Most people do not consider the development of allergies to be life threatening. This is usually the case, but in some cases a dangerous condition occurs that provokes angioedema (Quincke's edema). Pathology manifests itself in the form of an increase in the face or limbs as a result of swelling of the deep layers of the skin and subcutaneous tissues. Such a reaction is allergic in nature, it can be triggered by the use of medicines, food allergens, pollen, animal waste, or insect bites. This pathology is characterized by an abnormal response of the body to certain stimuli.
Characteristics and description of pathology
Angioneurotic edema - localized swelling of the subcutaneous tissue as a result of an increase in vascular permeability and outpouring of fluid from them. This phenomenon is often accompanied by the development of urticaria and itching on the surface layer of the skin. In some cases, the mechanism for the development of pathology remains unknown.
Most often Quincke's edema develops due to pathologicalimmune response to an irritant that comes from the external environment. As a result, the body begins to produce histamines and prostaglandins - substances that are responsible for the response to the inflammatory process. They contribute to an increase in the permeability of blood vessels, from which lymph flows into the surrounding tissue, angioedema occurs (ICD 10 - T78.3). This phenomenon was known back in the 19th century, when the German physiologist G. Quincke described similar phenomena in his patients, and also developed effective methods for their treatment.
Quincke's edema can also be observed on the internal organs, but most often it appears on the neck, arms and face. The most dangerous localization of angioedema is the respiratory organs and membranes of the brain, their damage can cause circulatory disorders and suffocation. Without assistance, death occurs.
This phenomenon occurs only in 2% of all possible allergic reactions. According to statistics, every tenth person in the world has experienced a similar problem in some form of its manifestation.
The rate of development of an allergic reaction can be different. In some cases, swelling develops in a few minutes, and sometimes it appears gradually over one or several days, depending on the amount of the allergen and the duration of its exposure to the body. The duration of the unpleasant condition can also be different, in some cases the pathology can persist for more than six weeks (chronic form).
Swelling in children
Angioneurotic edema in children and women is diagnosed most often. Also prone to such a reaction are people who have a predisposition to allergies. In some cases, pathology can manifest itself in he althy people of any age.
Children can suffer from angioedema from the first days of life. Pathology in this case can develop if they are fed with artificial mixtures, cow's milk, as well as with the use of medications.
In newborns, the disease is severe and often causes death. Edema of the stomach and meninges is often diagnosed. Quincke's edema in children is often accompanied by bronchial asthma.
If pallor appears on the child's skin, the nasolabial part of the face turns blue, heart rate increases, shortness of breath, you should immediately call a doctor, as this may indicate swelling of the larynx. Over time, the blueness will spread to other areas of the skin, suffocation will appear, the child will lose consciousness.
Varieties of pathology
Allergic angioedema can take several forms:
- Acute edema occurs as a result of the formation of an acute allergic reaction to an allergen. It is accompanied by the development of urticaria. Often such a reaction occurs to opiates, a contrast agent used in x-rays, NSAIDs and aspirin, as well as ACE inhibitors. In this case, the face, upper respiratory tract and intestines are affected. The disease may appear several years after the start of treatment with the above drugs.
- Chronic form in which edema persists for more than six weeks. The reason for this phenomenon is not known to medicine. Allergic reactions are suspected to be caused by chronic medications, food additives, and preservatives.
- The idiopathic form develops without urticaria. In this case, the period of exacerbation and regression alternate. The reasons for the development of such a pathology are unknown.
- Hereditary angioedema develops due to C1 inhibitor deficiency. The development of edema depends on stress and microtrauma. Most often, the pathology develops in men and can be inherited. Usually with this form of edema, the larynx suffers.
Causes of edema development
Many people know how angioedema manifests itself. But not everyone knows the reasons for its appearance. This phenomenon occurs in response to the effects of allergens on the human body. Allergens can be toxins, cosmetics, insect poisons, medicines, animal dander, and more.
In some cases, Quincke's edema may occur as a pseudo-allergic reaction, which appears due to high sensitivity to certain drugs and food. Also, the problem may appear as a complication of treatment with ACE inhibitors. This is usually seen in older people, in whom drugs slow down the breakdown of bradykinin in the body, which provokes dilation of blood vessels.and increase the permeability of their walls.
Hereditary angioedema develops due to a lack of C1 inhibitor, which regulates the activity of proteins responsible for blood clotting, control of inflammation and blood pressure, and pain. Its deficiency is due to gene disorders or accelerated consumption. This phenomenon can be triggered by infectious and autoimmune diseases, cancerous tumors. Sometimes swelling can occur as a result of hypothermia or severe stress.
Indirect causes of the development of pathology include some diseases of internal organs, helminthic diseases and disorders of the endocrine system.
Symptoms and signs of illness
Symptoms of angioedema are manifested in the form of swelling and swelling of the face (eyelids, cheeks, lips), oral mucosa, genitals. Sometimes the face swells so much that it becomes like a balloon, while the person cannot even open his eyes. The hands may also swell, especially the fingers, feet, and chest. In this situation, itching is absent, the color of the skin does not change. Usually in mild cases, the swelling goes away within three days, but sometimes it spreads to the larynx, causing difficulty in breathing. In this case, a person develops a cough, hoarseness, pallor of the skin of the face, and a speech disorder appears. In severe cases, airway obstruction, hypercapnic coma, and then death develop. Also in this case, there is a pain syndrome inabdominal area, vomiting, redness or blueness of the skin, bleeding on the mucous membranes. Such signs of allergy are diagnosed in 1/4 of patients. Quincke's edema is distinguished from ordinary urticaria by the depth of the skin lesion. Sometimes this swelling is called giant urticaria.
Symptoms of angioedema can manifest as low blood pressure, tachycardia, sweating, confusion, incoordination, development of fear of death, panic.
With gastrointestinal edema, the symptoms will resemble signs of indigestion: nausea, which is accompanied by vomiting, pain in the abdomen, diarrhea. Such a phenomenon is no less dangerous, as it can cause the development of peritonitis.
With swelling of the meninges of the brain, the symptoms of the pathology will resemble meningitis. In this case, headaches, photophobia, numbness of the neck muscles, convulsions, hearing and vision impairment, paralysis appear.
Angioneurotic edema of the joints does not pose a danger to human life. In this case, the synovial part of the joints is damaged, which provokes impaired mobility and the development of pain. In 50% of cases, swelling is accompanied by the development of urticaria. A person develops itching, blisters of various sizes, conjunctivitis and watery eyes.
First aid
Since this pathology can be life-threatening, the victim should be treated for angioedema. This eliminates human contact withallergen, if known, call an ambulance. When injecting a drug or an insect bite, a bandage is tightly applied above the injection or bite site or cold is applied to slow the spread of the allergen through the body as a result of vasoconstriction. Then the person is unfastened his clothes, thereby providing an influx of fresh air, calm him down, give him a drink of activated charcoal, which is previously dissolved in water, or an antihistamine. It is best if the antihistamine is given as an injection. Without fail, the victim must be given an alkaline drink. To do this, one gram of soda is dissolved in one liter of water.
In the absence of antihistamines, topical vasoconstrictors such as Otrivin or Nozivin can help. One of these drugs in the amount of a few drops is instilled into the larynx and nasopharynx.
Survey methods
Diagnosis of angioedema begins with a study of the anamnesis and examination of the patient, his questioning. Usually, in the absence of urticaria, the doctor clarifies the possibility of using ACE inhibitors. In the presence of Quincke's edema in the face and neck, diagnostic techniques are rarely used, since the diagnosis can be made on the basis of a visual examination of a person. In the case of a chronic course of pathology, doctors study the patient's diet and the medications that he takes. If other family members have similar manifestations, the doctor prescribes a study of C1 inhibitors to determine the form of the pathology.
It is difficult to diagnose angioedema of the brain and gastrointestinal tract, as the symptoms indicate a violation of blood circulation in the brain. In this case, laboratory blood tests are performed. With angioedema, the results of the analysis will show an increase in the concentration of immunoglobulins and eosinophilia. With non-allergic edema, signs of autoimmune diseases will be revealed.
The doctor also differentiates pathology from dermatomyositis, hypothyroidism, protoporphyria, kidney disease and superior vena cava compression syndrome.
Pathology Therapy
Angioneurotic edema treatment involves one that is aimed at restoring breathing, eliminating the allergen and stopping the edema. It is very important in this case to determine the cause of the development of pathology, to identify the allergen. In severe and moderate cases, the injured person is hospitalized. He is prescribed antihistamines and glucocorticosteroids, enterosorbents, and infusion therapy is also indicated. In the hereditary form of the pathology, the introduction of a C1 inhibitor is performed. If there is no such drug, a plasma transfusion is done. The patient is prescribed androgens and antifibrinolytic drugs. With swelling of the neck, hormones and diuretics are administered intravenously.
Medicated treatment
Angioedema drugs suggest using the following:
- Adrenaline solution to increase blood pressure and eliminate asphyxia.
- Hormonal drugs, such as Prednisolone.
- Antihistamines such as"Suprastin" or "Zirtek".
- Diuretic drugs (Lasik or saline).
- C1 inhibitors, in particular "Kontrykal".
- Sorbents.
The most important task of therapy is the protection of the respiratory tract, so the treatment is aimed primarily at eliminating their edema. Most often in this case resort to endotracheal intubation of the trachea. Adrenaline is used to prevent the development of suffocation. The final stage of therapy is the appointment of symptomatic medications.
Forecast
With timely assistance, the disease has charitable forecasts. In severe cases, anaphylactic shock, suffocation and death can occur. There are no guarantees that Quincke's edema will not appear in the absence of a predisposition to allergies. The human immune system can be rebuilt over time, for example, after suffering an infectious disease. Sometimes swelling may appear not after the first contact with the allergen, but in one of the following, when the person is not ready for such an event.
Prevention
To avoid contact with allergens in the modern world is almost impossible, but you can reduce the number of meetings with them, which is recommended. Doctors advise people who are at risk not to try new foods, especially those of exotic origin. When a doctor prescribes medicines, it is necessary to check them for the presence of allergens, and insect bites should also be avoided.
If you are prone to allergic reactions, doctors recommend always having antihistamines on hand, as well as recognizing the symptoms of Quincke's edema in order to prevent the development of dangerous complications in a timely manner. Also, each person should know how to provide first aid in the development of edema, since human life can depend on this knowledge.
In order to prevent recurrent angioedema, it is recommended to adhere to a special diet, not to use medications without a doctor's prescription. With a hereditary form of the disease, a person needs to avoid stressful situations and emotional stress, as well as viral infections and injuries. Such patients should not take medications that contain estrogen. When such people undergo elective surgery, they are first given prophylactic therapy using plasma transfusion.
