's edema? These and many other issues related to severe allergic reactions are covered in the article.

Causes of a severe allergic reaction

A dangerous condition develops under the influence of various types of irritants. in a quarter of cases it occurs with a hereditary predisposition to increased sensitization of the body; in some cases, doctors cannot determine the exact cause of the acute immune response. Quincke's edema code according to ICD - 10 - T78.3.

Provoking factors and allergens:

products of certain groups. In most patients, certain types of food cause a severe allergic reaction: honey, eggs, whole milk, citrus fruits. Red berries, fruits and vegetables, chocolate, seafood, and peanuts are also highly allergenic;
household chemicals, washing powders, body care compositions;
potent medications: iodine-containing agents, sulfonamides, antibiotics, aspirin, B vitamins, compounds with an anticonvulsant effect;
plant pollen during the flowering period;
poison that enters the body through insect bites;
cosmetics, especially low-price products with irritating ingredients;
helminthic infestations;
feather, wool, fluff of pets. Excrement, saliva, particles of dead epidermis in animals are dangerous irritants, especially for children;
physical factors: light, low temperatures;
viral and bacterial infections;
dry food for fish and parrots;
frequent, prolonged stress;
severe autoimmune diseases.

Basic Rules:

parents should prepare the child’s diet taking into account the degree of allergenicity of the products;
You should not feed your children food that contains dangerous synthetic fillers, preservatives, or dyes;
It is advisable to protect children from contact with potential allergens, especially if the body is weak. Plant pollen, animal hair, some drugs, insect bites are the main irritants that provoke angioedema;
You need to strengthen your immune system, spend time in the air, and do hardening. An important point is the prevention of passive smoking, which worsens the general condition of household members, especially children;
There should always be antihistamines in your first aid kit. Giant urticaria develops quickly, often within 15-30 minutes. Without allergy medication at home, serious consequences are possible. Allergy sufferers should always carry an antihistamine prescribed by a doctor.

Every person should know the symptoms, consequences, causes of angioedema. If signs of giant urticaria appear, the participation of health care workers is required. Don't panic: Correctly provided first aid often saves the life of an adult or child with an acute allergic reaction.

The following video contains useful advice from a specialist on how to provide first aid for angioedema and what can be done before specialists arrive:

A unique technology - autolymphocytotherapy - will help you cure allergic Quincke's edema in 2020. Long-term remission of the disease is achieved in 91% of patients.

This allergic disease was first described by the German neurologist Quincke in 1882.

Modern medicine distinguishes two different forms of it, similar only in external clinical manifestations: angioneurotic And allergic Quincke's edema. The identical clinical picture of these two diseases often leads to incorrect diagnosis and fatal complications. After all, treatment tactics and even intensive care for the two types of edema are very different!

It is possible to distinguish the allergic form of Quincke's edema from the angioedema only with the help of special studies.

Angioedema

Hereditary angioedema is a chronic disease belonging to the group of congenital immunodeficiencies. This form of edema is characterized by the presence of a genetically determined defect of the immune system, in which in most cases family inheritance can be traced.

Hereditary angioedema, in contrast to allergic angioedema, most often occurs in connection with injuries (bruises, compression by clothing, surgical interventions). Exacerbation of this form of the disease can also be provoked by the following factors: intense physical or psycho-emotional stress, hypothermia, infectious diseases, hormonal changes in the body: taking contraceptives, pregnancy.

Angioedema Angioedema manifests itself in the form of local swelling of the skin, subcutaneous tissue or mucous membranes of the respiratory tract, gastrointestinal and urogenital tract. In this case, skin itching is usually absent.

Hereditary angioedema is diagnosed by special laboratory tests that reveal a genetically determined defect of the immune system. A correctly established diagnosis of the disease will prevent life-threatening complications for patients.

Main directions in the treatment of angioedema

In the case of an acute form of the disease with swelling of the trachea, larynx, and bronchi, urgent measures are taken to relieve the acute condition.

Symptomatic therapy is carried out after laboratory confirmation of the diagnosis and only under the supervision of specialists in a hospital setting. Corticosteroids, tranquilizers, sedatives, including immunomodulators, as well as 2nd and 3rd generation antihistamines are used.

Patients with hereditary angioedema are categorically not recommended to play sports or work associated with increased risk of injury, physical effort, and mechanical pressure on the skin and subcutaneous tissue. It is advisable for patients to undergo surgical interventions in a hospital setting.

The treatment method “Autolymphocytotherapy” is not used for this form of the disease!

Allergic Quincke's edema and its manifestations in the patient

Allergic angioedema in external manifestations it is almost no different from the angioedema form of the disease. Its sign is clearly limited swelling of the skin and subcutaneous tissue, not accompanied by itching.

How do the symptoms appear?

Edema can occur in the face (swelling eyes, swollen nose and lips), extremities, as well as mucous membranes (oral cavity, larynx, tracheobronchial tree, gastrointestinal and urogenital tracts - even swelling of the genitals).

Quincke's edema localized in the face, lips, tongue is often accompanied by swelling of the larynx. This condition requires emergency first aid, as it threatens the patient’s life. Severe swelling in the throat area is accompanied by difficulty breathing, coughing and can lead to suffocation in an allergic person.

Unlike angioedema, its allergic variety is often accompanied by rashes in the form of urticaria. In this case, the following occurs: skin rash, severe itching and burning of the skin.

The allergic form of Quincke's edema is also called "giant urticaria", in fact it represents an extreme degree of allergic reaction (on a par with anaphylactic shock). And adrenaline injections in severe cases of an allergic reaction are one of the forms of emergency care for the patient.

A little about the causes of the disease

Allergic angioedema can be caused by foods that provoke the release of histamine by immune cells: fish, seafood, eggs, nuts, legumes, citrus fruits, tomatoes, eggplants, smoked products, chocolate, cheese, alcohol, confectionery with tartrazine dye. Therefore, for prevention, the patient must follow a hypoallergenic diet, excluding prohibited foods from the diet. Acute angioedema after eating allergens leads in the number of relapses among allergy patients.

Particular care should be taken by patients with seasonal rhinitis (hay fever) during the flowering period of plants, when allergic urticaria when eating fresh fruit can provoke Quincke's edema.

Therefore, if you experience frequent angioedema, then do not self-medicate at home! Be sure to get examined, take an allergen test and get an IgE test from an allergist at your nearest clinic.

Hypoallergenic diet, excluding the consumption of cause-significant allergenic foods;
Various medications, antihistamines and tablets (Suprastin, Kestin, Loratadine, Zyrtec, Erius, Ketotifen, etc.);
Hormonal ointments (Elocom, Advantan with prednisolone, etc.);
Folk remedies and homeopathy;
Grandmothers-healers.

They will not relieve you of the cause of the allergic disease, and at best they will only affect the symptoms of Quincke's edema.

A unique medical technology - autolymphocytotherapy (ALT) - will help you cure the cause of allergic angioedema and achieve long-term remission of the disease.

Problems of a patient with allergic edema

With the help of ALT, allergic angioedema is treated, which is caused by:

And they do not treat:

Get rid of angioedema using the ALT method in 2020!

“Autolymphocytotherapy” (abbreviated as ALT) has been widely used in the treatment of patients with various forms of allergic diseases for more than 20 years - the method was first patented in 1992.

ALT is used to treat angioedema in children and adults. For children, treatment with the Autolymphocytotherapy method is carried out after 5 years.

The method of “Autolymphocytotherapy”, in addition to the treatment of “Quincke’s edema”, is widely used for: atopic dermatitis, urticaria, food allergies, bronchial asthma, allergic rhinitis, hay fever, food allergies, allergies to household allergens, to pets, allergies to cold and ultraviolet rays ( photodermatitis).

The essence of the ALT method is to use lymphocytes’ own immune cells to restore normal immune function and reduce the body’s sensitivity to various allergens.

The main advantage of ALT over ASIT therapy is the possibility of simultaneous treatment of several allergic diseases. For example, hay fever and Quincke's edema with polyvalent allergies to pollen and food allergens.

Autolymphocytotherapy is carried out on an outpatient basis, in an allergology office as prescribed and under the supervision of an allergist-immunologist. Lymphocytes are isolated from a small amount of the patient's venous blood under sterile laboratory conditions.

The isolated lymphocytes are injected subcutaneously into the lateral surface of the shoulder. Before each procedure, the patient is examined in order to individually prescribe the dose of the administered autovaccine. Apart from its own lymphocytes and physiological solution, the autovaccine does not contain any drugs. Treatment regimens and the number and frequency of immune cells administered depend on the severity of the disease. Autolymphocytes are administered in gradually increasing doses with an interval between injections of 2 to 6 days. The course of treatment consists of 6-8 procedures.

Normalization of the functions of the immune system and a decrease in the body's sensitivity to allergens occurs gradually. The expansion of the hypoallergenic diet is carried out within 1-2 months. Cancellation of supportive symptomatic therapy is also carried out gradually under the supervision of an allergist. The patient is given the opportunity to have 3 free follow-up consultations within 6 months of observation after completing the course of treatment using the Autolymphocytotherapy method.

The effectiveness of treatment is determined by the individual characteristics of the immune system. This process to a certain extent depends on the patient’s compliance with the recommendations of the allergist during the period of treatment and rehabilitation.

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Angioedema, or otherwise angioedema, was first described in 1881, since then many studies have described its symptoms. Its treatment is carried out using both non-drug methods and pharmaceutical drugs. Quincke's edema is a swelling of the epithelium, subcutaneous tissue and submucosal membranes. The development of edema occurs extremely quickly and in an acute form.

Quincke's edema, the symptoms and treatment of which depend on the true origin of the pathology, is classified as follows:

Hereditary form of angioedema (HAE).
Acquired angioedema (PAE).
Allergic angioedema.
Angioedema of non-allergic origin (in the absence of C1 inhibitor pathology).

The classification of types of angioedema makes it possible to systematize the characteristics of the symptoms of each type and choose a treatment method. Very often, without sufficient knowledge, patients confuse true Quincke's edema with urticaria. Although the latter pathology accompanies only 1 type of edema, which is treated quite simply. The most complex form of edema is hereditary.

It in turn is divided into subcategories:

Hereditary forms of AO are not accompanied by urticaria. They are initially diagnosed at a very early age and subsequently systematically recur.

Acquired angioedema (AEO) is less common. Occurs, as a rule, with malignant neoplasms, chronic infectious diseases and autoimmune pathologies. The first manifestations occur already in adulthood (45-50 years) with subsequent systematic relapses.

Quincke's edema (symptoms and treatment by many are mistakenly associated with urticaria) in allergic forms has a completely different etiology. Allergic angioedema in this case is caused by hypersensitivity to certain allergens. As a result of this factor, local expansion of the epithelial vessels occurs, and the degree of permeability of the vascular walls also increases.

This leads to cell migration and swelling occurs in the deep layers of the epithelium. A separate form should be identified as AO with a non-allergic mechanism of development. This pathology is associated with malfunctions in the body's immune system. Basically, these are disturbances in the complementary system, which counteracts foreign agents and is responsible for the formation of inflammation and allergies.

When its activity is activated, the same processes occur as in the allergic form, but they are not caused by the activity of allergens.

The scientific literature separately describes a vibrational form that occurs against a background of vibrations, even minor ones.

Causes of development in children and adults

Angioedema is a pathology caused by numerous factors. Their reasons should be considered in relation to the classification. As mentioned above, hereditary forms are based on genetic factors. The causes of PAO are infectious, oncological and autoimmune pathologies.

The allergic form is characterized by a connection to the action of certain groups of allergens:

various chemicals;
Food;
pharmaceuticals;
plant pollen;
insect bites.

The formation of Quincke's edema with a normal level of inhibitor and its functional characteristics (edema of non-allergic origin) has its own characteristics. Regulation of the activity of the complementary system occurs due to variation in the level of the C1 inhibitor.

When there is an excess amount of it, the activity of the system slows down, and when there is a deficiency, it has a positive dynamic. Scientific developments have established that a decrease in the level of C1 is the source of Quincke's edema of non-allergic etiology. The reason lies in the increase in histamine levels.

Its increase occurs as a result of consumption in large quantities:

guilt;
cheese;
beer;
other types of alcohol;
smoked meats;
chocolate;
fish;
tomatoes;
spinach;
certain groups of pharmaceuticals (antibiotics, muscle relaxants, general anesthetics, narcotic analgesics);
iodine preparations in radiology;
ACE inhibitors.

The onset of the disease is provoked by the following group of factors:

In addition, AO may be associated with pathologies:

nervous system;
of cardio-vascular system;
gastrointestinal tract;
respiratory organs;
genitourinary system.

Mechanism of edema formation

Partially the scheme for the occurrence of edema has already been described above. They begin to form as a result of expansion of the vascular lumens, an increase in the volume of vessels and, as a consequence, an increase in the permeability of the vascular walls. As a result of free migration of cells, areas of edema are created.

The development of edema occurs rapidly (from several minutes to several hours). Swelling is localized in the area of the eyelids, lips, near the genitals, on the distal surfaces of the extremities, on the submucous membranes of the respiratory and gastrointestinal tract.

The first symptoms of Quincke's edema

Quincke's edema, the symptoms and treatment of which are described in dozens of sources, does not always fit the standard description. Therefore, when an exacerbation of the disease begins, it is important to notice the first manifestations of edema in time, since the situation can develop very quickly.

On the face

Localization of swelling on the face is typical for all forms of AO. Seals in most cases are located around the eyes, close to the eyelids, and around the lips. With massive edema, temporary loss of vision may occur due to compression of the eyelids.

Swelling located in the lip area can spread to the mucous membranes of the mouth, pharynx and larynx. In this regard, they pose the greatest danger.

In the respiratory tract

When the respiratory system is affected, swelling covers the areas of the lips, pharynx, tongue and just above the larynx. From the very beginning of edema, a hoarse voice is observed, which, as the edema develops, turns into a whisper with wheezing breathing. A “barking” cough often occurs. In severe cases, asphyxia and death of the patient are observed.

In internal organs

As a rule, the gastrointestinal tract is affected in all forms of OA. It manifests itself as systematic sharp pain due to swelling of the intestinal wall. Accompanied by anorexia, diarrhea and vomiting. Clinical manifestations are similar to those of “acute abdomen”, as well as intestinal obstruction. When internal organs are damaged, as a rule, there are no external manifestations.

Endoscopy reveals well-defined swelling on the intestinal mucous membranes. Swelling of the membranes of the brain manifests itself as severe headaches, in severe cases – signs of cerebrovascular accident and, in the absence of medical care, can lead to death. Swelling of the mucous membranes of the urinary tract is characterized by urinary retention.

On limbs and body

When the edema is localized on the distal surfaces of the upper and lower extremities, bluish compactions appear. Palpation leaves no pits or traces. There may be an itching sensation. Such swelling is not dangerous, but it does cause considerable discomfort.

Clinical picture with the development of edema

The symptoms and clinical manifestations of Quincke's edema are well known and allow the doctor to select the correct treatment in a short time. All forms of HAE are characterized by the formation of dense and painless edema of various locations. They can form on any part of the body or mucous membrane.

The swelling is pale in color, palpation leaves no traces. There is no itching or urticaria.

As a rule, there are no visible reasons for the onset of edema.

However, provocative factors may include:

HAE is characterized by constant localization of edema during relapses. The development of edema is relatively slow (8 – 30 hours). The use of antihistamines is not effective. The frequency of relapses is not stable.

The clinical picture of PAO is identical to that described above, but with distinctive features:

There are symptoms of concomitant oncological and autoimmune pathologies.
The onset of the disease is characterized by a later date.
Not burdened by heredity.

The course of allergic AO is accompanied by urticaria, itching and symptoms of atopic diseases. The area of edema is hot and hyperemia is observed. There are painful manifestations, and paresthesia may be observed when the nerves are compressed.

The development of edema is accompanied by a decrease in blood pressure and an anaphylactic reaction, as well as bronchospasm. Characterized by rapid development and rapid relief with antihistamines. Swelling goes away without treatment in 1-3 days.

The differences in forms of Quincke's edema are shown in the table:

Symptoms	Hereditary forms	Allergic origin
Aggravated medical history	No	Eat
Heredity	Available	Yes
Primary manifestation	In childhood	In young years
Dynamics	Slow course (11 – 36 hours), the beginning of remission after 1 – 5 days.	Rapid development and rapid disappearance.
Provocative factors	Injuries, pressure, stress, infections, medications, surgical procedures, stress, infections.	Contact with an allergen
Localization	Stable location	Unstable
Taking antihistamines	Not effective	Effective
Presence of urticaria	Absent	Present most often
Painful sensations	In most cases	As a rule, there are no
Laryngeal edema	Present	Not typical

First emergency aid for Quincke's edema

The first step is always to call an ambulance. The development of edema can be very rapid and unpredictable.

Before providing medical assistance:

Sit the victim in a comfortable position, avoid panic.
If the pathology is accompanied by urticaria, you can give the patient antihistamines. This will make his condition a little easier.
Provide good air access and ventilate the room.
Apply a cold compress or a heating pad with ice (or a plastic bottle) to the area of swelling.
It is recommended to drink plenty of fluids, preferably still mineral water. If this is not available, you can add a quarter teaspoon of soda to a liter of water.

In severe cases, it is better not to take any measures that, due to lack of skills and qualifications, can only worsen the patient’s condition.

What to do at home if there is swelling of the larynx?

If swelling of the larynx is suspected, even if it is swelling around the mouth and lips, when calling an ambulance, you should indicate that there is swelling of the larynx and the patient is suffocating. In this case, the nearest team will leave on an emergency basis for vital reasons. Apart from the above measures, it is impossible to take measures on your own. In this case, only qualified medical assistance is needed.

Treatment in hospital with drugs

The selection of medications for treatment is carried out by the attending physician after consultation with specialists:

Treatment tactics for Quincke's edema:

relief of acute conditions;
prevention in the current period of remission;
long-term preventative measures.

Therapy for hereditary edema involves both non-drug measures and the use of medications. The first involves providing respiratory functions through tracheostomy or intubation.

Medicines for HAE and PAO are approximately the same (dosage and choice are made by the attending physician):

The use of antihistamine drugs for HAE is ineffective. Quincke's edema, symptoms and treatment of its allergic form, as well as non-allergic ones, have their own characteristics.

Before starting drug treatment:

A hypoallergenic diet is established.
Medicines that may provoke the disease are discontinued.
Identified infectious and inflammatory processes are stopped.

The basis of treatment is third generation antihistamines:

Zyrtec;
Allergodil;
Telfast;
Cetrin;
Semprex.
Astemizole;
Terfenaddin;
Loratadine.

Second generation drugs can also be used:

Cetirizine;
Desloratadine
Rupatadine;
Ebastine;
Fexofenadine;
Loratadine;
Levocetirizine.

These pharmaceuticals can be used for a long time. The best effect is noted when used during remission. First generation drugs are not recommended. The reason is due to multiple side effects. Glucocorticosteroids are recommended in cases of severe disease. For health reasons, the administration of adrenaline is recommended.

Diet

Issues related to diet in each specific case must be agreed with your doctor.

In general, try to exclude the following foods from your diet:

whole milk;
eggs;
citrus;
coffee;
chocolate;
caviar;
smoked meats;
fish;
mustard;
nuts;
wheat;
tomatoes;
mushrooms;
raspberries;
cocoa;
strawberry;
spices;
sauces;
beet;
black currant;
carrot;
carbonated drinks;
alcohol.

Most often, a strict diet is introduced during periods of acute condition, and then foods that have a causal relationship with the occurrence of edema are simply excluded.

Traditional methods of relieving swelling

In folk medicine, there are many recipes for relieving swelling. But without a reliable diagnosis and the recommendation of the attending physician, you should not carry out independent treatment.

As an aid you can use:

These are the simplest and most accessible methods.

Usually the simplest swelling does not cause difficulties with treatment. However, in severe cases it requires serious treatment. Hereditary forms of edema and acquired AO persist for life. Therefore, it is necessary to systematically undergo a course of preventive treatment during the period of remission and follow all recommendations of the attending physician.

Laryngeal edema is the most dangerous of the angioedemas. Most often, deaths are associated with this type of attack.

If you have a disease accompanied by urticaria, contact with cold water under certain conditions can cause the development of giant urticaria after swimming. In some cases this ends in the death of the patient. Observations have established that if AO, accompanied by urticaria, has a relapse every six months, then this process will continue for at least 10 years.

There are known cases of spontaneous cessation of chronic AO, aggravated by urticaria. Most often this applies to children. Quincke's edema is a common pathology with high dynamics and frequent fatal outcomes. Therefore, if symptoms appear, you should immediately contact a medical facility so that doctors can treat you.

Article format: Lozinsky Oleg

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