Most people do not consider the development of allergies a life-threatening phenomenon. Usually it is, but in some cases a dangerous condition arises that provokes angioedema ( Quincke's edema). Pathology manifests itself in the form of an increase in the face or limbs as a result of edema of the deep layers of the skin and subcutaneous tissues. This reaction is allergic in nature, it can be triggered by the use of medicines, food allergens, pollen, animal waste products or insect bites. This pathology is characterized by an abnormal response of the body to certain stimuli.
Characterization and description of the pathology
Angioneurotic edema - localized edema of the subcutaneous tissue as a result of increased vascular permeability and the outflow of fluid from them. This phenomenon is often accompanied by the development of urticaria and itching on the surface layer of the skin. In some cases, the mechanism for the development of pathology remains unknown.
Most often, Quincke's edema develops due to a pathological reaction of the immune system to an irritant that comes from the external environment. As a result, the body begins to produce histamines and prostaglandins - substances that are responsible for the reaction to the inflammatory process. They help increase vascular permeability, from which lymph is poured into the surrounding tissue, angioedema occurs (ICD 10 - T78.3). This phenomenon was known back in the 19th century, when the German physiologist G. Quincke described similar phenomena in his patients, and also developed effective methods for their treatment.
Quincke's edema can be observed on the internal organs, but most often it manifests itself on the neck, arms and face. The most dangerous localization of angioedema is the respiratory system and the lining of the brain, their damage can cause circulatory disorders and suffocation. Without assistance, death occurs.
This phenomenon occurs only in 2% of cases of all possible allergic reactions. According to statistics, every tenth person in the world has faced a similar problem in some form of its manifestation.
The rate of development of an allergic reaction may be different. In some cases, edema develops in a few minutes, and sometimes it appears gradually over one or several days, depending on the amount of allergen and the duration of its effect on the body. The duration of the unpleasant state can also be different, in some cases the pathology can persist for more than six weeks (chronic form).
Edema in children
Angioedema in children and women is most often diagnosed. Also prone to such a reaction are people who are predisposed to allergies. In some cases, pathology can occur in healthy people of any age.
Children can suffer from Quincke edema from the first days of life. Pathology in this case can develop if they are fed with artificial mixtures, cow's milk, as well as with the use of medications.
In newborns, the disease is severe and often causes death. Often diagnosed with swelling of the stomach and meninges. Often, Quincke's edema in children is accompanied by bronchial asthma.
If pallor appears on the skin of the child, the nasolabial part of the face turns blue, the heart palpitations, breathing difficulties increase, a doctor should be called immediately, as this may indicate laryngeal edema. Over time, cyanosis will spread to other areas of the skin, suffocation will appear, the child will lose consciousness.
Varieties of pathology
Allergic angioedema can be of several forms:
- Acute edema occurs as a result of the formation of an acute allergic reaction to an allergen. It is accompanied by the development of urticaria. Often this reaction occurs on opiates, a contrast agent used in radiography, NSAIDs and aspirin, as well as ACE inhibitors. In this case, the face, upper respiratory tract and intestines are affected. The disease may appear several years after the start of treatment with the above drugs.
- Chronic form in which edema is observed for more than six weeks. The reason for this phenomenon is not known to medicine. Presumably, allergies can be caused by medications that a person constantly takes, food additives and preservatives.
- The idiopathic form develops without urticaria. In this case, the period of exacerbation and regression alternate. The reasons for the development of such a pathology are unknown.
- Hereditary angioedema develops due to a deficiency of the C1 inhibitor. The development of edema depends on stress and microtrauma. Most often, pathology develops in men and can be inherited. Usually, with this form of edema, the larynx suffers.
Reasons for the development of edema
Many people know how angioedema is manifested. But not everyone knows the reasons for its appearance. This phenomenon occurs in response to the effects of allergens on the human body. As allergens can be toxins, cosmetics, insect poisons, medicines, animal hair and more.
In some cases, Quincke's edema can occur as a pseudo-allergic reaction, which appears due to the high sensitivity to certain drugs and food products. Also, a problem may appear as a complication of treatment with ACE inhibitors. This is usually observed in people of advanced age, in whom drugs slow down the destruction of bradykinin in the body, which provokes the expansion of blood vessels and an increase in the permeability of their walls.
Hereditary angioedema develops due to a lack of an inhibitor C1, which regulates the activity of proteins responsible for blood coagulation, control of inflammatory processes and blood pressure, as well as pain. Its deficiency is due to gene disorders or the acceleration of its expenditure. This phenomenon can be triggered by infectious and autoimmune diseases, cancerous tumors. Sometimes edema can occur as a result of hypothermia or severe stress.
Indirect causes of the development of pathology include some diseases of internal organs, helminthic diseases and endocrine system disorders.
Symptoms and signs of the disease
Symptoms of angioedema are manifested in the form of swelling and swelling of the face (eyelids, cheeks, lips), the mucous membrane of the mouth, genitals. Sometimes the face swells so much that it becomes like a balloon, while a person can not even open his eyes. Hands, especially fingers, feet, and chest, may also swell. In this situation, itching is absent, the color of the skin does not change. Usually in mild cases, edema disappears within three days, but sometimes it spreads to the larynx, causing difficulty breathing. In this case, a person develops cough, hoarseness, pallor of the skin of the face, speech impairment appears. In severe cases, airway obstruction, hypercapnic coma, and then death develop. Also in this case, there is pain in the abdomen, vomiting, redness or blue skin, bleeding on the mucous membranes. Such signs of allergy are diagnosed in 1/4 of the patients. Quincke's edema is distinguished from ordinary urticaria by the depth of the skin lesion. Sometimes this swelling is called a giant urticaria.
Symptoms of angioedema can occur in the form of lowering blood pressure, tachycardia, sweating, confusion, impaired coordination of movements, the development of fear of death, panic.
With gastrointestinal edema, the symptoms will resemble signs of an upset stomach: nausea, which is accompanied by vomiting, pain in the abdomen, diarrhea. This phenomenon is no less dangerous, since it can cause the development of peritonitis.
With swelling of the meninges, the symptoms of pathology will resemble meningitis. In this case, headaches, photophobia, numbness of the neck muscles, cramps, hearing and vision impairment, and paralysis appear.
Angioedema of the joints does not pose a threat to human life. In this case, the synovial part of the joints is affected, which provokes a violation of mobility and the development of pain. In 50% of cases, swelling is accompanied by the development of urticaria. A person develops itching, blisters of various sizes, conjunctivitis and lacrimation.
First aid
Since this pathology can be life-threatening, the victim should be assisted with angioedema. To do this, eliminate the person’s contact with the allergen, if known, call an ambulance team. When injecting a drug or insect bite above the injection site or bite, a dressing is applied tightly or a cold is applied to slow the spread of the allergen throughout the body as a result of vasoconstriction. Then, a person is unfastened his clothes, thereby ensuring an influx of fresh air, soothe him, give activated carbon, which is previously dissolved in water, or an antihistamine drug. It is best if the antihistamine is given as an injection. Without fail, the victim must be given alkaline drink. For this, one gram of soda is dissolved in one liter of water.
In the absence of antihistamines, local vasoconstrictors, such as Otrivin or Nozivin, can help. One of these drugs in the amount of a few drops is instilled into the larynx and nasopharynx.
Survey methods
Diagnosis of angioneurotic edema begins with a history and examination of the patient, his survey. Usually, in the absence of urticaria, the doctor will clarify the possibility of using ACE inhibitors. In the presence of Quincke's edema in the face and neck, diagnostic methods are rarely used, since the diagnosis can be made on the basis of a visual examination of a person. In the case of a chronic course of pathology, doctors study the patient’s diet and the medications that he takes. In the presence of similar manifestations in other family members, the doctor prescribes a study of C1 inhibitors to determine the form of the pathology.
It is difficult to diagnose angioedema of the brain and gastrointestinal tract, as the symptoms indicate a violation of blood circulation in the brain. In this case, laboratory blood tests are performed. With Quincke's edema, the results of the analysis will show an increase in the concentration of immunoglobulins and eosinophilia. With non-allergic edema, signs of autoimmune diseases will be detected.
The doctor also differentiates the pathology from dermatomyositis, hypothyroidism, protoporphyria, kidney disease and superior vena cava compression syndrome.
Pathology therapy
Angioneurotic edema treatment involves one that aims to restore breathing, eliminate the allergen, and stop the edema. It is very important in this case to determine the cause of the development of pathology, to identify the allergen. In severe and moderate cases, the injured person is hospitalized. He is prescribed antihistamines and glucocorticosteroids, enterosorbents, and infusion therapy is also indicated. With a hereditary form of pathology, an C1 inhibitor is administered. If there is no such drug, do a plasma transfusion. The patient is prescribed androgens and antifibrinolytic drugs. With swelling of the neck, hormones and diuretics are administered intravenously.
Drug treatment
Angioneurotic edema drugs suggest the use of the following:
- Adrenaline solution to increase blood pressure and eliminate asphyxiation.
- Hormone medications, such as Prednisolone.
- Antihistamines, for example, Suprastin or Zirtek.
- Diuretic drugs ("Lasik" or saline).
- C1 inhibitors, in particular, "Contrical".
- Sorbents.
The main objective of therapy is the protection of the respiratory tract, so treatment is aimed primarily at eliminating their edema. Most often, in this case, they resort to endotracheal intubation of the trachea. Adrenaline is used to prevent the development of suffocation. The final stage of therapy is the appointment of symptomatic medications.
Forecast
With timely assistance, the disease has charitable forecasts. In severe cases, anaphylactic shock, choking, and death may occur. There are no guarantees that Quincke's edema will not appear in the absence of a predisposition to allergies. The human immune system can be rebuilt over time, for example, after diseases of an infectious nature. Sometimes edema may appear not after the first contact with an allergen, but in one of the following, when a person is not ready for such an event.
Prevention
It is almost impossible to avoid contact with allergens in the modern world, but you can reduce the number of meetings with them, which is recommended. Doctors recommend that people at risk do not try new foods, especially of exotic origin. When prescribing medications by a doctor, it is necessary to check them for allergens, and insect bites should also be avoided.
With a tendency to allergic reactions, doctors recommend that you always have antihistamines on hand, as well as recognize the symptoms of Quincke edema in order to prevent the development of dangerous complications in a timely manner. Also, each person should know how to provide first aid for the development of edema, since human life may depend on this knowledge.
In order to prevent repeated angioedema, it is recommended to adhere to a special diet, not to use medications without a doctor's prescription. With the hereditary form of the disease, a person needs to avoid stressful situations and emotional stress, as well as viral infections and injuries. Such patients should not take medications that contain estrogen. When conducting planned operations in such people, they are first prescribed preventive therapy using a blood transfusion.