Quincke edema is a severe acute pathology, manifested in the massive edema of subcutaneous fat, loose internal tissues, organs, mucous membranes, which can lead to the death of the patient from suffocation if the respiratory tract is affected. It was first described in 1882 by the physician Heinrich Quincke.
And today let's look at the causes, symptoms and treatment of Quincke edema in adults and children, compare photos of patients and find out the prognosis for such an allergy.
Features of the ailment
Quincke edema occurs in different age categories, it affects adults and small patients, but more often the disease affects people young, and, mainly, female.
In adults and children
Pathology is extremely dangerous in the development of edema of the laryngeal mucosa, as the tissues are so "swollen" that they can seriously hinder breathing. This is a real threat to life for children who have a small laryngeal lumen in almost a minute, and then suffocate the child.
- In younger children( up to 2 years), pathology occurs rarely - in only 2% of the case histories. But the swelling of Quincke can develop in infants. Pediatricians more often began to meet with a combination of edema and urticaria( an allergic reaction with the appearance of red itchy rashes and blisters).
- For women who are expecting a baby, Quincke's edema can also cause serious complications due to swelling and a disorder in the functions of the organs, a possible oxygen deficiency that occurs during swelling of the respiratory tract, which has a harmful effect on the health of the fetus, and also because of the danger of using many medications thatmakes it difficult to carry out emergency care and treatment of the disease.
- At the age of 13-17 years, the disease is often more severe, which pediatricians associate with hormonal changes caused by puberty of adolescents.
- In elderly people, this type of disease is rare.
About the features and types of edema Quincke will tell the video below:
In pregnant
Physiology during the bearing of the baby changes and the susceptibility of the woman to allergens increases many times, and swelling of tissues and organs is not uncommon. The probability of angioedema is especially increased in the second half of pregnancy. And the allergy unexpectedly arises even on those products, drugs and substances that before pregnancy did not give a pathological reaction.
In pregnant women, Quincke's edema is often accompanied by symptoms of giant urticaria, expressed as puffiness of the face, the appearance of itchy red blisters, spasms in the stomach, a sharp rise in pressure, shortness of breath, palpitations and the detection of protein in the urine.
Such pathological phenomena can significantly affect the development of the fetus, suffering from oxygen deficiency, pregnancy, health and even the life of the mother. Moreover, many pharmacological drugs used in the standard scheme of Quincke's edema treatment are contraindicated at this time. Therefore, even the slightest signs of a beginning edema should be the reason for the immediate call of the "first aid" service.
Classifications
Based on the general condition of
Given the general condition of Quinck's edema and its attendant factors, the following classification was developed:
- acute edema( duration up to 45 days);
- chronic( lasts more than 6 weeks, with relapses);
- acquired( observed about 50 times for the entire time of disease tracking in people older than 50 - 55 years);
- due to hereditary causes( occurs in about 1 to 150 thousand,
- edema accompanied by symptoms of urticaria,
- isolated( without accompaniment of other conditions).
According to the types of edema
An important fact, which primarily focuses medical attention, is the isolation of two types of dangerousedema of tissues with similar external manifestations:
- angioedema Quincke
- hereditary( non-allergic) angioedema( which many specialists do not classify as Quinck's edema as such).
The same symptomatology for completely different reasons for the development of these diseases often leads to misdiagnosis, serious complications and the use of incorrect emergency management and further treatment.
- With the allergic nature of the Quinck edema, the body reacts instantly to an allergen, which is expressed in the simultaneous release into the blood of a huge amount of histamine, a substance that regulates allergic reactions. This leads to inflammation and an increase in the permeability of the walls of the capillaries and the active infiltration of the liquid through them into the intercellular space of the tissues that begin to swell.
- Hereditary angioedema( pseudoallergic) edema is a congenital pathology associated with an overabundance or deficiency of the C1 inhibitor( a special whey protein produced in the liver) that causes uncontrolled reactions in the blood, in the form of extensive swelling of any part of the body. The suddenness of an exacerbation of a pathology can be provoked by a trauma, change of temperature, strong stress.
The features of hereditary edema and allergic angioedema:
| Signs | Hereditary | edema, allergic edema |
|---|---|---|
| reaction to allergens, toxins, drugs | no | have |
| Contact | injury explicit | no |
| Increased eosinophils | no blood | often |
| urticating, redness | no | is |
| Response to antihistamines and hormonal drugs | no | Is |
| IgG level of general IgE | OK | Very often byheight |
| Defects in the complement system | There is always | no |
This article is mainly devoted to the allergic form of Quincke's edema. The problems of hereditary edema require a separate analysis.
About signs of Quincke's edema read below.
Symptoms of
Quincke's edema may persist for several minutes, hours, rarely - days, then all symptoms disappear, but in the chronic form of the disease it periodically recurs.
The main symptoms and features of the pathology:
- The development of edema begins suddenly and occurs very quickly - for 5 to 25 minutes( less often for 1 to 2 hours), which is one of the main features of this pathology.
- There is a strong flow of mucous, subcutaneous tissue in the form of a dense painless swelling that occurs:
- on the eyelids, when they practically close( on one or two eyes);
- nose and lips, cheeks, tongue;
- on the lower jaw, neck, feet and hands;
- mucous membranes of the mouth, inner ear, larynx, tracheobronchial pathways;
- genital organs, stomach, intestines;
- and also affects the meninges.
- Peculiarity of puffiness is its painlessness( pain occurs only when palpating), density, feeling of tension and bursting of tissues.
- Edema, localized in the area of the tongue and larynx, is extremely dangerous. This condition, threatening life, requires emergency care. Strong puffiness of the pharynx, trachea, larynx( especially in children) is accompanied by a stridor( wheezing), a deaf cough, further spasm of the bronchial tubes, overlapping of the swollen mucous airway lumen, and a high likelihood of death of the patient from asphyxia( suffocation).
- Isolated Quincke's edema( 20% of cases) develops without itching on the skin. But more often( in half of cases) puffiness is accompanied by urticaria and it is characterized by itching blisters and burning sensation. And the general allergy at the same time is expressed in redness and itch of conjunctiva, tear, nasal congestion and discharge, sneezing, temperature, headache and weakness.
We learn more about why the allergic reaction of Quincke's edema occurs.
The causes of edema Quincke
Various factors contribute to the development:
- products: nuts, shellfish, chocolate, fish, milk, eggs, honey and other beekeeping products, smoked products, tomatoes, citrus fruits, stone, strawberries, cherries, raspberries, cheese, legumes;
- food additives - tartrazine, salicylates, sulfites, nitrates, preservatives, dyes;
- poison of bees, mosquitoes, wasps, hornets, mosquitoes;
- pollen and seeds of flowers, trees( flowering birch, alder, hazel, fescue, foxtail, bluegrass, fire, wormwood, stink, quinoa, hemp);
- medications, including: antibiotics, aspirin, ACE inhibitors, iodinated drugs, sulfonamides, B group vitamins, plasma, immunoglobulins, therapeutic sera and vaccines. Pharmacological agents, first of all, are dangerous for people prone to allergies, for children whose parents have allergic reactions. Any allergic conditions, including bronchial asthma, atopic dermatitis, increase the chance of developing Quincke's edema when these groups of drugs are administered.
- toxins in bacterial, parasitic, fungal, viral infections such as hepatitis, helminthiases, scabies, giardiasis;
- endocrine diseases, tumors, blood diseases;
- response to vaccines, serum;
- latex and items made from it - gloves, condoms, rubber urinary and intravenous catheters, tubes for intubation and drainage);
- feathers, saliva, fluff, wool, dandruff warm-blooded animals and birds;
- cosmetic( lacquers, mascara), household( powders), industrial chemicals, household dust;
- physical impact: pressure, cold, sun, vibration;
- hereditary congenital defect - insufficiency of certain enzymes.
Diagnostics
In the acute period, the following laboratory tests are assigned:
- Determination of the amount of total immunoglobulin E( IgE) that interacts with the allergen and is responsible for the development of allergic manifestations of immediate type in the blood serum. In the immunochemiluminescence study( IHL), the range of normal IgE values from 1.31 to 165.3 IU / ml.
- Identification of specific IgE, helping to detect "causal" allergens in reactions of immediate type. The effectiveness of therapy and prevention of allergy depends on the quality of this method of quantitative determination of immunoglobulins.
- Detection of disorders in the complement system( a cascade of 20 blood proteins regulating the immune response to the interaction of a foreign substance with an antibody) and analyzing its function for the diagnosis and control of autoimmune diseases.
After a few months( 2 - 3) after recovery, when a certain amount of antibodies reacting to the allergen appears, conduct:
- Allergic skin tests. The method consists in applying the probable allergen to the skin of the forearm( inner surface).Use intradermal injection( prik-test), the introduction of the substance into a scratch( scarification), application to the skin( applique).With a special susceptibility to the allergen, within 20 - 30 minutes, as a rule, a slight inflammation and redness around the place of application of the "suspected" antigen develops.
- Immunogram analysis( study of the immune system).
- Detection of systemic diseases, often provoking the development of Quincke's edema.
- In case of non-allergic nature of the edema, the entire body needs to be inspected in detail, including a wide range of general analyzes, bacteriological, biochemical analyzes, ultrasound and organ X-ray to detect pathology that causes swelling.
Next, the first aid for swelling of Quincke and subsequent treatment in the home and in the hospital are considered.
Diagnosis and treatment of Quincke's edema are discussed in this video:
Treatment
Immediate Assistance
Home and Work
Emergency care for Quinck's swelling in the larynx should be provided immediately, under any conditions, before the ambulance arrives. Delay can be fatal for the patient, especially - in childhood.
The greatest effect of removing the edema from the respiratory tract is the use of corticosteroids( Prednisolone, Dexamethasone), if they do not themselves cause an allergy in the patient, and, as an extreme means of saving life, Adrenaline( Epinephrine).However, its independent use in injections is dangerous for cardiac arrest, so it is better to pour the medicine from the ampoule under the patient's tongue( using a syringe without a needle) strictly at the age of dosage.
Why is it better to use pharmaceuticals in ampoules:
- first, the absorption of the drug occurs much faster, that with acute development of edema is of vital importance;
- secondly, with the latent edema of the esophagus, the stomach, any medications in tablets are simply useless.
In a hospital setting, the
Patient with symptoms of laryngeal edema, pharynx, and trachea is immediately sent to a hospital. Therapeutic measures are carried out in two stages: the first - the elimination of acute edema, the second - the elimination of symptoms, the identification of causes and treatment. Emergency therapy in the acute period of edema under stationary conditions is aimed at removing the edema, restoring vital functions in the shock state, reducing the body's response to histamine.
Basic measures:
- Adrenaline( Epinephrine) is administered immediately at dosages corresponding to age( 0.1-0.8 ml) to prevent a dangerous drop in blood pressure and the development of choking, subcutaneously, intramuscularly or intravenously( a critical case).If the procedure is repeated, the interval between injections is at least 20 minutes;
- for the removal of edema using hormone injections - Prednisolone, Dexamethasone in age doses from 2 months of life;
- intravenous injection of solutions against shock and to remove toxins from the body - Reopoliglyukin, Hemodez, 5% glucose solution;
- intravenous and intramuscular use of antihistamines - Suprastin, Dimedrol;
- to restore the volume of circulating blood and dangerously low blood pressure through a dropper pour in saline, colloidal solutions;
- diuretics( Furosemide, Lasix, Mannitol solution), removing allergens and excess fluid from the body, contributing to the decrease in swelling, apply at normal and high pressure;
- with bronchospasm is an intravenous infusion of Euphyllin with Dexamethasone;
- inhalation of pure oxygen is shown with obvious signs of its deficiency in the blood - hindered and shallow breathing, blue skin and mucous membranes, wheezing;
- hemosorption is a method of actively removing toxins and allergens from the blood that passes through absorbent sorbents.
Emergency treatment for the development of non-allergic hereditary edema Quincke provides:
- intravenous administration of Z-aminocaproic acid at 2-5 g( with 20 ml of glucose solution 40%);
- drip Contiral( 30000 units in NaCl solution 300 ml);
- blood plasma transfusion.
In the mild period
Therapy outside the acute stage provides:
- Complete elimination of the patient's contact with an established allergen if the cause of the edema develops as an allergic reaction with the symptoms of hives.
- Short courses of hormones temporarily "blocking" the immune system, Prednisolone, Dexazon, Dexamethasone. Prednisolone. Adults - up to 300 mg, newborns calculate the dose according to the formula 2 - 3 mg per kg of body weight of the baby, children older than a year and schoolchildren from 7 years in the same dosage. Dexamethasone to adults is 60 to 80 mg, to small patients in a strictly calculated dosage by weight: 0.02776 to 0.1666 mg per kilogram.
- Preparations for strengthening the nervous system( calcium, ascorbic acid).
- Vitamin complexes, Ascorutin for reducing vascular permeability, gamma globulin.
- Use of blocking agents of H1-receptor histamine( antiallergic) to reduce susceptibility to the allergen and block further histamine production. In the initial period, Suprastin, Dimedrol, Pipolphen, Tavegil are used intramuscularly, switching to the use of antiallergic drugs in Zirtek, Ketotifen, Terfenadine, Astemizol, Fexofenadine, Loratadine, Acryvastin, Cetirizine.
In this case:
- Suprastin: adults average 40 - 60 mg given that the dose per kilogram of body weight can not be more than 2 mg. Children: 1 - 12 months: 5 mg;from 12 months to 6 years: 10 mg;from 6 to 14: 10 to 20 mg.
- Ketotifen( excluding pregnant women) is shown to be an effective antiallergic agent in the combination of edema and bronchospasm, often occurring in patients with asthma or obstructive airway obstruction. Adults 1 to 2 mg 2 in the morning and evening. Children from 3 years - 1 mg( 5 ml of syrup);from half a year till 3 years - on 0,5 mg( 2,5 ml) in the morning and in the evening. Treatment is carried out for 2 - 4 months.
When swelling against the background of itchy rashes and blisters additionally used:
- Ranitidine, Cimetidine, Famotidine - drugs that suppress histamine H2-receptors;
- so-called calcium channel blockers( 20 - 60 mg Nifedipine per day);
- antagonists of leukotriene receptors( Montelukast, 10 mg per day).
In the treatment of hereditary angioedema, there are significant differences from the standard treatment scheme for Quincke edema. Absolutely useless corticosteroids and anti-allergic drugs that do not help the patient, and the wrong treatment of a timely unidentified angioedema of hereditary origin most often leads to the death of the patient.
Primary care is aimed at filling the deficit and increasing the production of the C-1 inhibitor. In most cases use:
- infusion of plasma;
- intravenous administration of tranexamic or aminocaproic acid;
- Danazol in a daily dosage of 800 mg, Stanozolol 12 mg;
- for long-term prophylaxis prescribe e-aminocaproic acid in a daily dose of 1 to 4 grams with regular monitoring of blood coagulability( twice a month).Danazol for 100 - 600 mg per day.
Prevention of the disease
Preventative measures are:
- In conducting an accurate diagnosis that determines the presence of a specific type of edema, which determines the treatment;
- Mandatory detection of an allergen that provokes pathology;
- A clear idea of the algorithm for conducting emergency care, the availability of necessary medications, which should always be at hand at the patient's.
- Very important is the mandatory restriction of products containing histamine releasing substances with a high content of tyramine and histamine, saturated with biogenic amines. These include:
- chocolate, tomatoes, strawberries, fish, citrus fruits, crayfish and oysters, pork, coriander, peanuts, alcohol, nuts, preservatives, including sulfites, benzoates, nitrites, sorbitol, tartrazine and orange-yellow, sodium glutamate;
- sauerkraut, sausage, red wine, cheese not fresh or fermented, ham, fermented products;
- dried ham, beef sausages, pork liver, canned tuna, anchovy, herring and her caviar, spinach, cheeses and fermented wines;
- cheeses roquefort, griyar, brie, camembert, cheddar, beer yeast, avocado.
Complications of
Complications that threaten life may include swelling affecting the laryngeal mucosa, with further increase in acute respiratory failure and asphyxia, as well as edema of the meninges with meningitis symptoms. These acute pathological conditions with late detection can lead to the death of the patient.
With Quincke's swelling affecting any organ, especially if accompanied by intense manifestations of urticaria, anaphylactic shock can develop rapidly. This is an extremely life-threatening allergic reaction that spreads throughout the body. It manifests itself in the following symptoms:
- generalized( common) itching;
- swelling of the tissues of the pharynx, tongue, larynx;
- appearance of urticaria( swollen and itchy red-pink spots, blisters);
- lacrimation, sneezing, spasm of the bronchi with excessive production of mucus blocking the flow of oxygen;
- nausea, vomiting, abdominal cramps, diarrhea;
- a rapid pulse, a drop in blood pressure, a violation of the rhythm of the heart muscle, an increase in acute cardiovascular insufficiency;
- convulsions, respiratory arrest, coma.
To fatal consequences for the patient also leads to incorrect treatment of angioedema with a hereditary character.
Forecast
The prognosis is quite favorable with the observance of preventive measures, accurate diagnosis and timely qualified treatment.
Many useful tips and information on the issue of Quincke's edema contain this video from Elena Malysheva: