Quincke's Edema - Causes, Symptoms and Treatment. MF.

Quincke edema( other names - acute angioedema, giant urticaria, trophoneurotic edema, angio edema) is a developing sudden limited or diffuse edema of subcutaneous adipose tissue and mucous membranes. Quincke's skin is affected by adults and children, but more often the disease occurs at a young age, especially in women. Children and the elderly are rarely seen.

Causes of edema Quincke

The allergic edema of is based on an allergic antigen-antibody reaction. Biologically active substances - mediators( histamine, kinins, prostaglandins) that are released in the pre-sensitized organism cause local expansion of capillaries and veins, there is an increase in the permeability of microvessels and tissue edema develops. The cause of allergic edema may be the effect of specific foods( eggs, fish, chocolate, nuts, berries, citrus fruits, milk), medicinal and other allergens( flowers, animals, insect bites).

In patients with nonallergic edema Quincke disease is due to heredity. Inheritance occurs by a dominant type. In the serum of patients, the level of inhibitors of C-esterases and kallikrein was lowered. Quincke's edema at the same time, like allergic edema, develops under the influence of substances that cause the formation of histamine - the same allergens. Edema develops in a sensitized organism under the influence of specific allergens: flowers, animals, food, medicine, cosmetics or nonspecific: stress, intoxication, infection, hypothermia. Predisposing factors may be diseases of the liver, thyroid( especially with its reduced function), stomach, blood diseases, autoimmune and parasitic diseases. Often in this case, the disease acquires a chronic recurrent course.

In some cases, the cause of edema Quinck can not be established( the so-called idiopathic edema).

Symptoms of edema Quincke

The disease begins suddenly. Within a few minutes, less often hours, pronounced edema develops in different areas of the face and mucous membranes. There can be local swelling of the lips, eyelids, scrotum, and also the mucous membranes of the mouth( tongue, soft palate, tonsils), respiratory tract, gastrointestinal tract, urogenital area. Edema is rarely accompanied by pain, more often patients complain of a feeling of tension of tissues. In the area of ​​the edema, the tension of the tissues of the elastic consistency is noted, with the pressure of the fovea not remaining, palpation( palpation) of the swelling is painless.

Quincke is most often swollen on the lower lip, eyelids, tongue, cheeks, larynx, and the swelling of the larynx and tongue can lead to the development of asphyxia - there is difficulty in breathing, aphonia develops, cyanosis of the tongue.

With the spread of edema to the brain and the meninges, there are neurological disorders( epileptiform seizures, aphasia, hemiplegia, etc.).

Quincke's edema can last for several hours or days, then disappears without a trace, but can recur periodically.

Quincke

edema Complications The most threatening complication may be the development of laryngeal edema with the growing symptoms of acute respiratory failure. Symptoms of laryngeal edema are hoarseness of voice, barking cough, progressive difficulty of breathing.

Swelling of the gastrointestinal mucosa may simulate acute abdominal pathology, with dyspeptic disorders, acute abdominal pain, increased intestinal peristalsis, and sometimes peritonitis symptoms.

The defeat of the urogenital system is manifested by the symptoms of acute cystitis and can lead to the development of acute urinary retention.

The most dangerous is the localization of the edema on the face, since it is possible to involve the meninges with the appearance of meningeal symptoms or labyrinth systems, which is manifested by signs of Meniere's syndrome( dizziness, nausea, vomiting).In the absence of emergency skilled care, such edema can lead to death.

A combination of acute hives and Quincke edema is possible.

Quinck

Swelling

Differential diagnosis is performed with lymphostasis, collateral edema with periostitis, erysipelas, Melkerson-Rosenthal syndrome. In the Melkerson-Rosenthal syndrome, along with edema of the lip of the chronic course, the folding of the tongue and neuritis of the facial nerve are revealed. With erysipelas, there is hyperemia( redness) in the area of ​​lesions in the form of tongues of flame.

Emergency first aid for swelling of the

• quinta With blood pressure lowering, 0.1-0.5 ml of 0.1% adrenaline solution is injected subcutaneously;
• In asphyxia( edema of the mucous membrane of the respiratory tract) injections of adrenaline;
• Hormone therapy: glucocorticoids( prednisolone 60-90 mg IM or IV, dexazone 8-12 mg IV);
• Desensitizing treatment: antihistamines( suprastin 2% - 2.0 w / m, Claritin, Zirtek, Erius, Telfast).
• Diuretics: Lasix 40-80 mg IV infusion in 10-20 ml of physiological solution;Preparations protease inhibitors: contrikal - 30,000 units IU in 300 ml of physiological solution, epsilon-aminocaproic acid 5% - 200 ml IV drip, then - 100 ml after 4 hours or 4 g per os 4-5 timesa day until the reaction is completely blocked;
• Detoxication therapy - hemosorption, enterosorption;
• Hospitalization in the allergological department.

Treatment of edema step by step:

• Elimination of contact with the allergen;
• administration of drugs to increase the tone of the sympathetic nervous system( calcium preparations, ascorbic acid, ephedrine);
• decreased parasympathetic activity( atropine) and the level of histamine( dimedrol, suprastin, tavegil);
• Vitaminotherapy is needed - prescribe ascarutin to reduce vascular permeability;
• Desensitizing therapy( ACTH, cortisone, prednisolone) treatment of group B vitamins and gamma globulin
• The basis for the treatment of the hereditary form of the edema of Quincke are medicinal preparations that enhance the production of the missing C1 inhibitor

. The hormone treatment in the absence of contraindications to hormone therapy is recommended inhospital.

Prevention of

The only reasonable prevention is avoiding contact with allergens.

Doctor therapist Naumenko ON