Quincke's edema (angioedema) is a sudden and non-painful swelling of deep areas of the skin or mucous membranes. This is an allergic reaction manifested by an increase in the size of the face, neck, arms and legs in people of any age. A dangerous consequence is the death of the patient.
Characteristics of the pathology
The disease was introduced and studied in 1882 by the German scientist Heinrich Quincke. Many situations are associated with the use of ACE inhibitor medications, such as Captopril and Enalapril. Pathology occurs in loose tissue located in the area of the larynx and tongue.
The disease is dangerous as it suddenly affects the upper part of the body and lasts from a few minutes to a couple of hours. Angioedema can occur in anyone and at any age. At risk are allergy sufferers and people sensitive to certain components and substances. It is necessary to exclude foods such as fish, squid, red fruits and vegetables, chicken and milk protein, and chocolate. Unfavorable environmental conditions provoke the development of new episodes.
Main causes and varieties
Edema in children reaches large sizes and quickly arises in various parts bodies. On palpation, the enlarged area seems dense and homogeneous, and when pressed, no depression appears. In 50% of cases, the child’s body is covered with a small rash. Swelling of the larynx and throat is extremely dangerous. Parents should know what causes Quincke's edema. This applies to children who are often exposed to allergic reactions and related complications.
The pathological process forms in the subcutaneous tissue and mucous membranes against the background of an increase in the size of blood vessels (venules) and transcapillary blood exchange. A special fluid accumulates in the tissues, causing swelling. The expansion and increase in the permeability of the vascular wall occurs as a result of the release of biologically active elements. The nature of Quincke syndrome and urticaria is similar, only in the latter case the vessels dilate in the upper layers of the skin.
There are two types of angioedema: allergic and pseudo-allergic. They differ in the reasons that cause dangerous pathology. In the first option, an irritant enters the blood, provoking a specific state of the body in response. Swelling appears due to previous urticaria, asthma, hay fever or food allergies.
The pseudoallergic type occurs against the background of congenital disorders of the immune system. The irritant is heat, cold or a chemical reagent.
Causes of pathology:
Angiotensin converting enzyme (ACE) inhibitors are used to control blood pressure. Edema associated with the use of this group of drugs occurs due to a decrease in the level of the enzyme angiotensin II, leading to an increase in bradykin and the occurrence of edema. After the first dose, the main symptoms of the disease appear.
Types of Quincke syndrome:
- Hereditary. Pathological conditions swelling recurs in any part of the body without rashes, appears in relatives and begins in childhood.
- Acquired. Develops in people over 20 years of age without urticaria. The family may not show symptoms of the disease.
- Allergic. Develops together with rashes and itching due to interaction with an irritant.
In 25% of cases, edema affects the larynx, trachea and bronchi. This is a very dangerous condition that requires urgent medical attention because there is a high risk of suffocation or anaphylactic shock.
Forms of the disease:
- Chronic.
- Spicy.
- Recurrent.
- Allergic.
- Non-allergic.
Most often, small children and young women suffer from the pathology. Babies are exposed to angioedema from infancy due to allergic reaction for a new product, drug, animal or infection.
A pregnant woman becomes sensitive to any influences, so there is an allergic danger. The presence of one episode of the disease indicates the development of Quincke's edema in the unborn child.
When angioedema affects the stomach or intestines, the patient experiences pain in the abdominal cavity, tingling of the tongue, tonsils, diarrhea and vomiting occur. With external manifestations of the disease, children suffer from fever and joint pain. Nervous excitement may occur and fainting may occur.
Typical symptoms
The characteristics of the symptoms depend on the type of edema. Quincke syndrome begins quickly, within 3-60 minutes various parts of the body enlarge, and the patient’s changed appearance becomes noticeable.
The patient feels tingling, burning and redness in the area of swelling.
When the eyelids become swollen, the eyes close completely. The pathology does not cause pain or itching, but skin tension occurs. For mild tissue swelling child's body getting worse general state, the temperature rises and the child may lose consciousness. You need to be attentive to infants, because they are not able to talk about the signs and complain about being unwell.
Manifestations of edema:
A serious condition is angioedema of the throat and tongue. The process of swallowing saliva is disrupted, causing dryness, cough, hoarseness and changes in breathing. A person can suffocate and die within minutes. With swelling of the lungs, there is discomfort in the sternum due to fluid entering the pleural cavity. Intestinal syndrome accompanied by vomiting, pain in the epigastric area and diarrhea. Angioedema of the bladder is characterized by a delay in the outflow of urine. If the syndrome affects parts of the brain and its membranes, headache, seizures and changes in consciousness appear.
Symptoms after taking medications do not occur immediately, but during the first week of therapy. Signs of mumps () are similar to Quincke's syndrome, the ear glands also swell, and the patient's face changes in appearance.
Associated complications
The disease can be prevented only by eliminating contact with the irritant. A dangerous consequence is suffocation, which can lead to coma and death of the patient. If swelling of the stomach or intestines occurs, the risk of dyspeptic disorders is high. With lesions of the urogenital tract, acute cystitis and urinary retention develop.
Facial swelling poses a serious threat, as there is a risk of damage to the brain and accompanying membranes. The patient experiences severe headache, nausea and vomiting. In the absence of medical care, a person quickly falls into a coma or dies due to lack of oxygen.
At the first signs of swelling on the suspected irritant, you should call an ambulance. This will protect against complications, serious consequences and save lives. The disease can recur suddenly at any time.
Diagnosis and treatment
The clinical picture for edema located on the face and other parts of the body allows us to establish the correct diagnosis. The situation is more complicated when signs of acute abdominal pain appear or when it is necessary to separate symptoms from diseases of the organs and nervous system.
It is difficult to distinguish between congenital and acquired angioedema and to determine the tendency to allergic reactions. The doctor must find out the hereditary predisposition to allergies, the presence of cases of edema in the patient’s relatives. Examinations are prescribed: electrocardiogram, ultrasound and x-ray diagnostics of the digestive organs and chest. A carefully collected anamnesis will prevent relapses and complications. Placing the patient in a hospital will speed up recovery and reduce the risk of negative consequences.
Urgent Care
Based on the description of complaints and examination data, the patient is divided into hereditary and acquired types of the disease. Genetic angioedema is characterized by mildly manifested and long-lasting swelling that affects the throat and stomach. Symptoms occur after injury in the absence of contact with allergens. No other manifestations of allergies are noted.
Diagnosis of non-allergic types of edema in the laboratory reveals a decrease in the amount and activity of the C1 inhibitor and autoimmune pathology. With allergic edema, an increase in eosinophils in the blood, an increase in the level of IgE, and positive skin tests are detected.
In case of wheezing and noisy breathing during laryngeal edema, laryngoscopy is required; in case of abdominal syndrome, a precise examination by a surgeon and the appointment of studies (laparoscopy, colonoscopy).
Before medical help arrives, it is necessary to perform basic life-saving procedures. Check the patient's breathing and free the chest and neck area, open the windows to ventilate the room. If the patient has been bitten by an insect, the sting is removed from the wound and the patient is given plenty of fluids with a sufficient amount of enterosorbents. An antihistamine should be given.
Check your pulse and measure your blood pressure. A cardiac massage is performed and medications are administered intramuscularly, intravenously or orally.
At home, you can administer Aminocaproic acid orally at a dosage of 7-10 g per day. If possible, a 100-200 ml dropper is placed. Allergic activity and the ability of blood to pass through the vessels into the tissue are reduced. Androgens are also taken or given intramuscularly. They are represented by drugs: Danazol, Stanozol and Methyltestosterone.
Daily dosage of male hormones:
- Danazol - no more than 800 mg.
- Stanazolol - up to 5 mg of the drug.
- Methyltestosterone - 10−25 mg sublingually.
Medicines improve the production of C1 inhibitor. There is a list of contraindications, which includes pregnancy and lactation, childhood, and cancer. prostate gland. Aminocaproic acid is administered to children.
Necessary medications:
Arriving medical workers examine the patient and determine the causes of the disease. It is enough to ask the patient about existing allergic reactions and pathologies, food consumed, medications taken, and contact with animals. Sometimes it is necessary to undergo analysis and allergy tests.
When the throat becomes swollen, the airways may close. To save life, a puncture or incision is made in the cricothyroid ligament and a tube is inserted to provide oxygen to the lungs.
The treatment method for Quincke's edema in non-allergic and allergic types is different. The first type reacts poorly to the main medications (adrenaline, antihistamines, glucocorticoids) used to treat acute manifestations of allergies. The effectiveness of antihistamines is due to the suppression of histamine synthesis and its interaction with receptors. They also relieve inflammation.
Medicines are administered in the prescribed manner, first adrenaline is given, then androgens and antiallergic medications. If the clinical reaction is weak, the administration of hormones and antihistamines is sufficient.
At the first sign of illness, adrenaline is injected into the muscle of the outer buttock. This provides fast action substances. In serious situations, when swelling appears in the neck or tongue, an injection is made into the trachea or under the tongue. IN best case scenario the drug is placed into a vein. It reduces the release of histamine and bradykinin, increases blood pressure, relieves bronchospasm and improves myocardial activity.
Adrenaline dosage:
- Adults - 0.5 ml of 0.1% solution.
- Children's age - From 0.01 mg per 1 kg of weight (0.1−0.3 ml of 0.1% product). If there is no improvement in the patient's condition, the administration is repeated.
Hormonal medications include Dexamethasone, Prednisolone and Hydrocortisone. Before help arrives, the medicine is injected into the buttock. The maximum effect is achieved with intravenous administration. If there is no syringe at hand, the ampoule is poured under the tongue. There are veins in this area that allow the medicine to be immediately absorbed.
Dosage of hormonal agents:
- Dexamethasone. You need to take from 8-32 mg. One ampoule contains 4 mg, and one tablet contains 0.5 mg.
- Prednisolone. The dosage ranges from 60−150 mg. The bottle contains 30 mg, and the tablet contains 5 mg of the substance.
Injection into a vein or muscle will speed up the absorption of the medicine, and the therapeutic effect will occur faster. The products relieve inflammation, swelling, and itching. Among antihistamines, drugs that block H1 receptors are used (Diphenhydramine, Loratadine, Telfast, Suprastin, Cetirizine, Zyrtec, Zodak, Clemastine, Diazolin). The antiallergic effect increases with the combination of H1 and H2 histamine blockers: Famotidine and Ranitidine. Medicines are injected into the muscle or taken in tablet form.
Antihistamine dosage:
Antihistamine medications eliminate Quincke's symptoms such as tissue swelling, itching, redness and burning. Inpatient monitoring is required at the discretion of the physician. The medical professional determines the severity of the patient's condition.
Mandatory hospitalization
Specialists who arrive at the scene determine the causes and type of swelling. Depending on the complexity of the disease and external manifestations, the patient is taken to a specialized department. For example, with severe anaphylaxis, the patient is sent to intensive care, and with swelling of the throat - to otolaryngology. If swelling is diagnosed medium degree severity, the patient is treated in allergology or therapy.
Indications for inpatient treatment:
In the hospital, 300 ml of fresh frozen plasma containing the required amount of C1 inhibitor is injected by drip. But in some situations, its use aggravates Quincke's syndrome.
Directions for treating edema:
- Exclusion of all allergens from the patient’s life (berries, fruits, vegetables, Pentalgin, Baralgin, Citramon, Indomethacin and Paracetamol).
- Drug therapy. Doctor prescribes antihistamines and corticosteroids. Sometimes treatment is supplemented with enzyme agents such as Festal.
Changing lifestyle and living conditions. Persons who have suffered from Quincke syndrome need to give up nicotine, alcohol abuse, and are also advised to avoid stress, overheating and hypothermia. Residential premises must be regularly cleaned and washed bed sheets at temperatures from 60 degrees.
If a person experiences a repeated episode of Quincke's edema, he needs to keep a syringe with adrenaline solution in his pocket. Timely and adequate treatment will save the patient’s life.
Prevention measures
If swelling is caused by allergens, it is necessary to exclude any contact with them and maintain a diet. Patients who have a family history of angioedema should use Captopril and Enalapril, as well as Valsartan and Eprosartan, with special care. The drugs can be easily replaced with drugs from another group.
Persons with hereditary edema should avoid injury and surgical interventions. To prevent angioedema associated with the reduction of C1 inhibitors, drugs containing androgens are chosen.
Persons sensitive to insect bites should use protective equipment. Parents whose children are prone to allergies need to limit contact with insects and also keep the apartment clean. It is important to regularly ventilate the room, carry out wet cleaning and ensure an optimal level of cleanliness.
The outcome of the disease depends on the severity of symptoms and the timeliness of treatment procedures. Laryngeal edema in the absence emergency assistance may result in the death of the patient. Recurrent urticaria accompanied by swelling for 5 months or more can last up to 12 years. Half of the patients experience long-term remission without concomitant treatment.
Genetically located angioedema recurs for decades. Precisely chosen therapy avoids complications and normalizes the patient’s quality of life. The outcome of the disease is favorable in most cases, because manifestations are limited to external changes in soft tissue. Angioedema can be controlled. Relapse occurs at any time, so the cause of the manifestation must be established immediately. At the first signs, medical help is required.
Content
An allergic reaction such as Quincke's edema is characterized by rapid development. The first symptoms of the disease appear just a few minutes after human cells come into contact with the antigen. Delayed treatment of the syndrome can lead to serious consequences, to avoid which you should read the following material.
What is Quincke's edema
The impact of certain chemical and biological factors on the body can trigger the development of allergies. In this case, Quincke's edema, or angioedema, is considered the most dangerous manifestation of the immune response. The reason for this is the high risk of damage to the brain and larynx. Experts, answering the question, Quincke's edema - what it is, as a rule, try to give a comprehensive answer. As a result, the patient receives very voluminous information with a great variety of complex medical terms. Meanwhile with more simple explanation The reader can familiarize himself with this phenomenon further.
Thus, Quincke syndrome occurs due to contact of a sensitized (sensitive) organism with an allergen. In this case, edema develops due to increased vascular permeability, which is accompanied by the release of a large amount of fluid into the intercellular space. Actually, this is the reason for the increase different parts the patient's body.
The first symptoms of Quincke's edema
Signs of an imminent allergy are considered to be swelling of the mucous epithelium and tingling in any part of the body. At the same time, touching on the topic “Angioedema - symptoms,” experts stipulate that each type of this disease is characterized by some special features. Given this fact, doctors, in addition to the allergic nature of the disease, also distinguish between hereditary and acquired reactions to biological or chemical factors. Depending on whether a person has a certain type of disease, signs of angioedema may be as follows:
|
Clinical picture (diagnostic options) |
Type of edema |
|
|
Allergic |
Hereditary/Acquired |
|
|
Onset of reaction and its duration |
Develops in 5-20 minutes. It goes away in a few days. |
Occurs within 2-3 hours. Disappears in a few days. |
|
Localization |
For the most part, swelling affects the area of the neck, face, limbs, and genitals. |
Develops in any part of the body. |
|
Characteristics of edema |
Pale or slightly red dense swelling that does not form a pit after pressure. |
Pale tense swelling, after pressing on which there is no pit left. |
|
Peculiarities |
Accompanied by urticaria and itching. |
Not accompanied by urticaria. |
Symptoms and treatment in children
Today, the number of young patients hospitalized due to severe allergic reactions significantly exceeds the number of adult patients. This fact due to poor environmental conditions and modern views parents who advocate early weaning of the child from the breast, the use of all kinds of chemical-based baby hygiene products.
Quincke's edema in children, as a rule, is manifested by swelling of the face, lips, genitals, feet and is not accompanied by urticaria. The most dangerous consequence Allergy is the spread of the syndrome to the larynx area. At the same time, the child has difficulty speaking and has a sore throat. Subsequent rapid progression of edema can lead to the most severe conditions requiring emergency medical care. Less serious manifestations of the disease can be treated at home by using antihistamines in the form of injections or tablets.
In adults
Character clinical manifestations The disease does not depend on the age of the person suffering from allergies. Adult patients experience symptoms completely identical to the symptoms of the disease in children. Meanwhile, it should be noted that in each specific medical history, the syndrome develops due to various reasons, which are identified through laboratory research. In addition, developing the theme “ Allergic edema Quincke’s symptoms in adults”, it is important to say that the capable part of the population often experiences symptoms of abdominal syndrome:
- uncontrollable vomiting;
- sharp pain in the abdomen;
- diarrhea.
Treatment of Quincke's edema in adults is somewhat different from therapeutic measures, used in the development of the disease in children. The difference lies in the use of medications with greater frequency and dosage. In a situation where the swelling progresses, you should call an ambulance. Before the specialists arrive, you need to inject the person with Prednisolone or Dexamethasone and put an antihistamine under his tongue.
How to treat Quincke's edema
From a medical point of view, it is somewhat absurd to believe that this disease can be dealt with without the intervention of specialists. However, the frequency of the search query “Treatment, angioedema” proves the opposite. The population relies more on their own brains than on doctors. As a result, it must be said that in severe cases of allergies (when the throat swells), it is vitally important for a person to receive medical care in a timely manner. Ignoring this fact is fraught with serious consequences. In general, therapy for angioedema may be accompanied by:
- The use of medications in the form of antihistamines, hormonal drugs, diuretics, vitamins.
- Using folk remedies;
- Surgical intervention - tracheostomy.
First aid for Quincke's edema
As a rule, allergy sufferers have a clear idea of how to relieve the syndrome. Self-help or mutual assistance for Quincke's edema is to take antihistamines. If there is progress in the pathology, the patient must be taken to the nearest medical facility from home. In addition, in medical reference books there are entire sections devoted to the topic “Quincke’s edema - emergency care.” However, do this complex algorithm Actions can only be taken by ambulance or hospital staff. You can find out what other actions you should take before the doctors arrive:
- Interrupt contact with the allergen.
- Free the patient's chest and neck from constricting clothing and jewelry.
- In the absence of antihistamines, you need to pour 2-3 drops of Naphthyzin into the mouth of an adult or child.
- Perform artificial respiration on the patient if he has lost consciousness.
Treatment at home
In a situation where the allergy has affected a small area of the body remote from the head, you can try to relieve the syndrome in your own home. Experts, answering the question of how to relieve angioedema at home, advise patients to take a warm bath with kelp infusion at the first manifestations of the disease. Due to the beneficial effects of this algae on skin receptors, swelling disappears within a couple of hours. At the same time, in order to prevent exacerbation of the pathology, patients are recommended to adhere to a special diet that excludes the main allergens from the diet.
Folk remedies
The experience of the older generation has more than once helped to cope with the most severe illnesses. Traditional medicines in the section “Quincke's edema, help” contain a large number of recipes with which you can quickly stop the syndrome. However, before using any product, it is imperative to check its components for allergenicity. Among the most effective traditional methods elimination of Quincke's edema can be distinguished:
- Milk with soda. A well-known remedy for sore throat can also be used to relieve allergy symptoms. Add ¼ tsp to a glass of warm milk. soda Drink healthy drink recommended throughout the day. Continue treatment until the swelling subsides and the patient looks better.
- Nettle infusion. 100 grams of dry herb should be poured with a glass of boiling water and left under the lid in a dark place for 2 hours. The finished product must be filtered. The infusion should be consumed ½ glass three times a day until the swelling completely disappears.
Video
Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.
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Quincke's edema - symptoms and treatment at home
Quincke's edema- 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 a rare disease that develops 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.
The state of the immune system and the mechanism of development of Quincke's edema
To understand the cause and mechanism of hereditary angioedema, it is necessary to disassemble one of the components 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
Mechanism of edema formation
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.
Causes of Quincke's edema
The main factors provoking the manifestation of hereditary angioedema:- Stress emotional and physical
- Infectious diseases
- Injury
- Surgical interventions, including dental procedures
- Menstrual cycle
- Pregnancy
- Taking contraceptives containing estrogens
- Non-Hodgkin's lymphoma
- Primary cryoglobulinemia
- Lymphocytic lymphoma
- Waldenström's macroglobulinemia
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 see Causes of Anaphylaxis
Types of Quincke's edema
| View | Development mechanism and characteristics | External manifestations |
| Hereditary angioedema | Recurrent swelling in any part of the body no urticaria; cases of Quincke's edema in the family; onset in childhood; worsening of the condition during puberty. |  |
| Acquired angioedema | It develops in middle-aged people and also manifests itself without urticaria. There are no reported cases of Quincke's edema in the family. |  |
| Quincke's edema associated with taking ACE inhibitors | It occurs in any part of the body, most often in the face, and is not accompanied by urticaria. Develops for the first time after 3 months of treatment with ACE inhibitors. |  |
| Allergic angioedema | Often develops simultaneously with urticaria and is accompanied by itching, often as a component of an anaphylactic reaction. The onset is caused by contact with an allergen. The duration of edema is on average 24-48 hours. |  |
| Quincke's edema without found causes (idiopathic) | Over the course of 1 year, there were 3 episodes of angioedema without an identified cause. It develops more often in women. Urticaria occurs in 50% of cases. |  |
Symptoms of Quincke's edema, photo
Precursors of Quincke's edemaPrecursors 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 | |||
| 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
| Swelling site | Symptoms | External manifestations |
| Swelling of the larynx and tongue. | The most dangerous complication Quincke's edema. Symptoms: difficulty swallowing, tickling, cough, increasing hoarseness, difficulty breathing, respiratory failure. |  |
| Swelling in the lung area | Fluid effusion into the pleural cavity: cough, chest pain. |  |
| Swelling of the intestinal wall | Abdominal pain, vomiting, diarrhea. |  |
| Edema urinary tract | Urinary retention |  |
| Edema of the meninges | Headache, possible convulsions, impaired consciousness. |  |
First emergency aid for Quincke's edema
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.
- 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 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
Where to inject adrenaline?
Usually on prehospital stage the drug is administered intramuscularly. The best place to inject adrenaline, this 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, 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 and the Allerjet audio instruction device. 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
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 hit medicine it immediately spreads into the sublingual veins, 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.
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
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.
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.
What to do if there is swelling of the larynx?
In case of laryngeal edema, complete closure of the airways is possible, in which drug treatment is 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?Treatment in hospital
In which department are they treated?
Depending on the severity and nature of the edema, the patient is sent to the appropriate department. For example, a patient will be sent to the intensive care unit in case of 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, do not life-threatening, the patient is being treated in an allergy department or a regular therapeutic department.
What is the treatment?
For allergic Quincke's edema As part of the 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.). In the case of a food allergen, enterosorbents are used ( Activated carbon, enterosgel, white coal and etc.). It is also carried out symptomatic therapy depending on the symptoms that arise, namely in case of difficulty breathing, medications that relieve bronchial spasms 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.
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.
Prevention of Quincke's edema
- In the case of an allergic cause of swelling, first of all you should eliminate contact with the allergen and follow a hypoallergenic diet.
- Persons with a family history of angioedema should take ACE inhibitors (captopril, enalapril), as well as angiotensin II receptor antagonists (valsartan, eprosartan) with caution. If episodes of angioedema occur due to the use of these medications, they should be replaced with drugs from another group.
- Persons with hereditary angioedema should, if possible, avoid surgical interventions and injuries.
- To prevent episodes of angioedema associated with a decrease in C1 inhibitor, the drugs of choice are synthetic male hormones (androgens), danazol and stanazolol. These drugs stimulate the production of C1 inhibitor. At the beginning, the dose is 800 mg per day, then when the effect is achieved, the dose is reduced to 200 mg per day, until minimum dose in one day. The drugs are contraindicated for: pregnant women, nursing mothers, children, patients with prostate cancer.
- In children, instead of using male hormones for prevention, aminocaproic and tranexamic acids are used, which have a higher safety profile.
- Before surgical interventions, short-term prophylaxis should be carried out. Drugs of choice: fresh frozen plasma, androgens, and of course C1 inhibitor concentrate (if possible).
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 skin layers, mucous tissues, and 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.), which occurs as a result of the 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, which consists of a collection of protein structures, is an important component of the immune system that 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;
- taking any medications.
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 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 that should be 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 respiratory tract or there is a suspicion that the pathology is localized in internal organs. Before paramedics arrive, first aid measures must be taken.
Quincke's edema - first aid
Emergency care for Quincke's edema, which can be provided before arrival ambulance, 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.
- Security drink 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;
- swelling of 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 medications:
- Z-aminocaproic acid;
- Contrikal.
Outside the 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).
Content
One of the most severe manifestations of an allergic reaction is Quincke's edema. This condition was first described by the doctor Heinrich Quincke, and this pathology is named after him. Another medical name for this disease is angioedema. The disease occurs in only 2% of people who are susceptible to allergic reactions. The disease develops rapidly and requires urgent medical intervention. Due to reasons that are not fully understood, it occurs more often in women or children.
What is Quincke's edema
Angioedema of this type is characterized by local swelling of the skin, damage to the mucous membranes, subcutaneous tissue of a pseudo-allergic or allergic nature. As a rule, a reaction occurs on the cheeks, lips, eyelids, tongue, neck; much less often it can appear on the mucous membranes, for example, the genitourinary organs, gastrointestinal tract, respiratory tract. In the latter case, air flow may be impaired, which poses a risk of asphyxia.
Symptoms
Quincke's disease has a distinct pronounced signs, they can persist from several minutes to several hours, in rare cases they do not pass for a day. Usually, all manifestations disappear without a trace, but in the chronic form of the pathology relapses occur. The main symptoms of Quincke's edema:
- It develops very quickly and suddenly, within 5-20 minutes (in rare cases 1-2 hours).
- Serious swelling of the subcutaneous tissue, mucous membranes to a dense, painless swelling occurs; it occurs on the cheeks, nose, tongue, lips, eyelids, mucous membranes of the mouth, tracheobronchial tract, larynx, inner ear, and sometimes affects the meninges, stomach, genitals, and intestines.
- One of characteristic features Quincke - absence of pain, unpleasant sensations appear only upon palpation; there is a feeling of fullness, tissue tension, and density.
- The typical location of swelling is on the upper body (face). Swelling of the larynx and trachea will be extremely dangerous for human life. This condition is a medical emergency.
- In 20% of cases of Quincke syndrome, the pathology is not accompanied by itchy skin, but half of the patients experience urticaria, which is characterized by burning and blisters.
- A general allergic reaction causes nasal congestion, lacrimation, itching of the conjunctiva, sneezing, fever, weakness, and headache.
Causes of Quincke's edema
To avoid a life-threatening condition, you need to know what causes allergic swelling. This may vary from person to person, but the most common risk factors include the following:
Classification
In medicine, Quincke syndrome, taking into account associated and main factors, is usually classified according to the following algorithm:
- acute edema – symptoms persist for up to 45 days;
- chronic – symptoms will last longer than 6 weeks with periodic relapses;
- acquired - during the entire period of observation, this type was recorded only 50 times in people over 50 years of age;
- hereditary angioedema – 1 case per 150 thousand patients is recorded;
- swelling along with symptoms of urticaria;
- isolated – without additional conditions.
Doctors always focus on two types of dangerous edema with similar external manifestations:
- angioedema;
- hereditary (non-allergic).
With the same symptoms of the disease, completely different factors become the cause of development. This situation often leads to an incorrect diagnosis, which is fraught with serious complications and the use of an incorrect regimen. emergency care, further therapy. It is very important at the stage of providing assistance to determine which type of pathology has developed in the patient.
Complications
If help is not provided to a person in time, Quincke syndrome can develop and cause serious complications. Here are the main consequences that can be caused by this pathology:
- The most threatening complication may be swelling of the larynx; signs of acute respiratory failure will gradually increase. Symptoms of this complication will be barking cough, hoarseness of voice, progression of breathing difficulties.
- Swelling of the gastrointestinal mucosa can cause acute abdominal pathology. Developing sharp pain in the abdomen, dyspeptic disorders, increased peristalsis, in rare cases, symptoms of peritonitis.
- Swelling of the urogenital system may be accompanied by signs of acute cystitis, which causes urinary retention.
- Dangerous complications can be caused by Quincke syndrome, which is localized on the face. The meninges may be involved in the process, and symptoms of meningeal diseases or labyrinthine systems may appear (manifested by signs of Meniere's syndrome). This swelling can be fatal without immediate medical attention.
- Acute urticaria may be combined with Quincke's reaction.
Diagnostics
After overcoming the crisis and eliminating the threat to life, the following laboratory tests may be prescribed:
- Measuring the amount of total immunoglobulin (IgE), which reacts with the allergen and provokes the development of allergic symptoms immediate type. An ICLA (immunochemiluminescent) study is carried out; the results show that the IgE value should normally be in the range of 1.31-165.3 IU/ml.
- Tests to detect specific IgE, which help determine the root cause (allergens) that provoke immediate swelling. The effectiveness of allergy prevention and treatment depends on the result of this technique.
- Determination of disorders in the complement system, analysis of function for the control and diagnosis of autoimmune diseases.
After recovery, several months later, when antibodies that respond to the allergen are present in the body, the following studies are carried out:
- Skin allergy tests. A classic method in which the suspected allergen is applied to the surface of the skin. If a person is sensitive to this reagent, the skin will show mild inflammation around the site where the agent is applied.
- Immunogram analysis or study of the immune system.
- Search for systemic diseases, which often cause Quincke syndrome.
- If there was pseudo-allergic edema, then it is necessary to examine the entire body, perform a wide range of tests (biochemical, bacteriological), do an ultrasound, and an x-ray of the organs.
Treatment of Quincke's edema
If a patient experiences swelling of the larynx, trachea or throat, he is immediately sent to a hospital for treatment. Treatment measures are carried out in two stages:
- elimination of an allergic reaction;
- eliminating symptoms, determining causes, prescribing treatment.
Emergency assistance during acute period in the hospital is aimed at eliminating threatening symptoms, ensuring normal operation vital signs, if observed state of shock. Doctors must reduce the body's reaction to the allergen. If the described symptoms appear, you should definitely call an ambulance. The main measures that can be taken for Quincke therapy:
- To prevent symptoms of suffocation and a dangerous drop in pressure, Epinephrine (Adrenaline) is administered intravenously, subcutaneously or intramuscularly in dosages according to the patient’s age. There should be a gap of at least 20 minutes between injections.
- You can relieve swelling by injecting hormones in an age-appropriate dose according to the instructions (Dexamethasone, Prednisolone).
- Intravenous administration of drugs against shock, to remove toxins from the body (Hemodez, Reopoliglyukin, 5% glucose solution).
- Intramuscular, intravenous administration of antihistamines (Diphenhydramine, Suprastin).
- To increase dangerously low blood pressure and restore blood volume, colloidal and saline solutions are infused through a dropper.
- The patient is given diuretic medications (Mannitol solution, Lasix, Furosemide), which remove allergens and excess fluid from the body, and reduce swelling. Can be prescribed for high and normal blood pressure.
- If bronchospasm is observed, then Dexamethasone with Eufillin is given intravenously.
- Mask with pure oxygen is indicated if there is a pronounced deficiency in the blood, shallow, difficult breathing, wheezing, blue discoloration of the mucous membranes and skin.
- Hemosorption is a method of actively removing allergens and toxins from the blood, which is passed through absorbent sorbents.
First aid for Quincke's edema
Allergic and idiopathic edema must be treated using different methods, but a person will not be able to independently determine the type of pathology. For this reason, you need to start therapy with medications that are effective in both forms of the disease (antihistamines, adrenaline, glucocorticoids). You must immediately call an ambulance and try to stop the spread of swelling. Emergency care for angioedema, which can be provided before the doctor arrives:
- clear the airways;
- check for breathing;
- measure blood pressure, pulse;
- if necessary, perform cardiopulmonary resuscitation (artificial respiration);
- administer the medications described above.
Tablets
This pathology must be treated with medications that can block H1 receptors. These include the following drugs:
- Lortadine;
- Suprastin;
- Citrisine.
To maximize the antihistamine effect of drugs, a complex of drugs is additionally prescribed to block H1 and H2. This group of medications includes:
- Ranitidine;
- Famotidine.
There are several forms of medications for treating angioedema; for maximum effect, intravenous solutions are usually prescribed. This is the fastest way to influence the allergen in the human body. If the cause of the swelling is known, e.g. chronic illness, or it does not threaten human life, then tablet forms can be used. Their main difference is that the effect occurs a little later.
This is a powerful synthetic glucocortecosteroid, which contains adrenal hormones and their synthetic analogues. This medication is prescribed for control metabolic processes(carbohydrates, proteins, minerals). If there is a need to treat Quincke's reaction with Dexamethasone, the dosage should be selected correctly. This is done by a doctor individually, the patient’s condition and sensitivity to medications are taken into account. The instructions for the drug indicate the following options for taking the drug:
- A small dose of 2-6 mg is taken in the morning;
- a large dose of 10-15 mg is taken 2-3 times per day;
- after reaching required result the dosage is reduced to 0.5-4.5 mg per day;
- exit from the course of treatment is carried out smoothly;
- if a child and not an adult is undergoing treatment, then the dose is calculated based on 0.083-0.33 mg of medication per 1 kg of weight.
Diet
Food allergens very often cause Quincke's reaction, so the diet must be selected very carefully. There are certain foods that are more likely to cause illness than others:
- strawberries;
- fish;
- eggs;
- seafood;
- citrus;
- strawberry;
- nuts.
If food has become the cause of the pathology, then doctors sharply limit the diet, but such a diet cannot be maintained for a long time. The body must receive the full range of necessary substances, so fasting should not be prolonged. Products are introduced smoothly, usually from one type, for example:
- The patient begins to consume semi-liquid mashed potatoes without adding oil. The serving is 100 g on an empty stomach, then 200 g 4 times a day.
- When the body adapts to the need to fully digest food, other products are added to the potatoes in the same way. It is important that the dishes do not contain any additives (exclude butter, milk, fruits, vegetables).
- Before introducing each product, a “provocation” is first carried out: on an empty stomach you need to eat 100 g of this dish.
There is a conventional order in which hypoallergenic products should be introduced. The plan for including additional dishes depends on the patient's dietary characteristics (identified dangerous foods). The following sequence is considered the most rational:
- potato;
- carrot;
- dairy products;
- bread (preferably stale);
- cereals;
- beef;
- fish;
- poultry meat;
- eggs.
Consequences
When an acute condition passes after the development of pathology, a person may experience dyspepsia and abdominal pain for several days. If the urogenital system is affected, then there is acute urinary retention and symptoms of cystitis appear. The worst consequence of Quincke syndrome is death due to acute respiratory failure. With meningeal signs of pathology, the following are often noted:
- vomit;
- nausea;
- dizziness.
Prognosis and prevention
The outcome of Quincke's pathology will depend on the degree of edema and the timeliness of emergency care. For example, in case of an allergic reaction in the larynx, in the absence of prompt therapeutic action, the outcome can be fatal. If the disease is recurrent and accompanied by urticaria for six months, then in 40% of patients the pathology will be observed for another 10 years, and in 50% a long-term remission occurs even without preventive treatment. The hereditary type of angioedema will recur throughout life.
Correctly selected preventive and supportive treatment will help to avoid relapse, which significantly reduces the likelihood of developing pathology or complications. Measures to prevent Quincke's reaction depend on the type of pathology:
- If there is a history of allergic genesis, then it is important to follow a diet and exclude potentially dangerous medications.
- If it is possible to recognize hereditary angioedema, then one should avoid viral infections, injuries, taking ACE inhibitors, stressful situations, estrogen-containing medications.
Photo of angioedema
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