Angioedema, which is better known as Quincke's edema, is a serious allergic reaction that can be life-threatening. Therefore, you need to know how its first symptoms manifest. Quincke's edema requires emergency care for the patient at home until the arrival of doctors.
The disease is manifested by severe swelling of the skin, as well as the mucous membranes. This condition was first described by Marcello Donati (1576). The term "angioneurotic edema" was introduced by Henryk Quincke (1882), whose name is still a pathological condition today. The chemicals that provoke it were identified in 1964. Since that time, doctors have been able to conduct targeted pathogenetic treatment.
Causes of pathology
Specialists divide it into allergic and pseudo-allergic Quincke edema. Symptoms and treatment of these conditions are somewhat different. Allergic edema is a strong reaction of the body to a specific allergen. The disease develops in people predisposed to immune reactions.
Pseudo-allergic edema is an inborn pathology of the complement system. An instant reaction develops in response to cold, heat, and chemical stimuli. The most common causes of Quincke edema include certain groups of allergens. The reaction can develop to household chemicals and chlorine-containing detergents and cleaners, decorative cosmetics and hygiene products, air fresheners and glass washing fluids, food and pollen from some plants.
Quite often in adults, symptoms of Quincke's edema appear on medications. Most often, such a reaction is caused by non-steroidal anti-inflammatory drugs, antibiotics, acetylsalicylic acid, drugs that regulate blood pressure.
Natural factors can also cause the development of Quincke edema. Symptoms are manifested in sea water and solar radiation, bee and wasp stings. The most dangerous food allergens are:
- honey;
- cocoa;
- peanut butter;
- chocolate;
- coffee;
- almost all seafood.
Hereditary factor
Heredity is a common factor in the formation of Quincke edema. Symptoms are clearly manifested when an infection enters the body, with trauma or stress. As a result of this immune response, basophils are destroyed and biologically active substances are released that support all inflammatory phenomena in the body (mediators). Allergens provoke edema at the first contact, without the release of immunoglobulin E and activation of mast cells.
So, edema develops in babies up to three years old and in people with an active complement system. Often the body reacts to snake and insect bites.
Indirect factors
Other causes of Quincke's edema include:
- Parasitic diseases or helminthic infestations.
- Pathology of the endocrine system.
- Diseases of the internal organs.
Gastrointestinal form
It manifests itself as an acute eating disorder, proceeds with signs of allergic gastritis. In this case, the walls of the stomach are attacked by food allergens, basophils and eosinophils accumulate in them. During their destruction, a severe vascular spasm occurs, and then swelling appears. The same picture is observed in the intestines. The patient is tormented by acute pain around the navel or in the epigastric region, in the lateral abdominal cavity. He feels nauseous, tingles in the palate and tongue, vomiting opens, and his stool becomes loose.
Joint form
It leads to swelling of the inner layer of the joint bag. The configuration of the bag is changing, mobility is partially lost.
Swelling with urticaria
This combination is considered the most common. In addition to the swelling, a rash appears - blisters of various shapes and sizes. The patient experiences severe skin itching or a burning sensation.
Diagnosis of the disease
A typical clinical picture (pronounced symptoms of Quincke's edema in open areas of the body) allows you to easily make a diagnosis with a visual examination. The situation is much more complicated in the clinical picture of an acute abdomen or ischemic transient attack, when the doctor has to compare the expressed symptoms with a number of diseases of the internal organs and diseases of the nervous system.
It is difficult to distinguish between acquired and hereditary angioedema, identifying the causative factor of pathology. The doctor studies the anamnesis, determines the presence of a hereditary predisposition to allergic reactions, the presence of cases of Quincke's edema in relatives. In addition, he is interested in cases of death of relatives from suffocation due to edema. To establish a diagnosis, it is important to know whether the patient was sick with autoimmune diseases, whether receptor blockers, ACE inhibitors, estrogens are taken.
Lymphoproliferative diseases, autoimmune pathology, and a decrease in the level and activity of the C1-inhibitor can be detected by laboratory diagnostics for non-allergic angioedema. Quincke's edema of an allergic nature is determined by an increase in the level of total IgE, blood eosinophilia, and positive skin tests.
With laryngeal edema, weighed down by stridor breathing, laryngoscopy is required, with abdominal syndrome, a surgeon should be examined and instrumental, including endoscopic (colonoscopy, laparoscopy).
Symptoms of Quincke edema in adults. Photo and description
Often, edema is localized on the face, capturing the mucous membranes of the eyes, the oral cavity. However, cases of damage to the gastrointestinal tract, membranes of the brain and joints were recorded. Edema develops rapidly and refers to emergency conditions that require urgent medical attention. Fortunately, this dangerous condition develops in only 2% of allergic reactions. In case of untimely medical care, it can lead to death due to asphyxiation (suffocation), developing in the larynx, Quincke's edema. The first symptoms in this case are a hoarse voice and a dry barking cough.
Swelling of the face and body
It can be of varying degrees of intensity: in some patients, the appearance changes slightly, but more often the changes frighten both the patient himself and his relatives. It has already been mentioned above how rapidly developing Quincke's edema. Symptoms in the form of edema primarily appear on the face, in some cases on its separate parts: lips, eyelids, tip of the nose, cheeks, ears. The face becomes puffy, the eyes turn into holes and watery. The skin turns pale. She gets hot and tight. The swelling is so dense that there is practically no trace left after pressure.
It can spread to the upper abdomen and chest, to the neck. Sometimes feet, genitals, hands are swollen. These are not the worst signs of Quincke's edema. Symptoms indicating that the pathology swept the vocal cords, the soft tissues of the larynx and descends into the trachea are deadly. Husky voice, sore throat, shortness of breath, barking cough and shortness of breath when inhaling require urgent medical attention. Otherwise, the patient may die.
The course of the disease in children
Most often, this pathology affects people over 20 years old, much less often - older people. In children, the disease is most often hereditary and can occur in a rather severe form. Often it is combined with urticaria. In special medical publications, you can often see photos of the symptoms of Quincke's edema. Treatment of children is complicated by the fact that it is difficult for doctors to make a diagnosis: even younger schoolchildren can not always adequately describe their condition, especially when it comes to two-, three-year-olds.
Since such an immune response can provoke laryngeal edema and asphyxiation, parents need to carefully monitor the condition of the child before the doctors arrive. From an hour to a day, laryngeal edema can last. If the child complains of tingling of the tongue and palate, after which vomiting and diarrhea occur, as well as sharp abdominal pain, then the edema also affects the gastrointestinal tract.
With edema, children can have a fever, disturb pain in the joints. Some babies are very excited, often they lose consciousness. After the child is diagnosed accurately and the allergen that provokes Quincke's edema is identified, parents should not be allowed to come into contact with him and should have all the necessary medications in their home to help at home.
First aid to the patient
It is very important to provide timely assistance to the patient with the appearance of symptoms of Quincke's edema. Home treatment begins with an antihistamine, but first you need to call the ambulance. As a rule, people with allergies always have the necessary medicines on hand (Zirtek, Tavegil, Suprastin). If there are no antihistamines in the house, with the symptoms of Quincke's edema, treatment can be started with the well-known drug "Naphthyzine". Drop two drops in the nose, calm the patient, open the vents: the patient needs fresh air. Free your neck and chest from tight clothing.
If the child is sick, take the baby in your arms. Try to be calm, because your nervousness is transmitted to the baby. If you know which allergen caused the reaction, remove it. It is necessary to apply cold to the site of edema. If the patient lost consciousness, he undergoes artificial respiration. Relatives of people with recurrent edema are well aware of the effectiveness of Prednisolone and, as a rule, can do intramuscular injection on their own.
It must be remembered that a person's life depends on coordinated and confident actions when removing the symptoms of Quincke edema before the arrival of doctors. Therefore, it is important not to be confused so as not to miss precious time.
Hospital treatment
In the hospital, further measures are continuing to treat Quincke's edema. In adults, the symptoms of pathology are relieved by antihistamines. In addition, intravenous infusion therapy is performed. It increases the volume of circulating blood, and also filters allergens through the kidneys with the help of protease inhibitors (Kontrikal), saline, epsilonaminocaproic acid, which is effective for pseudo-allergic edema.
"Lasix", "Furosemide" are administered intravenously. The doctor may prescribe “Ascorutin” at the end of infusion therapy, which helps reduce vascular permeability. Enterosorbent treatment is also indicated (Enterosgel, Polyphepan, Polysorb, Filtrum STI). These drugs bind food allergens in the gut.
Preparations for the treatment of Quincke's edema
In this article, we presented a photo of the symptoms of Quincke's edema. Treatment for adults or children should be started immediately after the onset of its first signs. To do this, you must always have antihistamines in the house. They are prescribed by a doctor, but a list of antiallergic drugs that are used in the acute period of edema will be given below.
First-generation drugs:
- "Diprazin."
- Suprastin.
- Fenistil.
- "Chifenadine."
- Tavegil.
These medicines act after a quarter of an hour. They effectively stop Quincke's edema, but lengthen the reaction time, therefore they are contraindicated in drivers and cause drowsiness. They have an effect on histamine H-1 receptors.
Second generation antihistamines stabilize mast cells, from which histamine enters the bloodstream. “Ketotifen” relieves airway spasm. Recommended for combination of bronchial asthma with angioedema or with bronchial obstructive diseases.
Third-generation drugs stabilize mast cell walls, do not inhibit the central nervous system, and block receptors for histamine. These include:
- Semprex.
- "Loratadine."
- Zirtek.
- "Terfenaddin."
- "Tsetrin."
The choice of drugs is carried out by a doctor in accordance with the following recommendations:
- Children under one year old - Fenistil.
- From one to four, Loratadin.
- Five to twelve - "Astemizol", "Terfenadine."
- For pregnant women - “Loratadin”, “Telfast”.
- For nursing mothers - "Clemastine", "Feniramin."
Quincke's edema is easier to prevent than to treat. In order to prevent pathology, household and food allergens should be excluded, not self-medicating, and at the first manifestations of allergic reactions (urticaria, dermatitis, conjunctivitis, seasonal rhinitis, bronchial asthma), consult an allergist urgently.