Angioneurotic edema, better known as angioedema, is a serious allergic reaction that can be life-threatening. Therefore, it is necessary to know how its first symptoms manifest themselves. Quincke's edema requires emergency care for the patient at home before the arrival of doctors.
The disease is manifested by severe swelling of the skin and mucous membranes. This condition was first described by Marcello Donati (1576). The term "angioneurotic edema" was introduced by Henryk Quincke (1882), whose name the pathological condition still bears today. The chemicals that trigger 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's edema. The 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 responses.
Edema of the pseudo-allergic type is a congenital pathology of the complement system. An instant reaction develops in response to cold, heat and chemical stimuli. The most common causes of angioedema include certain groups of allergens. A reaction can develop to household chemicals and chlorine detergents and cleaners, decorative cosmetics and hygiene products, air fresheners and glass cleaners, food and pollen from certain plants.
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's edema. Symptoms are manifested by sea water and solar radiation, bee and wasp stings. The most dangerous food allergens are:
- honey;
- cocoa;
- peanut butter;
- chocolate;
- coffee;
- virtually all seafood.
Hereditary factor
Heredity is a common factor in the formation of angioedema. Symptoms are clearly manifested when an infection enters the body, with trauma or stress. As a result of such an immune response, basophils are destroyed and biologically active substances are released that support all inflammatory phenomena in the body (mediators). Allergens provoke swelling at the firstcontact, without the release of immunoglobulin E and activation of mast cells.
So, edema develops in babies under three years of age and in people with an active complement system. Often the body reacts this way to snake and insect bites.
Indirect factors
Other causes of Quincke's edema include:
- Parasitic diseases or helminthic infestations.
- Pathologies of the endocrine system.
- Diseases of internal organs.
Gastrointestinal form
Manifested 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. In the course of their destruction, a severe vascular spasm occurs, and then swelling appears. The same picture is observed in the intestine. The patient is tormented by acute pains around the navel or in the epigastric region, in the lateral sections of the abdominal cavity. He develops nausea, his palate and tongue tingle, he vomits, his stool becomes liquid.
Articular form
It leads to swelling of the inner layer of the articular bag. The configuration of the bag changes, mobility is partially lost.
Swelling with urticaria
This combination is considered the most common. In this case, in addition to puffiness, a rash appears - blisters of various shapes and sizes. The patient experiences severe itching or burning sensation.
Diagnosis of disease
A typical clinical picture (pronounced symptoms of angioedema in open areas of the body) makes it easy to diagnoseupon visual inspection. The situation is much more complicated in the clinical picture of an acute abdomen or an ischemic transient attack, when the doctor has to compare the pronounced 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 the pathology. The doctor examines the history, 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 had autoimmune diseases, whether he is taking receptor blockers, ACE inhibitors, estrogens.
Lymphoproliferative diseases, autoimmune pathology, a decrease in the level and activity of the C1 inhibitor can be detected by laboratory diagnostics in non-allergic angioedema. Angioedema of an allergic nature is determined by an increase in the level of total IgE, blood eosinophilia, positive skin tests.
In case of laryngeal edema aggravated by stridor breathing, laryngoscopy is required, in case of abdominal syndrome - examination by a surgeon and instrumental studies, including endoscopic (colonoscopy, laparoscopy).
Symptoms of angioedema in adults. Photo and description
More often the edema is localized on the face, capturing the mucous membranes of the eyes and mouth. At the same time, cases of damage to the gastrointestinal tract, membranes of the brain and joints have been recorded. Edema developsrapidly and refers to emergency conditions that require urgent medical attention. Fortunately, this dangerous condition develops in only 2% of allergic reactions. With untimely medical care, Quincke's edema developing in the larynx can lead to death due to asphyxia (suffocation). The first symptoms in this case are a hoarse voice and dry barking cough.
Puffiness 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 and his relatives. It has already been mentioned above how rapidly Quincke's edema develops. Symptoms in the form of edema primarily appear on the face, in some cases on its individual parts: lips, eyelids, tip of the nose, cheeks, ears. The face becomes puffy, the eyes turn into slits and water heavily. Pale skin. She gets hot and tight. The edema 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 swell strongly. These are not the worst signs of Quincke's edema. Symptoms indicating that the pathology has covered the vocal cords, soft tissues of the larynx and descends into the trachea are deadly. Hoarseness, sore throat, shortness of breath, barking cough, and difficulty breathing while 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 be quite severe. Often it is combined with urticaria. In special medical publications, you can often see photos of the symptoms of Quincke's edema. The treatment of children is complicated by the fact that it is difficult for doctors to make a diagnosis: even younger schoolchildren cannot always adequately describe their condition, especially for two- and three-year-olds.
Since such an immune response can provoke laryngeal edema and asphyxia, parents need to carefully monitor the child's condition before the arrival of doctors. Swelling of the larynx can last from an hour to a day. If a child complains of tingling of the tongue and palate, after which vomiting and diarrhea occur, as well as a sharp pain in the abdomen, then the edema also affects the gastrointestinal tract.
With edema, children may have a fever, disturb pain in the joints. Some babies are very excited, often they lose consciousness. After the child has been accurately diagnosed and the allergen that provoked Quincke's edema has been identified, parents should avoid contact with him and have all the necessary drugs in the house to help at home.
First aid to the sick
It is very important to provide timely assistance to the patient when symptoms of Quincke's edema appear. Treatment at home begins with an antihistamine, but first it is necessarycall the ambulance. As a rule, people with allergies always have the necessary medicines on hand (Zirtek, Tavegil, Suprastin). If there were no antihistamines in the house, with symptoms of Quincke's edema, treatment can be started with the well-known drug Naphthyzin. Drop two drops into the nose, calm the patient, open the windows: the patient needs fresh air. Loosen your neck and chest from tight clothing.
If a 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. Cold should be applied to the site of swelling. If the patient has lost consciousness, he is given artificial respiration. Relatives of people with recurrent edema are well aware of the effectiveness of Prednisolone and, as a rule, can independently make an intramuscular injection.
It must be remembered that a person's life depends on coordinated and confident actions in removing the symptoms of Quincke's edema before the arrival of doctors. Therefore, it is important not to get confused so as not to miss precious time.
Inpatient treatment
Further measures for the treatment of Quincke's edema continue in the hospital. In adults, the symptoms of pathology are removed with antihistamines. In addition, intravenous infusion therapy is carried out. It increases the volume of circulating blood, and also filters allergens through the kidneys with the help of protease inhibitors ("Kontrykal"), saline, epsilon aminocaproic acid, effective inpseudo-allergic edema.
Lasix, Furosemide are administered intravenously. The doctor may prescribe Askorutin at the end of infusion therapy, which helps to reduce vascular permeability. Treatment with enterosorbents is also indicated (Enterosgel, Polyphepan, Polysorb, Filtrum STI). These drugs bind food allergens in the gut.
Drugs for the treatment of angioedema
In this article, we presented a photo of the symptoms of Quincke's edema. Treatment of adults or children should be started immediately after the onset of its first signs. To do this, you should always have antihistamines in the house. They are prescribed by a doctor, but below is a list of antiallergic drugs that are used in the acute period of edema.
First generation drugs:
- "Diprazine".
- "Suprastin".
- Fenistil.
- "Hifenadine".
- "Tavegil".
These medicines work in a quarter of an hour. They effectively stop Quincke's edema, but lengthen the reaction time, therefore they are contraindicated for drivers and cause drowsiness. Have an effect on histamine H-1 receptors.
Second generation antihistamines stabilize mast cells from which histamine enters the bloodstream. "Ketotifen" relieves spasm of the respiratory tract. Recommended for combination of bronchial asthma with angioedema or broncho-obstructive diseases.
Medicines of the third generation stabilize the walls of mast cells, do not depress the central nervous system, block histamine receptors. These include:
- Semprex.
- "Loratadine".
- Zyrtec.
- "Terfenaddin".
- Cetrin.
The choice of drugs is carried out by the doctor in accordance with the following recommendations:
- Children under one year old - Fenistil.
- From one to four years - Loratadine.
- From five to twelve - Astemizol, Terfenadine.
- For pregnant women - Loratadin, Telfast.
- For nursing mothers - "Clemastin", "Pheniramine".
Quincke's edema is easier to prevent than to treat. In order to prevent pathology, it is necessary to exclude household and food allergens, do not self-medicate, and at the first manifestations of allergic reactions (urticaria, dermatitis, conjunctivitis, seasonal rhinitis, bronchial asthma), urgently contact an allergist.
