Emergency treatment for angioedema. Quincke's edema (Angioedema, Giant urticaria)

Quincke's edema is an acute, suddenly developing serious illness, which affects subcutaneous fatty tissue and mucous membranes. This pathology has several other names: acute angioedema, trophoneurotic edema, giant urticaria, angioedema.

It was first described by the German therapist Quincke in the 19th century. The basis of its development is an allergic reaction immediate type biologically isolated active substances: histamine, heparin, serotonin, etc. Under their influence, the permeability of the smallest vessels increases and therefore edema develops.

Everyone can get sick age groups, but most often Quincke's edema occurs in young women. In childhood and old age they get sick much less often.

What is it?

Quincke's edema is a reaction to various biological and chemical factors, often of an allergic nature. Manifestations of angioedema are enlargement of the face or part or limb. The disease is named after the German physician Heinrich Quincke, who first described it in 1882.

Causes

Quincke's edema can be allergic and pseudo-allergic.

Allergic Quincke's edema appears upon contact with an allergen. For an allergic reaction to develop, the body must already be sensitized - there has already been an encounter with the allergen, and the body has developed antibodies. When this allergen enters the site of contact again, inflammation is caused: expansion appears. small vessels, their permeability increases and, as a result, tissue swelling occurs.

Allergens can be:

Flower pollen.
Various insect bites.
Wool and animal waste products.
Cosmetics.
Food products (citrus fruits, chocolate, eggs, fish products, various berries).
Medicines. The most common reaction is to antibiotics, painkillers, and vaccines. The reaction can range up to anaphylactic shock, especially if the drug is administered by injection. Vitamins and oral contraceptives rarely cause anaphylactic shock.

Pseudoallergic edema is hereditary disease, patients have a pathology of the complement system. This system responsible for triggering an allergic reaction. Normally, the reaction starts only when an allergen enters the body. And with pathology of the complement system, activation of inflammation also occurs from thermal or chemical exposure, in response to stress.

Symptoms of Quincke's edema

Quincke's edema is manifested by the occurrence of certain symptoms, this is the appearance of edema in places with developed subcutaneous tissue - on the lips, eyelids, cheeks, oral mucosa, genitals. The color of the skin does not change. There is no itching. In typical cases, it disappears without a trace after a few hours (up to 2-3 days). The swelling may spread to the mucous membrane of the larynx, which can cause difficulty breathing.

In this case, hoarseness of the voice is noted, barking cough, difficulty breathing (first exhale, then inhale), noisy breathing, hyperemic face, then suddenly turns pale. Hypercapnic coma occurs and then death may occur. Nausea, vomiting, abdominal pain, and increased peristalsis are also noted.

Angioedema differs from ordinary urticaria only in the depth of skin damage. It should be noted that manifestations of urticaria and angioedema may occur simultaneously or alternate.

Complications

With Quincke's edema affecting any organ, especially if it is accompanied by intense manifestations of urticaria, anaphylactic shock can develop at lightning speed. This is an extremely life-threatening allergic reaction that spreads throughout the body. Manifests itself in the following symptoms:

generalized (widespread) itching;
swelling of the tissues of the pharynx, tongue, larynx;
nausea, vomiting, spasmodic pain in the stomach, diarrhea;
convulsions, respiratory arrest, coma;
the appearance of urticaria (swelling and itching red-pink spots, blisters);
lacrimation, sneezing, bronchospasm with excessive mucus production, blocking the flow of oxygen;
increased heart rate, drop blood pressure, disturbance of the rhythm of the heart muscle, increase in acute cardiovascular failure.

It also leads to fatal consequences for the patient incorrect treatment angioedema with a hereditary nature.

What does Quincke's edema look like, photo

The photo below shows how the disease manifests itself in humans.

First aid

Quincke's edema develops very unpredictably and poses a threat to the patient's life. Therefore, the first thing to do is to call an ambulance, even if the condition is currently satisfactory and stable. And under no circumstances should you give in to panic. All actions must be quick and clear.

Before the emergency ambulance team arrives, you must:

Place the patient in comfortable position, calm down
Give an antihistamine (fenkarol, diazolin, diphenhydramine). Injectable forms of antihistamines are more effective, since it is possible that edema develops gastrointestinal tract and the absorption of substances is impaired. In any case, you need to take 1 - 2 tablets of the drug if it is not possible to get an injection. The medicine will weaken the reaction and alleviate the condition until the ambulance arrives.
Limit contact with the allergen. When bitten by an insect (wasp, bee), the sting must be removed. If you cannot do this yourself, you need to wait for specialists to arrive.
Enterosgel or regular sorbents can be used as sorbents. activated carbon.
Absolutely plenty of it alkaline drink(per 1000 ml of water 1 g of soda, either Narzan or Borjomi). Drinking plenty of fluids helps remove the allergen from the body.
Provide good access fresh air, remove objects that make breathing difficult.
To reduce swelling and itching, you can apply cold compress, a heating pad with cold water, ice.

In case of severe swelling, it is better not to take any measures on your own, so as not to provoke a worsening of the patient’s condition, and wait for an ambulance. The main thing is to do no harm.

Diagnostics

First of all, the doctor conducts an examination to get acquainted with the existing symptoms. In addition, the reaction of edema to the administration of adrenaline must be taken into account.

The next stage is to establish the cause of the pathology. As a rule, it is enough to ask the patient what allergic diseases are present in his medical history or the medical history of his immediate relatives, what is his body’s reaction to eating various products, taking (administering) medications, contact with animals. Sometimes specific blood tests and allergy tests are required to detect the cause.

How to treat?

For allergic angioedema, which is part of an anaphylactic reaction, the drugs of choice for treating patients are adrenaline, glucocorticoid hormones, antihistamines. In addition, detoxification therapy is carried out by intravenous administration special solutions(reoplyuglyukin, ringer lactate, saline, etc.).

In the case of a food allergen, enterosorbents are used (activated carbon, enterosgel, white coal etc.). Symptomatic therapy is also carried out depending on the symptoms that have arisen, namely, in case of difficulty breathing, drugs that relieve bronchospasm and dilate the airways (euphilin, salbutamol, etc.) are used.

It makes sense to provide data on the latest trends in the field of antiallergic drugs, the treatment of which is carried out in acute period Quincke's edema and between episodes of repeated angioedema.

First generation antihistamines: chloropyramine (suprastin), promethazine (pipolfen, diprazine), fenkarol (hifenadine), pheniramine (avil), dimethindene (fenistil), tavegil (clemastine), mebhydrolin (omeril, diazolin) act quickly (within 15-20 minutes). They are effective in relieving Quincke's edema, but cause drowsiness and prolong reaction time (contraindicated for drivers). Act on H-1 histamine receptors
The second generation blocks histamine receptors and stabilizes mast cells, from which histamine enters the bloodstream. Ketotifen (zaditen) effectively relieves spasm respiratory tract. Indicated when angioedema is combined with bronchial asthma or broncho-obstructive diseases.
Third generation antihistamines do not depress the central nervous system, block histamine receptors and stabilize the wall mast cells: Loratadine (Clarisens, Claritin), Astemizole (Astelong, Hasmanal, Istalong), Semprex (acrivastine), Terfenadine (teridine, Trexil), Allergodil (acelastine), Zyrtec, Cetrin (cetirizine), Telfast (fexofenadine).

For non-allergic Quincke's edema (hereditary, acquired Quincke's edema), accompanied by a decrease in the concentration of C1 inhibitor in the blood, the treatment tactics are somewhat different. In this case, adrenaline, hormones, and antihistamines are not the first choice drugs, since their effectiveness in these types of Quincke's edema is not so high.

The first choice drugs are those that increase the missing enzyme (C1 inhibitor) in the blood. These include:

Purified C1 inhibitor concentrate;
Fresh frozen plasma;
Male sex hormone preparations: danazol, stanazolol;
Antifibrinolytic drugs: aminocaproic acid, tranexamic acid.

In case of severe laryngeal edema and complete closure of the airways, an incision is made in the cricothyroid ligament and a special tube is installed for alternative path breathing (tracheostomy). In severe cases, they are transferred to an artificial respiration apparatus.

Diet

Diet adherence is mandatory. In this case, it is necessary to completely exclude not only products that cause a direct allergic reaction, but also a cross one. The menu of an allergic patient should not contain products with synthetic additives, artificial colors, or histamines. At the same time, the diet should not be depleted by replacing allergenic foods with hypoallergenic ones that are similar in calorie content.

Products that can cause an allergic reaction:

fish and seafood, chicken, eggs, dairy products, cocoa, peanut butter and nuts themselves;
strawberries, tomatoes, spinach, grapes;
spices different types, chocolate.

People prone to allergic reactions to foods should eat very carefully sauerkraut, cheese, rhubarb, legumes, fried and stewed meat and fish dishes, as well as broths. Drinking wine, even in small doses, is completely contraindicated.

Artificial food additives can also cause an allergic reaction: preservatives, dyes, flavors and taste stabilizers.

Prevention

Following certain rules will help prevent the development of soft tissue swelling:

eat right;
If you are prone to allergies, follow a gentle diet;
accept vitamin complexes to strengthen the immune system;
avoid contact with foods and medications that cause allergies;
for allergic reactions to certain types medications, be sure to notify your doctor;
When taking a new type of antibiotic, keep antihistamines on hand.

Forecast

The prognosis of the disease is favorable in most cases. The most dangerous for the patient is Quincke's edema localized in the larynx. In this case, only emergency medical care will help the patient avoid asphyxia. If breathing is significantly impaired, a tracheostomy is necessary.

Quincke's edema - what is it and how to prevent its occurrence? This phenomenon is also called giant urticaria, angioedema or acute angioedema. This is diffuse or limited swelling of the mucous membrane or fat subcutaneous tissue which develops suddenly.

It is diagnosed in people of different ages, both adults and children are susceptible to it, but it is especially common in women.

The disease was first discovered at the end of the 19th century by a German surgeon and therapist named Quincke. According to statistics, in lately The disease is becoming widespread and is increasingly being diagnosed in children.

Edema is usually classified as follows:

acute - lasting up to 6 weeks;
chronic - longer than this period;
acquired;
hereditary;
isolated from other conditions.

Almost every form requires urgent medical intervention and hospital treatment.

Symptoms of Quincke's edema

The disease is characterized by an abrupt onset and rapid progression - usually within a few minutes. Just look at the photos of people with similar phenomena, to understand - it is impossible not to notice it. Acute swelling of the skin is observed, most often in the face area, as well as on back surface hands and feet. As a rule, a person does not experience pain.

Features of Quincke's edema:

the skin turns pale;
swelling is able to change location and “move” from one part of the body to another;
the formation is dense; when pressing on it, no pits appear.

In both infants and adults, the pathology can be combined with urticaria - in this case, purple spots with clearly defined shapes appear on the patient’s body, they are very itchy and can merge, forming one continuous big spot.

There are several types of the disease, depending on the location of the swelling. The most common type is swelling of the trachea, larynx or pharynx. Its signs are:

anxiety;
difficulty breathing;
hoarse voice;
"barking" cough;
The skin of the face turns blue and then turns pale.

Sometimes the patient loses consciousness. This form of the disease is life-threatening, as it leads to a narrowing of the lumen of the pharynx and subsequent asphyxia, which can be fatal.

Swelling internal organs- another variety, which is accompanied by:

diarrhea;
vomiting;
severe pain in the abdominal area;
if it occurs in the stomach or intestines - tingling of the tongue and palate.

In this case, on skin There may be no changes, so diagnosing this form of edema can sometimes be difficult.

A rare type is swelling of the brain. Its symptoms:

lethargy and lethargy;
stiff neck;
nausea;
sometimes cramps.

In children, swelling is usually localized in the cheeks, eyelids, lips, hands, feet and scrotum. It is difficult for the child to speak and swallow; when the pathology spreads to the larynx, restlessness and blueness of the face develop, and sometimes hemoptysis begins.

Treatment depends both on the symptoms and form, as well as on the cause that triggered the occurrence of swelling. In any case, it should be started immediately before the swelling causes more life-threatening conditions.

Signs of Quincke's edema

It is easy to recognize the disease: the inconvenience it causes to a person consists mainly of a feeling of tension and swelling of the tissues. The first signs of the onset of pathology are difficult to miss due to their severity.

In addition to the above forms, there are also others:

In the area genitourinary system it is indicated by urinary disorders ( acute delay) and manifestations of cystitis.
In the gastrointestinal tract. This phenomenon is signaled sharp pains in the abdomen, increased peristalsis, dyspepsia, peritonitis.

To determine the source of swelling in a baby, it is necessary to examine his pharynx. Swelling of the pharynx, small tongue, and palate indicate damage to the subcutaneous tissue and mucous membranes. If the tonsils are affected, the symptoms of the disease are similar to those catarrhal form tonsillitis.

Swelling of the larynx, abdominal syndrome, neurological disorders- also common signs.

More rare manifestations in both adults and children are damage to the joints (fever, arthralgia, hydrarthrosis) and the heart.

The swelling persists for several hours or days, then disappears. The duration, severity of the condition and the nature of the manifestation of symptoms depend both on the source of its occurrence and on individual characteristics body.

Causes of Quincke's edema

The causes of Quincke's edema in people can be various conditions. In some cases, it is not possible to diagnose the provoking factor.

Injuries suffered can also cause the disease. acute diseases or severe stress.

Urticaria is often accompanied by swelling. It is characterized by the presence of itchy blisters on the body, usually symmetrical.

In children, as in adults, two forms of pathology are observed, depending on the provoking factors:

Allergic edema - when an allergen irritant enters the body. It leads to the release of histamines, prostaglandins and other mediator substances that dilate veins and capillaries and increase vascular permeability.
Non-allergic or hereditary edema becomes chronic and is activated upon contact with various substances leading to sensitization of the body. It could be flowers or plant pollen, poison from an insect or reptile bite. Non-specific pathogens are also common - hypothermia, intoxication of the body, stress.

Favorable factors for the development of the latter type are chronic illnesses - thyroid gland, liver, kidneys, stomach.

In a situation where it was not possible to find out the root cause, the edema is called idiopathic.

First aid for Quincke's edema

The disease often occurs unexpectedly and develops too quickly. A must visit. There is a high probability that it will take a person by surprise at home. It can be considered a serious threat to life, so you should call an ambulance immediately, even if general condition seems stable or satisfactory.

It is necessary to provide assistance to the person even before the doctors arrive - the sooner you begin to fight the manifestations of edema, the greater the likelihood that it will not lead to disastrous consequences.

What to do while the ambulance is on the way? The actions are:

If contact with allergens occurs, limit or completely eliminate their exposure. For example, remove a bee sting, or stop taking a medicine that contains an irritant. If you can't do it yourself, it's better to wait for a doctor.
Antihistamines are effective - Diphenhydramine or Diazolin. It is better to administer them by injection to prevent swelling of the stomach and intestines, which may impair absorption. medicinal substances. If it is impossible to give an injection, you need to take a pill - it will alleviate the condition.
Drink alkaline water- “Borjomi” or “Narzan”, you can simply dilute ordinary water with soda. This will remove the allergen from the body faster.
Take a sorbent - for example, activated carbon.
Apply ice or a cold compress to the area of swelling to reduce it and eliminate itching.
If the pressure drops or asphyxia begins, subcutaneous administration of adrenaline is necessary (usually available in people predisposed to such pathologies).
Unfasten the person’s collar, open the windows in the house or apartment so that the patient can breathe freely.

If the degree of swelling is severe, it is better not to do too much active actions, otherwise it can cause harm.

When this phenomenon develops in children, the actions are approximately the same as in adults. We should not forget about the need to drink plenty of fluids (neither hot nor cold). If the main provoking factor is insect venom that entered the body during a bite, if it is localized in the leg or arm area, a tourniquet is applied just above the wound. This is also done after injections.

Having noticed such signs as difficulty breathing or bluishness of the face, upon arrival the doctor will administer Prednisolone to the patient. Parents of a child who has previously experienced similar reactions need to have this drug in their medicine cabinet and know how to give injections.

Read more about how to cope with angioedema:

Treatment of Quincke's edema

It is complex in nature and has several goals. Initially, you need to eliminate the symptoms and, if necessary, use anti-shock therapy to avoid the development of anaphylactic shock. Also during the treatment process, the cause of the disease is affected (if it is identified) and the allergen is completely eliminated.

Subsequent therapy is gradual and includes the following methods:

prescription of drugs that increase the tone of the nervous system (sympathetic) - ascorbic acid, ephedrine, and also those containing calcium;
taking antihistamines (tavegil or suprastin);
vitamin therapy;
desensitizing agents;
C-1 inhibitor enhancers;
hormonal therapy - only in the absence of contraindications to it and exclusively in a hospital, under the supervision of a specialist.

How to treat this pathology in children? In addition to standard medications, corticosteroids - hydrocortisone, dexamethasone, and diuretics - are also widely used. At hereditary form administration of plasma with a C-1 inhibitor was prescribed.

In addition to the measures listed above, inhalations using a nebulizer, using corticosteroids, and oxygen therapy are effective. Site remediation is also often used chronic infection, causing swelling.

At home, it is necessary to have antihistamines and corticosteroids in order to promptly stop symptoms, the occurrence of which is not always possible to predict. This is especially true for people with a hereditary predisposition to such swelling, allergies and those suffering from chronic illnesses.

It is undesirable to consume products containing dyes or preservatives - they can cause allergies.

How to treat the idiopathic form when the causative agent is unknown?

To eliminate this type, doctors prescribe antihistamines, whose action is prolonged. But the effectiveness of such therapy cannot be guaranteed due to the lack of information about the cause of the disease and the impossibility of directly influencing it.

Some medications cause side effects such as dizziness, frequent weakness or fatigue, stomach pain and nausea. They disappear after completion of the therapeutic course.

Prevention of Quincke's edema

There is no way to predict its appearance, but recognizing its beginning is not difficult - it requires a prompt response. TO preventive measures include:

For allergy sufferers - avoid contact with the pathogen.
Parents should not rush to introduce foods into their baby's menu that can cause allergic reactions - eggs, fish, honey, chocolate, and many fruits. It is advisable to limit their use.

It is also necessary to always have medications on hand - antihistamines, sorbents, because it is not always possible to avoid some situations (for example, an insect bite).

Quincke's edema is an acute condition of swelling of the mucous membranes of the skin, which in depth can reach the subcutaneous fatty tissue.

Most often, swelling is on a person’s face, spreading to oral cavity, mucous membranes of the eyes, larynx and pharynx. However, there are known cases of damage to the gastrointestinal tract, joints and meninges.

Edema develops quite quickly and is classified as an emergency condition requiring prompt medical attention. Fortunately, this serious condition occurs in only two percent of all allergic reactions. It affects people of all ages, but most cases affect women and children.

Previously, edema was called angioedema, suggesting that its main cause of formation was a vascular reaction to excess nerve impulses in people with easily excitable nervous system. Nowadays, scientists no longer support this position.

History of Quincke's edema

Signs of angioedema were first noticed by doctors back in the 16th century. This was before Professor Quincke, after whom the disease was named. For example, Marcello Donato noted this condition back in 1586, but alas, he did not receive laurels. This story began in 1882 in the Prussian province of Schleswig-Holstein. Or rather, in the city of Kiel, where the main element is water. This happened in June, when Kiel Bay saw a sea regatta for the first time, and the Baltic wind stretched the sails of 20 yachts.

Frau Weber was still quite healthy in the morning and bargained profitably for several herrings at the fish market. However, then she managed to drink one cup of chocolate, a new variety of which was brought to the colonial shop this week. She served as a cook for Professor Heinrich Ireneus Quincke, who, fortunately, had not yet left for the University, where he headed the Department of Internal Medicine. And when the wheezing, suffocating and frightened cook flew in to him with a swollen face and slits instead of eyes, he managed to give him first aid.

Professor G. Quincke's monograph on angioedema of the skin, mucous membranes and subcutaneous tissue was printed by typesetters at the University of Kiel. Later, the Americans and British named the swelling after him, which caught on in the medical world.

What are the causes of Quincke's edema?

The mechanisms for the development of edema can be twofold:

increased permeability vascular wall developing against the background of an inherited feature of the complement system (special blood proteins that are responsible for immune protection);
allergic reaction.

Allergic edema

The swelling occurs via an immediate reaction mechanism. Various allergens act as provocateurs:

Infectious (viruses, bacteria, fungi).

Non-infectious, which include:

Insect (poisons and saliva of insects);

Household (epidermal mites and dust);

Epidermal (animal hair and dander, fish scales);

Plant (pollen of grasses and trees);

Medicinal;

Industrial (menthol, phenols, turpentine, etc.);

Food (seafood, citrus fruits, honey, chocolate, coffee, eggs).

The body, upon first contact with an allergen, responds by preparing basophils and mast cells, producing class E immunoglobulins.

In case of repeated consumption, inhalation - absorption of the allergen through the skin or mucous membranes and its penetration into the blood, mast cells and basophils recognize it, destroy it and throw it away large number inflammatory mediators (histamine and similar substances) or biological active substances into the bloodstream.

As a consequence, a spasm of the capillaries develops, the release of the liquid part of the plasma into the intercellular space from the vessels. Water gets most easily into those areas where there is a large amount of loose fiber:

hands, upper chest;
neck, face, lips, eyelids;
genitals, feet.

Massive swelling develops. This mechanism is more typical for adults with allergic heredity and a mature immune system.

Hereditary factor in the development of Quincke's edema

A certain number of people inherit a complement system that causes an immune response when it enters the body:

infections;
foreign substances;
or even under severe stress;
injury.

As a result, basophils are destroyed and inflammatory mediators are released. As a result, the same allergens, even at the first contact with the body, provoke angioedema, without the release of immunoglobulin E and activation of mast cells.

Angioedema develops according to this mechanism in children under 3 years of age and in individuals with an overly active complement system. Most often, this is how they react to snake and insect bites.

Indirect factors

Other factors that contribute to the formation of angioedema include:

diseases of internal organs;

diseases endocrine system.

Symptoms of Quincke's edema

It is worth noting that Quincke's edema develops very quickly: in a short period of time (from 2 to 30 minutes) it can go from drinking a cup of coffee or getting pollen into the nose to a truly terrifying sight of edema.

Swelling

A person with any localization of edema may experience anxiety or even a feeling of fear of death:

The first to swell is the face and its parts: ears, tip of the nose, cheeks, lips, eyelids;

everything becomes puffy, the eyes become very narrow and begin to water;

the skin becomes tense, pale and hot;

the swelling is so dense that it does not leave marks from pressure;

swelling may spread to the neck and top part abdomen and chest;

in some cases, the hands swell, turning the backs of the hands into pillows and the fingers into sausages;

There are known cases of swelling of the genitals, feet and abdominal skin;

swelling can have different expressions, and some people get away with only minor changes in appearance.

These are impressive, but not the most serious signs Quincke's edema. The situation is much worse when, along with external deformity of the patient’s face, the following appears:

difficulty breathing and shortness of breath;

sore throat.

This indicates that the swelling has progressed to soft fabrics larynx, vocal cords and descends into the trachea. If not accepted urgent measures at this stage, you can witness how a person turns blue before his eyes, loses his creation and suffocates. However, at this stage there is no need to give up, since artificial respiration can push the swollen walls of the respiratory tract, and the ambulance team that arrives during this time will carry out all other emergency measures and push the laryngoscope blade into the throat.

Articular form of Quincke's edema

This form leads to non-inflammatory swelling of the synovial membrane of the joints, deterioration of their mobility and changes in configuration.

Gastrointestinal form

It manifests itself as eating disorder and occurs with the phenomena of allergic gastritis, in which food allergens attack the wall of the stomach and basophils and eosinophils accumulate in it, the destruction of which causes swelling and vascular spasm. A similar pattern occurs in the intestines.

The victim begins to experience sharp pain near the navel or in epigastric region, in the lateral sections of the abdomen.
There is tingling of the palate and tongue, nausea, vomiting of eaten food, after which loose stools occur.

Quincke's edema with urticaria

This combination is not uncommon. In addition to swelling of the skin, subcutaneous tissue and mucous membranes, a rash in the form of blisters is formed on the skin, which has different size, which is accompanied by a burning sensation or itchy skin.

Depending on the symptoms, Klinke's edema is divided into chronic (longer than 6 weeks) and acute (up to 6 weeks).

Swelling of the meningeal membranes

He gives a clinic of serous meningitis:

Sound and photophobia, headaches.
Numbness of the neck muscles, making it difficult to bring the chin to the chest.
The tension of the meninges as a result of edema does not allow raising the straightened leg without pain, but it decreases when the patient lies on his side with his legs adducted and throws his head back (cock or gun dog pose).
Vomiting and nausea of central origin are characteristic, and there may be convulsions.

It is also worth noting the fact that the main diagnostic (and to some extent therapeutic) procedure for meningitis, which provides the opportunity to take cerebrospinal fluid for analysis and reduce her blood pressure ( spinal tap) was also first proposed by G.I. Quincke.

Symptoms in children

Unfortunately, children are also susceptible to Quincke's edema quite often.

Household allergization – shampoos, washing powders, fabric softeners, bath foams.

Feeding infants with artificial food.

Reception medicines, also affects the likelihood of developing angioedema.

Early refusal breast milk and switching to protein cow's milk, foods rich in thickeners and dyes.

Vaccinations against everything, antibiotics for any reason, multivitamins for no apparent reason.

As a result, Quincke's edema can appear in children from the first days or months of life. For example, for newborns and children under 3 years of age, the most common non-allergic nature of edema, which is caused by the complement reaction and hereditary predisposition. At the same time, the death of a child from such sudden death as a result of laryngeal edema can reach 25% of all cases.

Children are much more likely than adults to experience meningeal symptoms and gastrointestinal edema (but articular syndrome is less common in children).

An allergic manifestation of Quincke's edema often occurs in children together with bronchial asthma or urticaria, while abdominal pain is not typical for this form.

Swelling of the larynx is one of the most terrible signs, at the slightest manifestation of which you need to call an ambulance. The narrowing of the lumen of the larynx, as a rule, goes through 4 stages, which are quite smoothed out and characterized by a short period of time.

The first degree stenosis is still compensated and allows the child to breathe without shortness of breath. However, with physical activity, retraction of the area above the navel and the upper notch of the sternum already appears.

Second degree - the child turns pale, palpitations appear, and his nasolabial area turns blue. At this time, the tissues experience severe acid starvation, and the brain suffers. The baby is excited and restless. All abdominal muscles and the chest participate in breathing.

The third degree is accompanied respiratory failure(blueness of fingers, lips, sweating, pallor). The baby sucks in air with difficulty and noise.

Fourth degree – suffocation with slow heartbeat, shallow breathing, loss of consciousness or lethargy.

First aid

In this part we'll talk about mutual and self-help:

At the first manifestations of Quincke's edema, it is necessary to call an ambulance. If she clearly does not arrive, but there is an opportunity to drag or take the patient to the nearest medical institution- feel free to drag it, having first completed step two or three.

Taking an antihistamine (preferably under the tongue, taking into account the age-specific dosage).

In the absence of antihistamines or other allergy medications, naphthyzin (nasal drops) in a dosage of 2-3 drops should be poured into the mouth of a teenager or patient (or dripped into the nose).

We calm the victim, open the windows, free him chest and neck from tight clothing, remove jewelry (earrings, chains, etc.). We take the child in our arms, do not become hysterical and do not scream.

If you have identified an allergen, we remove it if possible.

Apply ice to the area of swelling.

Perform artificial consciousness if the person is unconscious.

Usually, a family with a patient with recurrent edema knows about Prednisolone and can administer this device intramuscularly without outside help.

Do not forget that a person’s life depends on reasonable and coordinated actions from the first minutes of Quincke’s development.

Urgent Care

Here comes the time for professional medical assistance from the staff of a clinic, hospital or ambulance:

Stopping contact with the allergen.

Against the background of reduced pressure, Quincke's edema should be administered subcutaneously with a solution of adrenaline (0.1%) in a dose of 0.1 - 0.5 ml.

Glucocorticoids (60-90 g prednisol hymisuccinate - intramuscular or intravenous or 8 to 12 mg dexamethasone intravenously).

Antihistamines: clemastine 2 ml or suprastin 1-2 ml intramuscularly or intravenously.

For swelling of the larynx:

Allergen exclusion.

Oxygen inhalation.

Intravenous drip of saline solution 250 ml.

Epinephrine (adrenaline) intravenously (0.1 – 0.5 ml).

If the above is ineffective, tracheal intubation is performed. Before it: 0.1% - 0.5-1 ml atropine sulfate intravenously, 1 ml dormicum (midazolam), 2 ml relanium (diazepam) intravenously, 1 mg per kg of body weight ketamine intravenously.

Sanitation of the upper respiratory tract.

Attempt at tracheal intubation (single). If it is impossible to perform or ineffective - conicotomy (dissection of the ligament between the thyroid and cricoid cartilages), artificial ventilation the victim's lungs.

Hospitalization.

In the absence of laryngeal edema, hospitalization is indicated for the following groups of patients:

swelling as a result of taking medications;

if swelling developed for the first time;

patients with severe respiratory and cardiovascular pathologies;

persons who have received a certain vaccination;

people who have recently suffered a heart attack, stroke, or acute respiratory viral infection.

Treatment of Quincke's edema

Measures to suppress allergies continue in hospital settings:

prescription of glucocorticoids, antihistamines;

Conducted infusion therapy(intravenously) to filter allergens through the kidneys and increase blood circulation, using protease inhibitors, physical. Solution, epsilomaninocaproic acid;

for pseudoallergic edema, epilonaminocaproic acid is indicated in doses of 2.5-5 g per day intravenously or orally;

forced diuresis is used - furosemide, lasix;

Ascorutin is often prescribed to reduce vascular permeability;

energy absorption is indicated (Filtrum STI, Enerosgel, Activated carbon, Polyphepan, Polysorb), as a result of which food allergens are present in the intestines.

It makes sense to provide data on the latest trends in the field of antiallergic drugs, treatment of which is carried out during the acute period of edema and between episodes of repeated angioedema.

1st generation antihistamines: promethazine (diprazine, pipolphen), chloropyramine (suprastin), pheniramine (Avil), fenkarol (hifenadine), mebhydrolin (Diazolin, Omeril), tavegil (clemastine), dimethindene (fenistil), pheniramine (Avil) act quickly. They are effective in relieving edema, but prolong reaction time and cause drowsiness.

The second generation stabilizes mast cells and blocks histamine receptors. Zaditen (ketotifen) copes well with airway spasms. Used when angioedema is combined with broncho-obstructive diseases or bronchial asthma.

Third-generation antihistamines block histamine receptors, depress the central nervous system and stabilize the mast cell wall: telfast (fexofenadine), cetrin, zyrtec (cetirizine), allergodil (acelastine), terfenadine (trexil, teradine), semprex (acrivastine), astemizole (istalong, hasmanal , Astelong), loratadine (Claritin, Clarisens).

Choice medical supplies carried out with the following preferences:

In children under 1 year: Fenistil.

From 12 months to 4 years: Cetirizine, Loratadine.

From 5 to 12 years: Astemizole, Terfenadine, Loratadine, Cetirizine.

For pregnant women: Telfast, Loratadine, Astemizole.

For nursing: Clemastine and Pheniramine.

For liver pathologies, as in children.

At renal failure, just like for pregnant women.

Thus, angioedema, symptoms and treatment are presented above; it is easier to prevent than to relieve. For the purpose of prevention, it is important to reduce the number of food and household allergens, avoid unnecessary use of medications, and at the first manifestations of allergies (urticaria, dermatitis, bronchial asthma, conjunctivitis, seasonal rhinitis) seek help from an allergist.

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Quincke's edema is an acute allergic condition characterized by swelling of the skin, mucous membranes, and, less commonly, internal organs, joints, and meninges. In the medical literature, angioedema is sometimes called giant urticaria, or angioedema shock.

Quincke's edema can occur in any person, but people who suffer from allergies are most susceptible to it.

Allergy - this is a hypersensitive reaction of the body to certain stimuli ( allergens).
Such irritants are:

House dust.
Plant pollen.
Some food products: chocolate, milk, seafood, strawberry, orange.
Some medications.
Wool, feathers, down of pets.

Allergic reactions come in two types: immediate and delayed.
Angioedema is an immediate form of allergic reaction and is very dangerous disease. When an allergen gets inside, the body begins to produce large amounts of histamine. Histamine is usually in an inactive state and is only released when pathological conditions. The released histamine causes edema tissues, thickens the blood.

Non-allergic Quincke's edema is formed by people who have congenital pathology the complement system, which is transmitted from parents to children. The complement system is a combination of proteins in the blood that is responsible for the body's immune defense. The proteins are activated when an allergen enters the body, and defense mechanisms begin humoral regulation to eliminate the irritant.

In people with an impaired complement system, protein activation occurs spontaneously, as the body's response to chemical, physical or thermal stimuli. As a result, a massive allergic reaction develops.

Exacerbations of non-allergic Quincke's edema are manifested by edematous changes in the skin and mucous membranes of the stomach, intestines, and respiratory tract.

Spontaneous exacerbation of pseudoallergic edema can be provoked by a sharp change in temperature, emotional experiences, or trauma.

In a third of all cases of Quincke's edema, the cause of this reaction of the body cannot be determined. In other cases, the cause of edema is food or drug allergies, insect bites, bloodstream diseases, and autoimmune diseases.

Symptoms of Quincke's edema

Sudden swelling of the face ( lips, nose, eyelids), neck, back of the foot and palm, genitals. As a rule, there is no pain. The skin in the area of edema is pale. Edema can “move” across the surface of the body. The swelling is dense to the touch; if you press with your finger, a hole does not form. Most often, swelling is combined with urticaria. Clearly defined itchy purple spots form on the body. The spots can merge with each other into one large spot. Hives itself is unpleasant, but not life-threatening. This is essentially swelling of the upper layers of the skin.

A dangerous form of the disease is swelling of the larynx, pharynx, and trachea, which occurs in 25% of patients. Laryngeal edema is accompanied by the following symptoms:

Anxiety.
Difficulty breathing.
Barking cough.
Hoarseness of voice.
Blueness of the facial skin, then pallor.
In some cases, loss of consciousness.

When examining the mucous membrane of the throat in these cases, swelling of the palatine arches and palate is observed, as well as a narrowing of the lumen of the pharynx. If the swelling spreads further, to the trachea and larynx, then a state of asphyxia - suffocation - may occur. If medical assistance is not provided in time, the victim may die.

When swelling of the internal organs occurs, it is externally manifested by severe abdominal pain, diarrhea, and vomiting. When the swelling is localized in the stomach or intestines, the first sign is tingling of the tongue and palate.

Edema of the meninges is rare.
Its symptoms:

Lethargy and lethargy.
Rigidity of the neck muscles ( I can’t touch my chin to my chest when I tilt my head).
In some cases - convulsions.

General symptoms edema of different localization:

Fever.
Excitement or lethargy.

Classification of Quincke's edema

Acute edema.
Chronic edema.
Edema due to hereditary causes.
Acquired edema.
Edema isolated from other conditions.
Edema combined with urticaria.

Diagnosis of Quincke's edema

When a patient with edema goes to the doctor, the first thing the doctor does is stop the manifestations of edema. In the future, when determining the causes of the disease and thinking through the treatment strategy, the doctor is guided by the following anamnesis data:

Has anyone in the family had allergies? Did they have an allergic reaction to the administration of vaccines?
Has the patient had allergies before? If so, were there any signs of seasonal allergies?
Are there any animals in the house?
What is your eating style, what foods and dishes are most often consumed.

When making a differential diagnosis between edema of an allergic or pseudo-allergic type and a hereditary disease, the doctor must find out whether there was any edema in childhood. In the hereditary form, edema occurs in close relatives of different generations; as a rule, it is not accompanied by urticaria. Edema is provoked by minor microtrauma, stress or surgery.

At allergic factor a history of edema; there are frequent allergic reactions in relatives; there are disorders of the digestive system. In such patients, when conducting allergy tests, the results are positive.

In the acute period of the disease it is carried out laboratory methods diagnostics, for example, determination of immunoglobulin E in blood serum.

During the period of remission, allergy tests are performed. The essence of the tests is that a small amount of a possible allergen is administered via intradermal injection; or through a scarification test - through microscopic punctures with a needle in the skin. In some cases, moisten a tampon in an allergen solution and apply it to the skin area ( application method).

The test is carried out using 10 - 15 types of allergens. If after a certain time the injection, scratch or application site turns red, it means the result for this particular allergen is positive. Depending on the presence and intensity of redness, 4 results are distinguished: negative, doubtful, weakly positive And positive.

However, skin tests in some cases have contraindications, this must be remembered:

Exacerbation of chronic infections.
Acute respiratory disease(ORZ).
Hormone therapy being taken.
Age restrictions ( not older than 60 years).

For non-allergic type of edema it is carried out general examination, which includes bacteriological tests, biochemical and general blood tests, etc.

Emergency care for acute angioedema

Acute edema is an emergency; First aid will help save the patient’s life.

Waiting for him to arrive" Ambulance“, it is necessary to lay the patient down and raise his legs, open the window. In cases where the cause of edema is obvious ( bee sting or medication injection) – apply ice to this area to reduce itching.

If the bite or injection was made in the arm, then bandage it with a tourniquet above the site of the lesion. If you are stung by a bee, remove the sting as soon as possible.

Give drinking plenty of fluids; let the sorbents take in ( Enterosgel, Sorbex, or activated carbon). The sorbent will help quickly remove the allergen from the body. Place vasoconstrictor drops into the nose ( for example, naphthyzin).

If possible, you need to give an injection of an antihistamine: diphenhydramine, Claritin or others. If only at hand antihistamine tablets, then they should be given under the patient’s tongue.

Adrenaline, prednisolone or hydrocortisone are injected under the skin. If swelling does not occur for the first time, then prednisolone should be carried with you at all times.

Treatment of Quincke's edema

Therapy is aimed at suppressing allergic reactions. In severe cases, when urticaria cannot be stopped, it is administered by injection. prednisolone, dexamethasone, hydrocortisone.
The doctor prescribes:

Antihistamines.
Enzyme preparations to reduce sensitivity to allergen.
Hypoallergenic dietary food (exclusion from the diet of coffee, chocolate, citruses, alcohol, spicy foods).

Therapy is carried out aimed at sanitizing all areas of chronic infection. Bacteria, when there is an allergen in the body, promote the release of histamine.

When treating edema of hereditary origin, replenishing therapy is prescribed, which corrects the deficiency of certain substances in the body ( C1 inhibitors)

When treating the idiopathic form with an unknown allergen, long-acting antihistamines are prescribed. However, they only help to remove external manifestations, but do not affect the cause of the disease, therefore they are not a complete treatment.

Prevention of Quincke's edema

To exclude the manifestation of allergies and often associated angioedema, you need to:

Carry out regular cleaning and wet cleaning.
Glaze the shelves with books so that dust settling on the paper does not accumulate.
Replace down and feather pillows with pillows with hypoallergenic synthetic filling.
Use hypoallergenic cosmetics; Before first use, test for the presence of a reaction: apply the cosmetic product with a smear on inner surface elbow and wait 15 minutes; If there is redness, do not use the product.
It is advisable not to wear synthetic clothing.
Children should not be allowed to play with bright plastic toys ( they may contain allergens and toxic substances).
When carrying out any medical procedures at the doctor’s office, warn about a possible positive allergic reaction.
If an allergy manifests itself to pet fur, it is necessary to limit contact with animals on the street, at guests, etc. as much as possible.
Following a diet will help prevent the allergen from entering food.
During flowering of plants, antihistamines should be taken preventively.