How to treat Quincke's edema: an emergency care algorithm and drugs

For most of us, allergic reactions are an unpleasant, but not dangerous, phenomenon for life and health. However, such a statement would be erroneous in relation to Quincke's edema. What is hiding under this name, we suggest you find out further. Consider also the causes of this reaction, first aid and treatment directions.

What is it?

What is Quincke edema? This is a pathological, disproportionate reaction of the immune system to some kind of external stimulus. As a result of this, the body produces histamines and prostaglandins - specific substances that are responsible for the immune response to inflammation. In particular, they help increase the permeability of small vessels (capillaries). Lymph from them begins to flow into the surrounding tissue.

How does Quincke edema begin? Accordingly, with the passage of lymph into the tissues of the organs surrounding the vessels. Such an incorrect reaction of the body to an irritant was known to medicine many centuries ago. But it was not so long ago scientifically studied. The name of the reaction was given by the name of the German physiologist Heinrich Quincke, who described similar pathological cases from observations of his patients in the late 19th century. It was he who developed the first effective methods of treating such a condition.

Invalid names

You can read about Quincke's edema in the ICD 10 - the International Classifier of Diseases. In addition to the correct, scientific, incorrect descriptions of this condition are still used:

1. Angioneurotic edema. Not entirely accurate description. The fact is that it was previously believed that such edema is caused by dysfunction of the nerves that control the narrowing and expansion of blood vessels.
2. Quincke tumor. Consonant, but incorrect. Such a name completely contradicts the description of Quincke edema in the ICD 10. This has no relation to real tissue tumors. They represent a pathological proliferation of cell tissue, and not swelling caused by excessive secretion of lymph.

Sometimes this swelling is called a giant urticaria. But this is also not the right name. Quincke's edema is still much more dangerous. And it has significant differences. In particular, the patient has completely no skin itching, which is so characteristic of hives. Another distinguishing feature is the absence of a rash (it happens not only with urticaria, but also with other allergic reactions).

If you press on the swollen area, it will continue to remain tight - it will not form a fossa. Skin color with such edema does not change, remains the same.

Reaction characteristic

What does Quincke's edema look like, you can find out by looking at the photos in this article. It affects many tissues, including internal organs. But still, most often it can be seen on the external (skin, mucous) tissues of the upper half of the body - the face and neck. He also “chooses” locations such as limbs and genitals.

But the most dangerous is the appearance of such reactions on the organs of the respiratory system and the meninges. Here, such complications of Quincke's edema as choking and disturbance of cerebral circulation become real. If the necessary medical attention is not provided on time, an allergic reaction can lead to death.

But do not think that Quincke's edema is a common form of allergy. According to statistics, these complex cases make up no more than 2% of the total mass of allergic reactions of the body. But such edema is not an example of an exotic disease. The chance to encounter him first hand is quite large. The same medical statistics show that every 10th person in the world has experienced Quincke's edema in a different form of severity.

Development

An allergic reaction to Quincke's edema occurs in patients of all ages. However, children and young women are at risk here. Of course, people who are generally prone to allergies are at greater risk of experiencing it. But Quincke's edema can develop in a person who does not belong to risk categories.

The average propagation rate of such a reaction cannot be called. In some cases, severe swelling may appear in a few minutes. And in other cases, it progresses over several hours or even several days. It depends on the type of allergen, and on the time of its exposure to the body.

The duration of the period during which edema does not descend can also be individual. In some cases, it does not pass within a week. If the term is more than 6 weeks, it makes sense to talk about chronic Quincke's edema.

A person is susceptible to such an allergic reaction, starting from the first days of his life. The causes of Quincke edema in infants are feeding with artificial mixtures, adding cow's milk to the diet, and taking a number of medications.

In the first months of life, the reaction is experienced by the body much harder than in the adult period of life. Therefore, most deaths, unfortunately, are observed among infants. More importantly, in young children, severe forms of edema affecting the gastric mucosa and meninges are more common. In some cases, this allergic reaction is combined with bronchial asthma.

Common causes

As with other types of allergic reactions, Quincke's edema begins, develop, as a response to allergens - various substances:

1. Elements of various food products: nuts, fruits, milk and egg whites, chocolate, fish products, honey, a number of food additives - dyes, preservatives, flavor enhancers and more.
2. Medicines, among which antibiotics, type B vitamins, bromides, anesthetics, aspirin, iodides, a group of antihypertensive drugs should be highlighted.
3. Toxins and poisons (especially insect poisons).
4. Animal hair.
5. Pollen of plants.
6. Household chemicals or industrial chemicals - turpentine, phenol, etc.
7. Dandruff, dust.
8. Various microorganisms - bacteria, fungi, viruses.

Of course, for each patient, the allergen is individual. It can be any substance that is absolutely safe for other people. The fastest and most severe allergic reactions develop, as a rule, in response to the actions of the poisons of insects and snakes.

There are indirect factors contributing to the development of severe Quincke edema. This is a number of diseases of internal organs, endocrine pathologies and helminthic invasions.

Do not forget that there is a risk category - people with a hereditary predisposition to an allergic reaction in the form of Quincke edema. They can develop it even without visible allergens. For example, with severe stress or in response to hypothermia.

Symptoms

Consider how Quincke's edema manifests itself. The reaction begins with the following:

1. Swelling and a significant increase in the size of the soft tissues of the face and neck. In some cases, the patient's face swelled so much that it looked like a ball or a balloon. Instead of eyes, there may be slots. In some cases, the patient is not at all able to open her eyes.
2. In some cases, the edema further passes to the hands, affects the areas of the fingers, feet, manifests itself on the chest. That is, it affects all layers of the skin, including mucous membranes and subcutaneous tissue.
3. In rare cases, it can affect the digestive tract and joints. A similar reaction is mainly observed if allergens enter the stomach with food or they (allergens) are drugs.
4. It should be noted and such signs as a decrease in pressure, increased work of sweat glands, tachycardia.
5. Consciousness may become confused, coordination may be disturbed. The patient may note causeless fear, anxiety and anxiety.

We note that in half the cases, Quincke's edema additionally accompany urticaria. It is expressed as follows:

1. Itchy skin.
2. Lacrimation.
3. Conjunctivitis.
4. The appearance of various sized blisters.

Anxiety symptoms

We also note specific cases of edema, when the patient urgently needs medical attention.

The fact that edema begins to develop in the upper respiratory tract (larynx, trachea, bronchi, mucous membranes of the nasopharynx and pharynx) is indicated by the following:

1. Strong sore throat.
2. The occurrence of a "barking" cough.
3. Difficulty breathing (especially when inhaling).
4. Speech problems.
5. The skin turns red first and then turns blue. There may even be slight bleeding due to capillaries bursting as a result of pressure.

If the edema passes to the tissues of the organs of the upper respiratory tract, then this is dangerous for the patient with death from asphyxiation. The development of Quincke's edema on the mucous membrane of the larynx is typical for 1/4 of the patients.

If the face has a gastrointestinal form of edema, then the difficulty is that it is simply confused with an upset digestive tract. The patient will complain about the following:

1. Acute pain in the epistragal zone.
2. Vomiting
3. Diarrhea.
4. Nausea.
5. Difficult urination.

These symptoms cannot be ignored, because only a qualified specialist can make a true diagnosis to the patient. If they are ignored, Quincke's edema can turn into peritonitis, which is dangerous for the probability of death.

Another disturbing form of edema affects the meninges. The main symptomatology here is quite similar to the signs of meningitis. The following is noted:

1. Fear of sound and light.
2. Severe headaches.
3. Numbness of the occipital muscles (a person cannot press his own chin to his chest).
4. Vomiting and nausea.
5. Visual and speech impairment.
6. Paralysis.

The joint form of edema is not life threatening. With her, he affects the synovial parts of the joints. This is expressed in a decrease in the mobility of the latter, a pain syndrome.

All parents need to know the manifestations of Quincke edema in young children: for kids, it is dangerous because the child is not yet able to explain what is happening to him. The following symptoms are considered alarming:

1. Blue nasolabial area.
2. The general pallor of the skin.
3. Labored breathing.
4. Heart palpitations.
5. The spread of cyanosis to other areas of the skin.
6. Increased sweating.
7. Choking accompanied by loss of consciousness.
8. Pulse reduction.
   

First aid

Each person needs to be familiar with the emergency care algorithm for Quincke's edema. Of course, the first thing you need to call an ambulance. If this is not possible, try to take the patient to the doctor yourself.

How to treat Quincke's edema? In addition, you can try to help a person yourself by following this instruction:

1. Reassure the patient. Do not try to lay him down - he should remain in a sitting position. Take a small child in your arms.
2. If you were able to identify the source of the allergy, then it is necessary to exclude even its slightest effect on the body of the victim. For example, stop taking the medication or food, leave a certain location.
3. If the swelling was caused by an animal bite, then be sure to remove (if any) its sting. To prevent the poison from spreading throughout the body, a tourniquet is applied to the injured limb (it can be kept for no more than 30 minutes). If this is not possible, a cold compress or ice is applied to the bite site. These same methods are good if edema began to develop in response to an injection.
4. To facilitate the patient’s breathing, free him from tight clothing, jewelry. Open the window or take the person to fresh air.
5. What else could be the clinical recommendations for Quincke's edema? If it was caused by the ingestion of food or drugs, then the patient urgently needs to take a sorbent (1 tablet per 10 kg of weight) - activated charcoal, Smecta, Enterosgel. Gastric lavage is prohibited - with swelling of the larynx, the patient may be choked with vomit.
6. Apply a large compress to large edema to help narrow the vessels.
7. Offer the patient an unlimited, plentiful drink - mineral water, a light soda solution.
   

Medical assistance

Antihistamines for Quincke's edema are the main treatment. The first generation drugs are considered the most effective. "Tavegil", "Diphenhydramine", "Suprastin" with Quincke's edema are extremely effective. Often enough one tablet to significantly alleviate the condition of the patient.

The drug blocks the effects of histamine on special vascular receptors. This counteracts the growth of edema, which makes the person's condition stabilize. To remove excess fluid from his body, diuretics are used. For the best effect, the tablet is placed for resorption under the tongue.

If antihistamines have helped the patient somewhat, this is not a reason to cancel the ambulance call! Especially in cases where it is not possible to independently identify an allergen.

How to treat Quincke's edema? If there are no antihistamines on hand, refer to the vasoconstrictor drugs used for the common cold - Otrivin, Nazivin, Rinonorm. Place a few drops in the nasopharynx and larynx. It is important to remember that many medications themselves can cause severe forms of Quincke edema.

Pills will be effective only if the patient does not have swelling of the esophagus or larynx. Otherwise, he simply will not be able to swallow the pill. Therefore, in some cases, the output is only in subcutaneous or intravenous administration of drugs. This help can be entrusted only to qualified doctors.

In particular, glucocorticosteroid agents may be used. The most popular are Dexamethasone and Prednisone from Quincke's edema. These hormones are able to "turn off" the reaction of the immune system to allergens. How to treat Quincke's edema with their help? As a rule, they are administered intravenously or subcutaneously. If this is not possible, the contents of the ampoule are poured out to the patient under the tongue.

If such assistance is not provided on time, procrastination can result in asphyxia and clinical death for the patient. In such cases, you need to turn to artificial respiration.

Inpatient treatment

Depending on the severity of the patient’s condition, the ambulance doctors either provide the necessary assistance on the spot or hospitalize him. Mandatory placement in a hospital is subject to patients with fixed laryngeal edema. The following persons will also be hospitalized:

1. People who first encountered Quincke's edema.
2. Children.
3. Patients with a severe form of an allergic reaction.
4. Patients with edema caused by medication.
5. Patients with severe pathologies of the respiratory and cardiovascular system.
6. Recently vaccinated citizens.
7. Patients who have recently had ARVI, stroke, heart attack.

If the patient's condition is stable, he is placed in the allergological department. In severe cases - in intensive care unit, intensive care unit. Antihistamines, diuretics, glucocorticosteroid drugs are administered to patients. Using sorbents, they purify the blood of allergens.

How to treat Quincke's edema? They use drugs that differ in the complex effect on the immune system in combination with a minimum of side effects. These are Ketotifen and Loratadin. For the treatment of infants, Fenistil is preferred.

How to protect yourself from Quincke's edema? Be careful about exotic foods, do not take medications (especially for subcutaneous, intravenous administration) without checking them for an allergic reaction of the body. This is especially true for people who are prone to allergies.

It is important to note that in your first-aid kit should always be on hand antihistamine medications that help relieve the condition with such edema. In addition, you should be aware of the rules of first aid for Quincke's edema. Especially if you have small children.