Home Tooth pain Quincke's edema (Angioedema, Giant urticaria). Quincke's edema: symptoms and treatment What causes angioedema

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Quincke's edema (Angioedema, Giant urticaria). Quincke's edema: symptoms and treatment What causes angioedema

Quincke's edema is an acute condition in which there is significant swelling of the skin layers and subcutaneous fat, sometimes involving the mucous membranes in the pathological process. The disease is named after the doctor G. Quincke, who first described it in 1882. The second name of the pathology is angioedema.

Quincke's edema - causes

Like urticaria, Quincke's edema is associated with dilation of blood vessels and an increase in their permeability to the liquid medium of the blood, but in in this case swelling appears not in the superficial, but in the deep layers of the skin, mucous tissues, subcutaneous fat layer. The accumulation of penetrating interstitial fluid in the tissues determines edema. The dilation of blood vessels and an increase in their permeability occurs due to the release of biologically active substances(bradykinin, histamine, etc.), occurring as a result of an immune response under the influence of certain factors.

One of the rare varieties of the pathology under consideration - hereditary angioedema - is associated with a disorder in the complement system that is inherited. The complement system, consisting of a collection of protein structures, is an important component immune system, which is involved in inflammatory and allergic reactions. The regulation of this system occurs due to a number of enzymes, among which is the C1 inhibitor. With a deficiency of this enzyme, uncontrolled activation of complement occurs and a massive release of substances that cause edema.

The first signs of hereditary angioedema may appear in childhood, but in most cases they debut in puberty or middle age. The development of an attack is often preceded by certain provoking phenomena:

infections;
powerful emotional stress;
surgery;
injuries;
reception of any medicines.

Allergic angioedema

Allergies are the most common cause of angioedema. At the same time, the disease is often combined with other diseases of an allergic nature - hay fever, bronchial asthma, urticaria, etc. If the mechanism of occurrence of the pathology in question is an allergy, Quincke's edema acts as a kind of response to the irritant. Irritating factors may include:

food products and additives to them (fish, citrus fruits, honey, nuts, chocolate, flavors, dyes, preservatives, etc.);
feathers and down of birds;
insect poison and saliva;
room dust;
household chemicals;
solar radiation;
high or low temperatures;
medicines, etc.

Idiopathic angioedema

There is also idiopathic angioedema, the cause of which cannot be determined. In this case, attacks of inadequate reaction of the body cannot be associated with any specific preceding factors. Many experts call this form of pathology the most dangerous, because without knowing what causes edema, it is impossible to prevent its occurrence and eliminate the effect of the culprit factor.

Quincke's edema - symptoms

Angioedema the symptoms are pronounced, which are difficult not to pay attention to, including because they can cause considerable discomfort and complicate the functioning of certain parts of the body. Swelling in the affected area is noticeable to the naked eye, the skin (or mucous membrane) looks swollen, while practically not changing its shade (only later it may become noticeably pale).

Common localization sites are:

face;
oral cavity;
language;
larynx;
trachea;
genitals;
upper and lower limbs;
internal organs (stomach, intestines, bladder, meninges etc.).

In the affected area, patients feel tension, tightness, mild pain, burning, tingling, and rarely itching. Affected internal organs can cause reactions such as sharp pains in the abdomen, nausea, vomiting, diarrhea, pain when urinating, headache etc. The affected respiratory tract reacts with the appearance of shortness of breath, coughing, difficulty breathing, and can cause suffocation. Allergic angioedema is often accompanied by the appearance of itchy red rashes. Harbingers of swelling may include mild burning and itching.

How quickly does Quincke's edema develop?

In most cases, if an allergic reaction is involved in the development mechanism, Quincke's edema appears rapidly, starting suddenly. Symptoms develop within 5-30 minutes, and resolution should be expected after a few hours or 2-3 days. With the non-allergic nature of the pathology, swelling often develops within 2-3 hours and disappears after 2-3 days.

Angioedema of the larynx

Angioedema of the throat poses a serious danger to the body and can even cause sudden death. In just a few minutes, the airway can become completely blocked due to swollen tissue. Danger signs, which should become an urgent reason to call an ambulance, are:

bluish facial skin;
severe wheezing;
a sharp drop in blood pressure;
convulsions.

Angioedema of the face

On the face, Quincke's edema, photos of which show severe symptoms, is often localized in the area of the eyelids, cheeks, nose, and lips. At the same time, the palpebral fissures may sharply narrow, nasolabial folds may smooth out, and one or both lips may sharply increase in size. Swelling can quickly spread to the neck area, affecting the airways and blocking air access. Therefore, angioedema on the face should be stopped as early as possible.

Angioedema of the extremities

Signs of Quincke's edema, localized on the arms and legs, are often observed on the back of the feet and palms. This type of reaction is less common than those described above and does not pose a particular threat to the functioning of the body, although it does cause significant discomfort. In addition to the appearance of limited areas of compaction on the extremities, the skin may acquire a bluish tint.

What to do with Quincke's edema?

Patients who have had an episode of sudden swelling of one or another part of the body at least once in their life should know how to relieve Quincke's edema, because the pathology can occur again suddenly. First of all, you should call an ambulance, especially when swelling appears in the area respiratory tract or there is a suspicion that the pathology is localized in the internal organs. Before paramedics arrive, first aid measures must be taken.

Quincke's edema - first aid

Emergency care for angioedema, which can be provided before the ambulance arrives, includes the following steps:

Isolation of the victim from the action of the stimulus (if it is established).
Ensuring free access to clean air.
Freeing the patient from constrictive clothing and accessories.
Position the patient in a semi-sitting or sitting position to facilitate breathing.
Maintaining a calm environment around, preventing panic.
Applying a cold compress to the affected area.
Provide plenty of fluids (preferably alkaline).
Taking medications: vasoconstrictor nasal drops (Naphthyzin, Otrivin), antihistamines(Fenistil, Suprastin) and sorbents (Enterosgel, Atoxil) orally.

The above measures, which provide assistance with Quincke's edema, are necessary, first of all, when the following is observed:

swelling of the nose;
swelling of the lips;
swelling of the oral mucosa;
swelling of the throat, larynx;
swelling of the neck;
edema internal organs.

How to treat Quincke's edema?

Emergency drug therapy to eliminate acute edema and restore vital functions may include the use of the following drugs:

Adrenaline – for lowering blood pressure;
Prednisolone – with Quincke’s edema, the main manifestations are relieved;
Glucose, Hemodez, Reopoliglyukin - to eliminate shock and remove toxins;
Diphenhydramine, Suprastin injection - for an allergic reaction;
Furosemide, Mannitol - for normal and high blood pressure to remove excess fluid and allergens;
Eufillin with Dexamethasone - to relieve bronchial spasm, etc.

Non-allergic angioedema has a different treatment, sometimes carried out through blood plasma transfusion and the use of the following drugs:

Z-aminocaproic acid;
Contrikal.

Outside acute stage treatment may include:

exclusion of established irritants;
short courses hormone therapy(Prednisolone, Dexasone);
the use of drugs to strengthen the nervous system and reduce vascular permeability (Ascorutin, calcium, vitamin complexes);
taking antihistamines (Loratadine, Suprastin, Cetirizine).

Quincke's edema is usually defined as an allergic condition, expressed in its rather acute manifestations. It is characterized by the occurrence of severe swelling of the skin and mucous membranes. Somewhat less frequently, this condition manifests itself in the joints, internal organs and meninges. As a rule, Quincke's edema, the symptoms of which can appear in almost any person, occurs in patients suffering from allergies.

Main features of the disease

Considering the fact that allergy, as we have already noted, is a determining factor for predisposition to angioedema, it would not be amiss to consider the mechanism of its action, which will allow us to get a general picture of the disease. An allergy in particular is a hypersensitive reaction on the part of the body to certain irritants (allergens). These include:

Plant pollen;
Dust;
Certain foods (oranges, strawberries, milk, chocolate, seafood);
Medicines;
Down, feathers and pet hair.

Directly allergic reactions exist in two varieties: immediate-type reactions and delayed-type reactions. As for Quincke's edema, it acts as an immediate form of such a reaction, and is extremely dangerous character. Thus, the body, when an allergen enters its environment, begins to produce a significant amount of histamine. As a rule, histamine in it is in an inactive state and its release occurs exclusively in conditions of a pathological nature. It is the release of histamine that provokes swelling while simultaneously thickening the blood.

When considering indirect factors that contribute to the emergence of a predisposition to a condition such as Quincke's edema, the following types can be distinguished:

Angioedema, depending on the nature of its occurrence, is of two types: allergic and pseudoallergic.

Allergic Quincke's edema. This type of edema manifests itself in the form of a specific response from the body that occurs when it interacts with an allergen. Most often, allergic swelling occurs in the case of food allergies.
Non-allergic Quincke's edema. In this case, the formation of edema is relevant among those people who have a congenital pathology formed in the complement system (a protein complex found in fresh blood serum) transmitted to children from parents. The complement system, due to its own characteristics, is responsible for ensuring immune defense body. When an allergen enters the body, proteins are activated, after which to eliminate the irritant defense mechanisms humoral regulation is carried out.

Violation of the complement system determines the spontaneous activation of proteins, which becomes the body’s response to certain stimuli (chemical, thermal or physical). The result is the development of a massive allergic reaction.

In the case of exacerbation of Quincke's edema and its non-allergic symptoms, edematous changes occur in the skin, as well as in the mucous membranes of the respiratory tract, intestines and stomach. Spontaneity of exacerbation of pseudoallergic edema can be provoked by factors such as a change in temperature, injury or emotional experiences. Meanwhile, in a third of cases resulting in angioedema, the cause of this reaction is unexplained. For other cases, the cause of its occurrence can be explained by drug or food allergies, bloodstream diseases and insect bites, as well as autoimmune diseases.

Quincke's edema: symptoms

As can be understood from the name itself, Quincke's edema is characterized by the occurrence of acute swelling of the skin (mucous membranes or subcutaneous tissue). Its most common manifestation is swelling of the facial tissue of the skin, as well as the feet and dorsum of the hands. As for pain, it is usually absent.

In the area where edema occurs, the skin becomes pale, while it itself can change its localization to one or another part of the body. The swelling is characterized by the density of the formation, which, when pressed with a finger, does not form a characteristic pit. In most cases, Quincke's edema is combined with a disease such as. In this situation, purple itchy spots with clearly defined shapes appear on the body, and they can merge with each other, forming a solid spot. When discussing urticaria, it should be noted that although this disease is unpleasant in itself, it does not pose a danger to life. It, in fact, acts as edema, characteristic of the upper layers of the skin.

This form of the disease is swelling of the pharynx, larynx or trachea is extremely dangerous, and it occurs in 25% of cases. The following symptoms are characteristic of laryngeal edema:

Difficulty in breathing;
Anxiety;
The appearance of a “barking” cough;
Hoarseness of voice;
A characteristic blue discoloration that appears on the skin of the face, followed by pallor;
Loss of consciousness (in some situations).

During an examination of the mucous membrane of the throat with these types of angioedema, the symptoms are characterized by swelling that forms in the palate and palatine arches, and a narrowing in the lumen of the pharynx is also observed. With further spread of edema (to the trachea and larynx), the next condition becomes asphyxia, that is, attacks of suffocation, which, in the absence of medical assistance, can lead to death.

Concerning swelling of internal organs, then it manifests itself in the following states:

Severe pain in the abdominal area;
Vomit;
Diarrhea;
Tingling of the palate and tongue (if swelling is localized in the intestines or stomach).

In these cases, changes in the skin, as well as visible mucous membranes, can be excluded, which can significantly complicate the timely diagnosis of the disease.

It is also impossible to exclude from consideration such a type of Quincke's edema as swelling in the area of the meninges, although it is quite rare. Among its main symptoms are the following:

Lethargy, lethargy;
Rigidity characteristic of the muscles of the back of the head (in this case, when tilting the head, the patient is unable to touch the chest with the chin);
Nausea;
Convulsions (in some cases).

Edema various localizations have the following common symptoms:

Lethargy or agitation;
Joint pain;
Fever.

Based on associated factors and general conditions, Quincke's edema has the following classification:

Acute edema (illness duration is up to 6 weeks);
Chronic edema (illness lasts longer than 6 weeks);
Acquired edema;
Edema caused by hereditary causes;
Swelling with urticaria;
Edema isolated from any type of condition.

Diagnosis of Quincke's edema

An extremely important component in diagnosing the disease is determining the factors that provoke it. For example, this could be a consideration of the possible connection of this condition with the use of certain foods, medications, etc. Such a connection can also be confirmed by taking appropriate allergy tests or by identifying a specific type of immunoglobulin in the blood.

In parallel with allergy tests, an assessment is also carried out. Additionally, a sample is taken to analyze various elements in the complement system, and stool analysis for helminths and protozoa. Possible exclusion of autoimmune diseases, as well as blood and intestinal diseases are being considered.

Quincke's edema: elimination of symptoms and treatment

The focus of therapy in this case is aimed at suppressing current allergic reactions. Severe cases in which relief of urticaria is not possible include injections of dexamethasone, prednisone and hydrocortisone. In addition, the doctor prescribes:

Antihistamines;
Enzyme preparations aimed at suppressing sensitivity to the action of an allergen;
Hypoallergenic diet food with the exclusion of citrus fruits, chocolate, coffee, alcohol, and spicy foods from the diet.

In addition, therapy is also carried out, providing for the sanitation of each of the areas with chronic infection. The release of histamine in the presence of an allergen in the body is facilitated by bacteria.

In the case of treating edema due to its hereditary genesis, the doctor determines replenishing therapy for the patient. With its help, the lack of C1 inhibitors in the body is subsequently corrected.

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One of the most pronounced manifestations of allergies is Quincke's edema - this is the body's reaction to biological objects or chemical substances, which are perceived by the immune system as foreign and dangerous.

Complications can be fatal, so the disease requires urgent medical attention. I will talk about the causes of angioedema, symptoms and treatment of the pathology in this publication.

Quincke's edema - what is it?

Quincke's edema is a violent allergic reaction accompanied by swelling of the skin and mucous membranes, in more rare cases - of internal organs, meninges or joints. Other names for the disease are angioedema, giant shock.

Anyone can develop Quincke's edema, but people with one or another type of allergy are at risk.

At the physiological level, such rapid allergic edema occurs due to the release of large amounts of histamine into the blood. This substance is inactive in its normal state, but when an allergen enters the body, it is released, leading to thickening of the blood and the development of severe swelling.

Some episodes of angioedema are due to heredity, or their etiology cannot be determined. Genetic cause associated with disruption of the complements of the immune system.

This is a complex of proteins that is responsible for the immune response to the invasion of allergens and other foreign objects, pathogenic cells. If the complement system is disrupted, then such proteins begin to spontaneously react even to harmless stimuli, for example, exposure to heat or cold. As a result, a violent allergic reaction occurs.

In most cases, allergic angioedema is associated with a specific allergen:

food products;
medications;
cosmetics or household chemicals;
poisons from insect and snake bites;
dust or pollen;
pet hair.

The following may accompany edema and increase the risk of its development:

Symptoms of Quincke's edema in adults and children develop within 20-30 minutes after contact with the allergen. At first, the lesion can be localized on the neck, eyelids, lips, then moves to the palate, tongue and tonsils.

Features of edema:

Density, no indentation remains after pressing;
Painless;
The color does not differ from the surrounding mucous membranes and skin;
May be combined with urticaria (rash).

Swelling often occurs on the face, neck and respiratory tract, since the nasopharynx and larynx are in most cases the gateway for allergens to enter.

The very first signs of Quincke's edema are as follows:

tickle in the throat;
the voice becomes hoarse;
difficult to swallow and breathe.

A person feels fullness and tension at the site of swelling. The greatest danger is the spread of swelling to the respiratory tract - the larynx and bronchi - as this can lead to the development of suffocation.

Other possible manifestations depending on the location of the edema:

mucous membrane of the stomach and intestines - nausea, vomiting, abdominal pain and diarrhea;
bladder - problems with urination;
membranes of the brain - vomiting, dizziness, meningeal syndrome (headache, stiffness of the muscles of the back of the head and neck, pulling the knees towards you and the inability to straighten them).

Quincke's edema in children - features

All parents should be aware of what their child is allergic to and try to avoid exposure to these substances, be it food, pollen or certain medications.

The most dangerous condition is swelling of the larynx. It develops rapidly and the following symptoms appear:

anxiety;
shortness of breath, difficulty breathing;
blue discoloration of limbs and face;
enlarged neck veins;
sometimes hemoptysis.

The structure of subcutaneous fat in children differs from that in adults, therefore, with Quincke's edema, the larynx swells faster.

Among the causes of angioedema in childhood, the first places are occupied by the following allergens:

food - eggs, citrus fruits, berries, chocolate, milk, nuts;
medications - Penicillin, Ampicillin, iodine preparations, Aspirin, B vitamins;
insect poisons, plant pollen and dust.

If the swelling is not allergic in nature, then it can be triggered by stress, infections, exposure to light or temperature, and toxic substances.

Signs of Quincke's edema in children, which occurs in the mucous membrane of the intestines, stomach and esophagus:

sharp pain in the abdomen;
bloody diarrhea;
repeated vomiting.

First aid for Quincke's edema - 10 steps

Quincke's edema is an emergency condition, and a person's life may depend on the actions of people nearby before the doctor arrives. You need to act especially quickly when an allergic reaction is localized in the face, neck, tongue, or pharynx.

For Quincke's edema, first aid is as follows:

Eliminate contact with the allergen;
Remove or unfasten tight clothing;
Provide a flow of fresh air;
Make a subcutaneous injection of 3% Prednisolone solution at a dosage of 1-2 mg per 1 kg of body weight;
Inject intramuscularly an antihistamine - Suprastin solution 2% at the rate of 0.1 ml per year of life (i.e. if the child is 7 years old, then 0.7 ml is administered) or Pipolfen solution 2.5% in the same dose;
If there are only tablets (Claritin, Suprastin, Diphenhydramine), then put them under the tongue;
Give the patient plenty of water or unsweetened tea and sorbents to remove the allergen from the body ( Activated carbon, Enterosgel);
If swelling develops in the nasopharynx or nose, additionally instill drops with a vasoconstrictor effect (Naphthyzin, Galazolin, Otrivin);
If swelling is localized on an arm or leg, be sure to apply a tourniquet above it;
When a bee stings, it is important to quickly remove the sting and apply cold to the affected area.

List of drugs, which can be used independently for mild allergic edema:

Claritin
Benadryl
Allertek
Loratadine
Zodak
Clargothyl
Loragexal
Clarisens
Fenkarol
Letizen
Parlazin
Claridol
Laurid
Suprastin
Clarotadine
Fenistil
Cetirinax
Tavegil.

In case of repeated episodes of allergies - urticaria, angioedema - always carry with you antihistamines and Prednisolone.

Treatment of angioedema in adults and children, drugs

In the treatment of Quincke's edema the following is used:

Tranexamic and aminocaproic acid, H1-antihistamines and glucocorticosteroids (GCS) for acute angioedema.
Diuretics, corticosteroids long acting and plasmapheresis in severe conditions.
If the above drugs are ineffective, Methotrexate, Cyclosporins, Warfarin are used, and sometimes they resort to injection of Epinephrine.
A long course of antihistamines is prescribed if the cause of the swelling is not established and it does not interfere with normal breathing.
With rapidly increasing swelling of the larynx and respiratory failure A tracheostomy may be required - an incision in the trachea and its connection to the external environment using a cannula (special tube).

Chronic angioedema treated with:

H1-antihistamines 2nd generation - Fenistil, Loratadine, Kestin;
1st generation H1-antihistamines for exacerbation of allergies at night and increasing symptoms - Diphenhydramine, Antazoline, Hydroxyzine. Their disadvantage is that they cause drowsiness.

During therapy, it is also important to sanitize all foci of infection, since pathogenic bacteria, when an allergen enters the body, stimulate the release of histamine.

Allergy sufferers must adhere to a diet that excludes chocolate, alcoholic beverages, red berries and citrus fruits, coffee, hot and spicy foods.

Anaphylactic shock with Quincke's edema may become the next step in the development of an allergic reaction.

This dangerous condition, accompanied by itching, difficulty breathing, anxiety, loss of consciousness and convulsions. In such cases, every minute counts, so help must be provided immediately - Hydrocortisone or Prednisolone must be administered and urgently take the person to the hospital.

Forecast

The disease develops unfavorably if medical care is not provided on time. Possible complications:

respiratory failure;
swelling of the membranes of the brain;
swelling of the mucous membrane of the stomach, esophagus, intestines;
anaphylactic shock;
damage to the genitourinary organs.

Any of these conditions can lead to death. Children are in the most dangerous situation, as their swelling spreads very quickly.

With timely assistance, the prognosis is favorable.

For most people, allergic reactions seem like an unpleasant, but not life-threatening condition. In most cases, this is true, but all this does not apply to such a dangerous manifestation of allergies as angioedema.

Description

In most cases, angioedema occurs due to a disproportionate reaction of the immune system to some external irritant. As a result, the body produces special substances responsible for the body's response to inflammation - histamines and prostaglandins. These substances increase the permeability of blood vessels, especially small capillaries, and lymph from them begins to flow into the surrounding tissues. This is how allergic Quincke's edema occurs, which is also traditionally called angioedema. But in fact, this name is not entirely accurate. It was given this name because it was previously thought that swelling was caused by dysfunction of the nerves that control the dilation and constriction of blood vessels.

The name “Quincke’s tumor” is also found, which is an even more incorrect term, since Quincke’s edema has nothing to do with real tumors, which are pathological proliferation of cellular tissue. Angioedema was known many centuries ago. But the name was given to it in honor of the German physiologist Heinrich Quincke, who described edema of this type in his patients at the end of the 19th century. He also developed the first effective ways their treatment.

Photo: Valerio Pardi/Shutterstock.com

Quincke's edema can affect many body tissues and internal organs. But most often, swelling appears on the external tissues of the upper body - the face and neck. Quincke's edema also often occurs on the extremities and genitals. But Quincke's edema, which affects the respiratory organs and meninges, is especially dangerous. They can lead to such severe complications as a violation cerebral circulation and suffocation. Without proper help, such complications can be fatal.

Swelling is not the most common allergic reaction. The incidence of this syndrome is only 2% of all allergic reactions. However, it cannot be said that angioedema is an exotic disease with little chance of encountering. According to many studies, at least every tenth person has experienced angioedema in one form or another at least once in their life.

Angioedema can develop at any age. However, it most often affects young women and children. People who are prone to allergic reactions are more likely to suffer from angioedema. However, this does not mean that edema cannot appear in cases where a person is not at risk.

The rate of development of Quincke's edema may vary in individual cases. Sometimes swelling develops completely in a few minutes, and sometimes swelling progresses gradually over hours or even days. It all depends on the amount of allergen and the duration of its exposure. The duration of swelling may also vary. Sometimes swelling may not go away for weeks, becoming chronic. The chronic type includes swelling that lasts more than 6 weeks.

Children can be susceptible to edema from the very first days of life. In infants, it is often provoked by feeding with artificial formulas, as well as by consuming cow's milk and medications. As a rule, the disease in the first months of life is more severe than in adults and often ends in death. Also in children, the gastric form of Quincke's edema and the form affecting the meninges are more often observed. Edema in children is often combined with bronchial asthma.

Causes

As with other allergic reactions, the syndrome develops in response to allergens entering the body. They can be various substances and agents:

substances contained in food, especially nuts and fruits, egg and milk whites, fish, honey, chocolate, nutritional supplements– dyes, flavor enhancers, preservatives, etc.
medications, especially antibiotics, anesthetics, B vitamins, bromides and iodides, aspirin, some antihypertensives
poisons and toxins, primarily insect poisons
plant pollen
animal fur
household chemicals or industrial chemicals - phenol, turpentine, etc.
dust and dandruff
microorganisms – fungi, bacteria and viruses

Any substance that is safe for most other people can act as an allergen for each individual person. However, particularly strong and rapid allergic reactions develop in response to the venom of snakes and insects.

Indirect factors contributing to the development of angioedema include some diseases of internal organs, helminthic infestations, endocrine diseases.

There is also a group of people with a genetic predisposition to the disease. In such people, such swelling can develop regardless of allergens, for example, during hypothermia or stress.

Symptoms of Quincke's edema

In most cases, the symptoms of Quincke's edema are swelling and enlargement of the soft tissues of the face, neck and head. In some cases, the face swells so much that it begins to resemble balloon, but instead of eyes there are only slits, or the patient cannot open his eyes. Sometimes the swelling spreads to the arms, especially the toes, feet, and upper chest.

As a rule, edema affects all layers of the skin, subcutaneous tissue and mucous membranes. In rare cases, swelling may affect the joints and organs of the gastrointestinal tract. The last form of edema is observed only when allergens enter the stomach with food and medications.

Quincke's edema is also sometimes called giant urticaria. However, edema is more dangerous than urticaria and has some differences from it. In particular, unlike urticaria, the patient does not have itchy skin. Also unlike many other forms of allergic skin reactions, swelling is not accompanied by a rash. When you press on the swollen area, it seems dense and does not form a dimple. Skin color remains unchanged, or slight pallor of the skin is noted.

Signs of angioedema may also include symptoms such as decreased blood pressure, tachycardia, and increased sweating. Consciousness may become confused, coordination is impaired, restlessness, anxiety and fear appear.

The most dangerous symptoms are those that indicate swelling in the upper respiratory tract - trachea, bronchi, larynx, mucous membranes of the pharynx and nasopharynx. If the swelling spreads to these tissues, the patient faces asphyxia. Similar symptoms include a barking cough, sore throat, difficulty breathing, especially when inhaling, and problems with speech. The skin may first turn red and then turn blue. Bleeding may occur due to small burst capillaries of the mucous membranes. Symptoms of Quincke's edema on the mucous membrane of the larynx appear in approximately one fourth of patients.

However, the absence of symptoms should not be an excuse to delay or avoid treatment or not seek medical attention. After all, swelling may continue to develop, and precious time may be lost.

Symptoms of the gastrointestinal form of Quincke's edema are in many ways similar to indigestion - acute pain in the epigastric region, vomiting, nausea and diarrhea, difficulty urinating. In this case, only a doctor can make a diagnosis and prescribe treatment. Swelling of the gastrointestinal tract is also dangerous, as it can develop into a dangerous complication - peritonitis.

Edema of the meninges is no less dangerous than edema of the larynx and trachea. The main symptoms in this case are similar to those of meningitis. These are headaches, fear of light and sound, numbness occipital muscles, expressed in the inability to press the chin to the chest. Nausea and vomiting, convulsions, paralysis, visual and speech disturbances may also appear.

The articular form of Quincke's edema is not life-threatening. It affects the synovial parts of the joints, which results in pain and decreased mobility.

Angioedema can also be accompanied by urticaria (in about half of the cases). This type of allergic reaction is accompanied by itching, blisters of various sizes, lacrimation and conjunctivitis.

The symptoms of Quincke's edema in young children can be difficult to recognize, but all parents should be able to do this, since this syndrome is especially dangerous for children, and the baby cannot report what is happening to him. If the child’s skin appears pale, the nasolabial area turns blue, the heartbeat quickens, and breathing becomes difficult, this means a lack of oxygen associated with laryngeal edema. Subsequently, the cyanosis spreads to other areas of the skin, and sweating increases. Then suffocation may occur with loss of consciousness and a decrease in pulse rate.

Treatment

In itself, swelling of the skin tissues and mucous membranes is not life-threatening and can go away on its own. However, complications of Quincke's edema, affecting the respiratory organs and meninges, as well as anaphylactic shock developing against its background, are extremely dangerous.

Emergency care for Quincke's edema

If the symptoms described above develop, you should immediately call emergency assistance. If it is not possible to call for help, then you should try to deliver the patient to the doctor yourself. However, any person is able to provide first aid to others for allergic edema.

The help algorithm is as follows. First of all, the patient must be reassured. Bed rest is not recommended. It is better for the patient to be in a sitting position. small child you can take it in your hands.

If the source of the allergy is known, then all measures must be taken to stop it from entering the body. For example, stop eating or taking medication, or leave the place where airborne allergens are located.

If the condition was caused by an insect bite, then its sting should be removed from the wound. To prevent the poison from spreading throughout the body, apply a tourniquet to the bitten limb above the bite site. Keep the tourniquet for no more than 30 minutes. If this cannot be done (the patient was not bitten on a limb), then ice or a cold compress should be applied to the bite site. The same methods should be used if swelling develops after injection of any drug.

To make breathing easier, the victim must remove tight clothing, a tie, unbutton the top buttons of a shirt or blouse, remove chains from the neck, open a window, or transfer the victim to a room with free access to fresh air.

If the development of the syndrome occurred as a result of the ingestion of food or a drug into the stomach, then you should take sorbents - activated carbon in a dosage of 1 tablet per 10 kg of weight, smecta or enterosgel. Gastric lavage is prohibited, since if there is possible swelling in the larynx, the patient may choke on vomit.

Is it possible to reduce swelling at home? Very few non-drug medications are suitable for this purpose. For example, a cold compress can be applied to large swelling, which would help to constrict the blood vessels. It is also recommended to drink plenty of liquids with an alkaline reaction - mineral water, soda solution.

But the main treatment is antihistamines. First generation antihistamines, such as suprastin, tavegil and diphenhydramine, are more suitable for this. Despite the fact that they cause drowsiness, their speed of action is slightly higher than that of other drugs in this class. In most cases, one tablet will be enough. The principle of action of antihistamines is based on blocking the effects of histamine on special receptors in blood vessels. Thus, the growth of edema stops, and the patient’s condition stabilizes. Diuretics are used to remove excess fluid from the body. To speed up the absorption of the drug, the tablet can be placed under the tongue.

It should be borne in mind that even if taking antihistamines led to the stabilization of the patient’s condition, this is not a reason to cancel the ambulance call. This is especially true in cases where the cause of the allergy is unknown, or the effect of the allergen on the patient’s body has not been completely eliminated.

In the absence of antihistamines, topical vasoconstrictor drugs for the treatment of runny nose (nosivin, otrivin, rhinonorm) can help. A few drops of this drug need to be instilled into the nasopharynx and larynx. It should also be borne in mind that antihistamines themselves, in rare cases, can cause allergies.

But, of course, drug therapy with tablets will be effective only if the patient does not have swelling of the esophagus and larynx and is able to swallow the tablet. Often, only subcutaneous or intravenous administration of the drug can help with swelling. These manipulations are best performed by ambulance workers, except in cases where the people next to the patient have sufficient experience.

When treating angioedema, glucocorticosteroid drugs, such as prednisolone (60-90 mg) or dexamethasone (8-12 mg), are also often used. Hormones turn off immune reactions body to allergens. As a rule, these drugs are administered subcutaneously or intravenously, but if it is not possible to inject, it is recommended to pour the contents of the ampoule under the tongue.

To increase blood pressure, a solution of a vasoconstrictor, adrenaline, is injected subcutaneously. Typically a solution of 0.1% is used in a volume of 0.1-0.5 ml. Measures to increase blood pressure are carried out until the systolic pressure is 90 mm.

If the patient has already had cases of edema, it is recommended that his relatives have drugs ready for subcutaneous administration.

If the victim is not provided with medical assistance in a timely manner, asphyxia and clinical death. If there is no breathing, artificial respiration should be started.

Treatment in hospital

After the ambulance arrives, doctors, depending on the severity of the condition, can provide assistance to the patient on the spot or hospitalize him. All patients with obvious signs of laryngeal edema are subject to hospitalization. The following categories of patients also fall into this group:

having swelling for the first time
patients with severe disease
patients with drug-induced edema
patients with pathologies of the cardiovascular system and respiratory organs
recently vaccinated
have recently had an acute respiratory viral infection, stroke or heart attack

In the hospital, patients with angioedema are placed either in the allergy department, or in the intensive care unit or ward intensive care- in case of severe life-threatening condition. Treatment of patients continues with infusions of antihistamines, glucocorticosteroids and diuretics. Procedures are also carried out to purify blood from allergens using sorbents. Binding of food allergens is carried out using enterosorbents.

In addition to first-generation antihistamines, other drugs of this class can be used, which have a more complex effect on the immune system and have less side effects. These include Ketotifen, which is effective not only for edema, but also for bronchial asthma, Astemizole, Loratadine. The latter remedy can be used during pregnancy and in children over one year old. For the treatment of edema in infants, Fenistil is preferred.

At obvious signs laryngeal edema, the dose of drugs can be increased - prednisolone - up to 120 mg, dexamethasone - up to 16 mg. In addition to administering the necessary drugs, emergency or hospital workers can also use oxygen inhalation, and in severe cases, tracheal intubation.

Prevention

We live in a world in which we are surrounded by millions of different substances and potentially dangerous agents. It is not always possible to avoid them, but such meetings should be kept to a minimum. For example, you should not try exotic foods, you should check medications, especially when administered parenterally (intravenously, subcutaneously or infusion), for allergies, and avoid insect bites. You should not take all medications and dietary supplements in a row, especially those that do not seem to be particularly necessary, but are actively advertised or are taken by friends. First of all, precautions apply to people who are prone to allergies. Special attention You should pay attention to the composition of medicines or food products and ensure that there are no individually dangerous allergens among their components.

But for those who do not have such a predisposition, there are no guarantees. After all, a person’s immunity can change over time, for example, after suffering acute infectious diseases.

It should also be understood that severe allergic reactions, such as Quincke's edema, are insidious. Sometimes they may not occur after the body’s first contact with the allergen, but one of the subsequent ones, when the person may not be at all prepared for such a development of events.

Therefore, you must always be prepared and have with you necessary medications, helping to cope with the manifestations of allergies, as well as to be able to recognize Quincke's edema and the symptoms characteristic of it. You need to know how first aid is provided for Quincke's edema. After all, not in every situation can you count on quick medical assistance, and the speed of providing first aid to a patient may depend on his life.

Quincke's edema is a diffuse or suddenly limited swelling of the mucous membranes, fascia and fatty tissue. Otherwise, Quincke's edema is called "acute angioedema" or "giant urticaria."

This disease occurs in both children and adults, but young people, and especially women, are most susceptible. Teenagers and the elderly suffer from this disease less often. The most dangerous thing about this disease is that those symptoms that are characteristic of Quincke's disease appear regardless of age, very often lead to conditions in which death is possible if emergency assistance is not provided to the person in time.

Quincke's edema is the action of allergic reactions that contribute to the production of large amounts of the mediator histamine. This is what causes inflammation to begin. circulatory system person. Doctors divide Quincke's edema into two types:

1. Edema is hereditary, it is an extremely rare genetic disease;

2. Acquired, the reasons for the development of this type of disease will be given below.

Quincke's edema develops in a very short period of time (from 60 seconds to 60 minutes). In each individual case, everything depends on the type of pathogen and the characteristics of the organism. In most cases, Quincke manifests itself in soft form, but there are also more severe cases. If the disease is severe, swelling of the throat and tongue appears, and the airways become blocked. I think it is clear to everyone that these manifestations can seriously threaten a person’s life.

It is necessary to know the symptoms of Quincke, because the disease is very serious. Having the necessary information will give you the opportunity to promptly notice the onset of swelling and call emergency help. The symptoms that appear are not always the same, but generally the following picture can be observed:

Swelling of the skin. The onset of edema is manifested by the sudden appearance of a small swelling on the skin of the face, arms and legs, usually pink in color.

Quincke's edema in the photo
- discomfort is felt in the affected areas, those parts of the body where the swelling appears are itchy, and sometimes a burning sensation and pain may be observed;

Sometimes a swelling appears that resembles nettle burns. Typically, the rash appears in the part of the body where hair grows. It can be not only the head, but also the arms and even the legs.

In extremely rare cases, it can lead to hoarseness, a feeling of tightness in the throat (lump in the throat) and difficulty breathing.

Antigens lead to severe swelling, intensive release of biogenic compounds. Also, some food products, pollen, dust, medicines, some irritating factors natural nature: bright sunlight or cold. As you can see, dozens of irritants can be the cause, which is why edema is very dangerous, not only for children, but also for adults. One of the most common reasons are: powders, air fresheners, etc. It should be noted that the manifestation of symptoms of the disease (the appearance of edema) may not begin immediately, but after 72 hours.

Acute, painless, swelling of the deep layers of the skin and subcutaneous tissue or mucous membranes, caused by increased vascular permeability. In some cases, it can lead to complete closure of the airways and death.

The disease was first described in 1882 German doctor and explorer Heinrich Quincke.
More than 90% of all cases of Quincke's edema and emergency visits medical care associated with the use of medications, especially ACE inhibitors(captopril, enalapril).
Quincke's edema can be of several types:
- Hereditary angioedema
- Acquired angioedema
- Quincke's edema associated with allergic reactions (usually urticaria)
- Quincke's edema associated with taking medications (more often in the elderly with ACE inhibitors)
- Quincke's edema of unknown cause (idiopathic)

Hereditary angioedema rare disease developing in only 1 person out of 150 thousand people. It was first described in 1888 in five generations of an American family. The onset of episodes of the disease is most often recorded at the age of 7-15 years. All patients with hereditary angioedema have a tendency to develop autoimmune diseases(systemic lupus erythematosus, autoimmune thyroiditis, etc.). The disease is transmitted in an autosomal dominant manner and the chance of having a child in a couple in which one parent is sick is 50%.
Cases acquired angioedema quite rare, only 50 cases of the disease were described during the period 1997-2008. The disease most often develops in people over 50 years of age.
The incidence of angioedema associated with the use of ACE inhibitors is 1-2 cases per 1 thousand population.

To understand the cause and mechanism of hereditary angioedema, it is necessary to disassemble one of the components of the immune system. We will talk about the compliment system. The complement system is an important component of both innate and acquired immunity, consisting of a complex of protein structures.

The complement system is involved in the implementation of the immune response and is designed to protect the body from the action of foreign agents. In addition, the complement system is involved in inflammatory and allergic reactions. Activation of the complement system leads to the release of specific immune cells(basophils, mast cells) biologically active substances (bradykinin, histamine, etc.), which in turn stimulates the inflammatory and allergic reaction.

All this is accompanied by dilation of blood vessels, an increase in their permeability to blood components, a decrease in blood pressure, and the appearance of various rashes and swelling. The complement system is regulated by specific enzymes, one of these enzymes is the C1 inhibitor. The quantity and quality of which determines the development of Quincke's edema. It has been scientifically proven that the lack of C1 inhibitor is the main cause of the development of hereditary and acquired Quincke's edema. Based on its function, the C1 inhibitor must inhibit and control complement activation. When it is not enough, uncontrolled activation of the compliment occurs and from specific cells (mast cells, basophils), a massive release of biologically active substances is carried out that trigger the mechanisms of an allergic reaction (bradykinin, serotonin, histamine, etc.). The main cause of edema is bradykinin and histamine, which dilate blood vessels and increase vascular permeability to the liquid component of the blood.

In the case of allergic Quincke's edema, the development mechanism is similar to an anaphylactic reaction. cm.

Mechanism of development of anaphylaxis

Edema occurs in the deep layers, subcutaneous fatty tissue and mucous membranes as a result of dilation of blood vessels (venules) and an increase in their permeability to the liquid component of the blood. As a result, interstitial fluid accumulates in the tissues, which causes swelling. The dilation of blood vessels and an increase in their permeability occurs as a result of the release of biologically active substances (bradykinin, histamine, etc.) according to the mechanisms described above (the complement system, the mechanism of development of anaphylaxis).

It is worth noting that the development process of Quincke's edema and urticaria are similar. Only with urticaria does vasodilation occur in the superficial layers of the skin.

Stress emotional and physical
Infectious diseases
Injury
Surgical interventions, including dental procedures
Menstrual cycle
Pregnancy
Taking contraceptives containing estrogens

The following diseases contribute to the manifestation of acquired angioedema:

Chronic lymphocytic leukemia
Non-Hodgkin's lymphoma
Lymphosarcoma
Myeloma
Primary cryoglobulinemia
Lymphocytic lymphoma
Waldenström's macroglobulinemia

All these diseases contribute to a decrease in the level of C1 inhibitor and increase the possibility of uncontrolled activation of complement with the release of biologically active substances.

In angioedema associated with the use of ACE inhibitors, the development of the disease is based on a decrease in the level of a specific enzyme (angiotensin II), which in turn leads to an increase in the level of bradykin. And accordingly this leads to swelling. ACE inhibitors (captopril, enalapril), drugs mainly used to control blood pressure. Symptoms of Quincke's edema do not appear immediately after using such medications. In most cases (70-100%), they appear during the first week of treatment with these drugs.

Causes of allergic Quincke's edema cm.

Causes of anaphylaxis

Precursors of Quincke's edema: tingling, burning in the area of edema. U

35% of patients experience pink or red skin on the trunk or extremities before or during swelling.

In order to understand the symptoms of Quincke's edema, you need to understand that the appearance of symptoms and their characteristics vary depending on the type of edema. So, angioedema during anaphylactic shock or other allergic reaction will differ from an episode of hereditary or acquired angioedema. Let's consider the symptoms separately for each type of Quincke's edema.

Type of edema	Symptoms
Type of edema	Onset and duration of swelling	Place of appearance	Characteristics of edema	Peculiarities
Allergic Quincke's Edema	From a few minutes to an hour. Usually in 5-30 minutes. The process resolves after a few hours or 2-3 days.	Most often the area of the face and neck (lips, eyelids, cheeks), lower and upper limbs, genitals. Swelling can occur in any part of the body.	The swelling is dense and does not form a pit after pressure. The swelling is pale or slightly red.	In most cases, it is accompanied by hives and itchy rashes.
Quincke's edema is hereditary and acquired, as well as associated with taking ACE inhibitors,	Swelling in most cases develops within 2-3 hours and disappears in 2-3 days, but in some patients it can be present for up to 1 week.	Swelling most often appears in the eyes, lips, tongue, and genitals, but can appear in any part of the body.	The swelling is often pale, tense, there is no itching or redness, and there is no pit left after pressure.	Not accompanied by urticaria.
Quincke's edema without found causes	See allergic angioedema			Urticaria occurs in 50% of cases

Symptoms of Quincke's edema depending on the location of occurrence

Do I need to call an ambulance?

An ambulance should be called in any case of Quincke's edema. Especially if this is the first episode.

Indications for hospitalization:

Swelling of the tongue
Difficulty breathing caused by swelling of the airways.
Intestinal swelling (symptoms: abdominal pain, diarrhea, vomiting).
No or insignificant effect from treatment at home.

How can I help before the ambulance arrives?

Clear the airways
Check for breathing
Check pulse and blood pressure
If necessary, perform cardiopulmonary resuscitation. see First aid for anaphylactic shock.
Administer medications

The tactics of drug treatment for non-allergic Quincke's edema and allergic edema are slightly different. Considering the fact that non-allergic angioedema reacts poorly to basic medications (adrenaline, antihistamines, glucocorticoids) are used to treat acute allergic reactions. However, as practice shows, it is better to start with these medications, especially if a case of Quincke's edema is detected for the first time and its exact cause has not yet been determined.

The drugs are administered in a certain sequence. At the beginning, adrenaline is always administered, then hormones and antihistamines. However, if the allergic reaction is not so pronounced, the introduction of hormones and antihistamines is sufficient.

Adrenalin

At the first symptoms of Quincke's edema, you should administer

adrenalin. This is the drug of choice for all life-threatening allergic reactions.

Where to inject adrenaline? Usually on prehospital stage the drug is administered intramuscularly. The best place for the injection of adrenaline, this is the middle third outer surface hips. The peculiarities of blood circulation in this area allow the drug to quickly spread throughout the body and begin to act. However, adrenaline can also be injected into other parts of the body, for example, into the deltoid muscle of the shoulder, gluteal muscle, etc. It is worth noting that in emergency situations when swelling occurs in the neck and tongue, adrenaline is injected into the trachea or under the tongue. If necessary and possible, adrenaline is administered intravenously.

How much should I enter? Usually in such situations there is a standard dose for adults of 0.3-0.5 ml of a 0.1% solution of adrenaline, for children 0.01 mg/kg of weight on average 0.1-0.3 ml of a 0.1% solution. If there is no effect, the administration can be repeated every 10-15 minutes.

Currently, there are special devices for convenient administration of adrenaline, in which the dose is strictly defined and dosed. Such devices are the EpiPen syringe pen, the device audio instructions on the use of Allerjet. In the USA and European countries, such devices are worn by everyone suffering from anaphylactic reactions and, if necessary, they can independently administer adrenaline.

Main effects of the drug: Reduces the release of allergic reaction substances (histamine, bradykinin, etc.), increases arterial pressure, eliminates spasms in the bronchi, increases the efficiency of the heart.

Hormonal drugs

The following drugs are used to treat an allergic reaction: dexamethasone, prednisolone, hydrocortisone.

Where to enter? Before the ambulance arrives, you can administer medications intramuscularly, into the same gluteal area, but if possible intravenously. If it is not possible to administer it with a syringe, it is possible to simply pour the contents of the ampoule under the tongue. There are veins under the tongue through which the drug is well and quickly absorbed. The effect when the drug is administered under the tongue occurs much faster than when administered intramuscularly, even intravenously. Since when a drug enters the sublingual veins, it immediately spreads, bypassing the hepatic barrier.

How much should I enter?

Dexamethasone from 8 to 32 mg, in one ampoule 4 mg, 1 tablet 0.5 mg.
Prednisolone from 60-150 mg, in one ampoule 30 mg, 1 tablet 5 mg.

Medicines also exist in tablets, but the speed of onset of effect is much lower than with the above methods of administration (IM and IV). If necessary, hormones can be taken in tablet form in the indicated doses.

Main effects of the drugs: relieve inflammation, swelling, itching, increase blood pressure, stop the release of substances that cause allergic reactions, help eliminate bronchospasm and improve heart function.

Antihistamines

The drugs that block H1 receptors are mainly used (loratadine, cetirizine, clemastine, suprastin). However, it has been proven that the antiallergic effect is enhanced by a combination of H1 and H2 histamine blockers. H2 receptor blockers include: famotidine, ranitidine, etc.

Where to enter? It is better to administer the drug intramuscularly, however, the drugs will also work in tablet form, but with a later onset of effect.

How much should I enter? Suprastin – 2 ml-2%; in tablets 50 mg;

Clemastine – 1 ml – 0.1%;

Cetirizine - 20 mg;

Loratadine – 10 mg;

Famotidine – 20-40 mg;

Ranitidine – 150-300 mg;

Main effects of the drugs: eliminate swelling, itching, redness, stop the release of substances that trigger an allergic reaction (histamine, bradykinin, etc.).

Medicines used for non-allergic Quincke's edema knitted with a decrease in the level of C1 inhibitor (hereditary, acquired Quincke's edema)

Drugs that are usually administered during hospitalization:

Purified C1 inhibitor concentrate, administered intravenously, is used in Europe and the USA. Not yet used in the Russian Federation.
In the absence of a C1 inhibitor concentrate. Fresh frozen plasma 250-300 ml is administered, which contains a sufficient amount of C1 inhibitor. However, in some cases, its use may increase the exacerbation of Quincke's edema.

Drugs that can be administered independently before the ambulance arrives:

Aminocaproic acid 7-10 g per day orally until the exacerbation completely stops. If possible, place a dropper in a dose of 100-200 ml.
Effects: the drug has antiallergic activity, neutralizes the effect of biologically active allergy substances (badikinin, kaleikrein, etc.), reduces vascular permeability, which helps eliminate edema.
Male sex hormone preparations(androgens): danazol, stanazol, methyltestosterone.

Doses: danazol 800 mg per day; Stanazolol 4-5 mg per day, taken orally or intramuscularly; Methyltestosterone 10-25 mg per day, route of administration, under the tongue.

Effects: These drugs enhance the production of C1 inhibitor, thereby increasing its concentration in the blood, which eliminates the main mechanism for the development of the disease.

Contraindications: pregnancy, lactation, childhood, prostate cancer. In children, aminocaproic acid is used together with androgens.

In case of laryngeal edema, complete closure of the airways is possible, in which drug treatment not always effective. In this case, a puncture or cut into the cricothyroid ligament (cricothyriotomy) can be performed to save life. see How to ensure airway patency during laryngeal edema?

Depending on the severity and nature of the edema, the patient is sent to the appropriate department. For example, the patient will be referred to intensive care unit with severe anaphylactic shock. If there is swelling of the larynx, this may be in the ENT department or the same intensive care unit. In case of moderate Quincke's edema, which is not life-threatening, the patient is treated in the allergy department or a regular therapeutic department.

What is the treatment?For allergic Quincke's edema, which is part anaphylactic reaction The drugs of choice are adrenaline, glucocorticoid hormones, and antihistamines. In addition, detoxification therapy is carried out by intravenous administration special solutions (reoplyuglyukin, ringer lactate, saline solution, etc.). When 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.

For non-allergic Quincke's edema(hereditary, acquired Quincke's edema), accompanied by a decrease in the concentration of C1 inhibitor in the blood, 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 swelling of the larynx and complete closure of the airway, an incision is made in the cricothyroid ligament and a special tube is installed for an alternative route of breathing (tracheostomy). In severe cases, they are transferred to an artificial respiration apparatus.

The length of hospital stay depends on the severity of the disease. On average, when treated in a therapeutic department, the patient's stay in the hospital is 5-7 days.

Quincke's edema is a type of immediate allergic reaction to external irritants. This disease is dangerous; its onset is sudden and leads to extensive swelling of the skin, attacks of suffocation and increased blood pressure. The irritant role is played by both food products or medications, and the influence of external physical factors(sun, wind, cold). If symptoms of the disease appear, you should immediately contact a medical facility. If the disease is ignored, the consequences of edema lead to a deterioration in the body's condition and even death. To answer the question of how long angioedema lasts, it is necessary to understand the types of the disease.

For the development of edema, a few minutes are enough from the time the allergen enters the body. There have been cases where swelling occurred after a few hours.

The disorder is easy to identify: the patient experiences extensive swelling of the skin. Often the disease affects the facial skin and neck, and damage to the mucous membrane of the body is possible. When the disease becomes more complicated, swelling spreads to the brain. It's threatening further development neurological disorders.

The duration of the disease varies depending on complications:

With normal swelling, the effects of the disease last for several days. The period increases to one week in case of complications. If the disease has not affected important parts of the body (the brain and the mucous membrane of the respiratory tract), then the swelling goes away without a trace. The transfer of Quincke's edema leads to a recurrence of the disease in the future. After an illness, the body may experience acute rejection of other allergens.
Swelling of the larynx lasts from 2-3 days to several weeks. Complications of laryngeal edema lead to progression of the disease. How quickly the disease makes itself known is determined by the patient’s body’s reaction to various allergens. Diseases of the respiratory system lead to attacks of suffocation, difficulty breathing, and dry cough. Untimely treatment of laryngeal edema creates the basis for the occurrence of chronic diseases of the respiratory system.
Swelling of the gastric mucosa lasts for one week. The consequences appear in the form acute pain, disturbances in appetite and body condition, and the appearance of symptoms of peritonitis. After 7-8 days, the patient’s condition improves, nutrition and intestinal motility normalize. After some time, the attack may recur. After the disease has passed, the patient should undergo full examination gastrointestinal tract to determine possible consequences.

With angioedema, it is better not to delay contacting a doctor. Sometimes untimely appeal seeking help leads to death.

Damage to the urogenital system by Quincke's disease leads to urinary retention and the occurrence of pain during urination. Swelling may appear in the genital area. With medical supervision and taking medications, the disease goes away after 2-4 days. With complicated edema of the urogenital system, the illness time increases to 7 days.
The longest and most dangerous is swelling on the face. Lobes of the brain may be affected. Patients exhibit symptoms unpleasant consequences: dizziness, nausea or vomiting, headaches. Some patients experienced disease progression within 6 weeks. Ignoring facial symptoms leads to irreparable damage to the body or death. With proper medical examination and medication, attacks can be eliminated in 7-10 days.

Quincke's disease is inherited and is chronic. Some medical institutions provide the opportunity to take tests that will help identify the allergen. After a reaction to the allergen occurs, the patient must stop all contact with it in the future.

Quincke's edema can vary in duration. The duration of the disease is influenced by the following factors:

An area of the body or specific organs that is affected by disease.
Conducting a medical examination, and taking tests if necessary.
Acceptance of prescribed medical supplies, which remove negative consequences of edema.

Proper treatment and medical examination, will reduce the progression of the disease and relieve Quincke's edema. Periodic preventive maintenance reduces the possibility of the disease occurring.

There are many causes of swelling and even more possible reasons. However, one of the most serious manifestations of swelling is Quincke's edema, which is also called angioedema. In this case, the person is very quickly exposed to this disease and it is necessary to provide assistance as quickly as possible, otherwise there is even a possibility of death. Now we will understand what can cause this complex type of edema, how it develops, and what methods exist for its elimination and treatment.

Before we begin to consider how angioedema occurs, the ways of its development, the symptoms of this disease and methods of combating it, it is worth talking about what it is.

So, the essence of the disease is that in a short period of time a person is affected soft fabrics, mucous membrane and skin. Outwardly, it looks like a strong increase or swelling of certain areas of the skin, and it is very difficult to confuse angioedema with something else.

The causative agent of this disease in most cases is an allergen that has entered the body, that is, a reaction to a specific pathogen is observed. In this case, the body’s reaction is such that when the transferred allergen is activated, the human body reacts with an increased release of histamine into the vessels.

More often this pathology is distributed in the face, neck and upper parts torso. For these reasons, there is a high risk of swelling of the upper respiratory tract and complete blockage of breathing. Needless to say, in such cases urgent qualified assistance and hospitalization.

You have received a general idea of this pathology with the occurrence of severe swelling, and it’s time to talk about the reasons for such a reaction of the body. Doctors around the world are convinced that angioedema has two development mechanisms:

Allergic;
Pseudo-allergic;

In the first case, as mentioned above, the activator is the allergen and the body’s violent hypersensitivity to this pathogen (this scenario occurs most often). At the same time, substances produced by the body itself enter the blood in large volumes, due to which the permeability of blood vessels increases.

Blood passes through the walls of blood vessels and enters the soft tissues, then there is an increase in the intercellular distance and a general expansion of the body tissues, as well as the skin epithelium. Outwardly, it looks and is characterized precisely as swelling.

There are many reasons for allergic edema:

Hypersensitivity to any food product;
Reaction to chemicals;
Flowering plants;
Medications;
Insect bites;
Animal fur, etc.

Pseudoallergic angioedema is a congenital pathology in the human body, which manifests itself as a mutation of the compliment system ( separate species proteins responsible for the reactions of the immune system to individual factors).

In this case, the activator is not a third-party allergen. The body can erroneously react to any manifestations, such as heat or cold, physical damage or stress. In other words, angioedema can begin spontaneously when the compliment system is erroneously activated.

When angioedema occurs, all symptoms appear very quickly, sometimes the time from the onset of the reaction to its apogee does not exceed 2-3 minutes. Of course, this comes into force individual characteristics the human body, however, the picture of the development of pathology in all people is approximately the same.

At the same time, it is quite easy to recognize such swelling; first of all, the reaction begins with the swelling of the eyelids, lips, and tongue. Further, the reaction goes deeper than the oral cavity, affecting the soft palate, tonsils and respiratory tract. The affected outer areas of the skin increase in size by 2-3 times, and the eyes may become completely swollen.

In some cases, one might say atypical, Quincke's edema affects the genitals; in such situations, the swelling affects the labia in women and the scrotum in men.

The entire reaction is painless, you can only feel the pressure on the affected areas increasing with every second, a tingling sensation. In this case, the skin acquires a slightly pale tint, and upon palpation no traces or pits remain.

Other symptoms include the following:

Hoarseness in the voice;
Difficulty breathing;
Cough;
Vomiting.

Everything happens because the tongue and organs of the upper respiratory tract swell, the risk increases every minute and there is a high probability of asphyxia (suffocation).

With Quincke's edema, the victim is almost always overcome by a feeling of anxiety or even hysteria. The first thing to do in such cases is to try to calm the person and immediately call an ambulance. However, there are a number of activities that should not be carried out before help arrives; their use is necessary:

Give the patient any antihistamine. This action will slow down the allergic reaction and allow at least a little relief of swelling. In this case, you need to pay attention to the age and weight category of the victim, so as not to get an overdose.

There are times when antihistamines are not at hand, then any vasoconstrictor drugs will do, for example, nasal drops with the desired effect. You need to drop them into your nose, dilute them with water and try to wet your throat and mouth with them.
IN mandatory Free the patient from restrictive clothing and jewelry. You need to remove all chains from your neck, unfasten the top buttons, loosen your tie and belt on your trousers. All this can interfere with the respiratory process in this already difficult situation. It is also worth opening the windows to let more fresh air into the room.
If the causative agent of Quincke's edema is known, the patient should be protected from it as quickly as possible However, if the reaction was caused by some product (eaten or drunk), and the swelling has already become critical, in no case try to cleanse the stomach by inducing vomiting, this may worsen the situation.

Remember, this pathology appears unexpectedly and develops very quickly, sometimes in a matter of minutes. You must do everything to wait for the arrival of doctors who will be able to provide emergency care and hospitalize the patient with subsequent treatment measures.

Usually, after angioedema forms and a person is hospitalized, doctors take a number of actions to reduce the intensity of swelling and the body’s recovery processes. In such situations, antihistamines are prescribed for some time to suppress allergies.

Further, treatment can be individual, it all depends on the cause of Quincke's edema. In any case, the reasons for activating the process are established. After this, some are prescribed drugs to reduce vascular permeability, others are recommended to periodically take a course preventive measures, remove all possible allergy triggers from the diet, etc. In any case, treatment should be prescribed by an experienced specialist and compliance with it is very important.