Update: October 2018
Today, angioedema is an acute condition of edema.
skin, mucous membranes, which reaches into the subcutaneous depth
Most often, swelling is located on the face, extending to
eye mucosa, oral cavity, pharynx and larynx. But known
cases of damage to the gastrointestinal tract, the meninges and
Edema develops fairly quickly and is an emergency.
conditions requiring immediate medical attention. Fortunately
this dangerous condition develops only in 2% of all allergic
Им могут страдать люди любого возраста, но чаще поражаются children
Previously, edema was often called angioneurotic, suggesting that
its main cause is the vascular response to excess nerve
impulses in irritable people with easily excitable nervous
by the system. Modern science does not support this position.
From the history
Signs of angioedema were observed by doctors as early as 16
century, before the German professor Quincke, in whose honor he was
named. For example, the Italian Marcello Donato noted this condition
back in 1586, but, alas, it was not he who got the laurels.
This story began in the Prussian province of Schleswig-Holstein in
Or rather, in the small town of Kiel, where the Baltic Sea reaches
the very heart of the city, and where the main element is water. it
it happened in June, when the Kiel Bay first saw
the sea regatta, and the Baltic wind pulled the sails of twenty tight
Frau Weber is about to die. In the morning she was still quite
healthy and even profitably bargained a pair of herrings at the fish market.
But then she managed to drink a cup of chocolate, a new brand of which
only this week they brought to the colonial shop, and which she
I tried it all before once.
Fortunately, Professor Heinrich Ireneus Kwinke, whose
unhappy served as a cook, at this time in her office only
was going to go to the University, where he headed the department of internal
diseases. Therefore, when scared and wheezing from asphyxiation frau
rushed into it with slits instead of eyes and swollen face, quickly
managed to give her first aid and prevented him from going to Easter
angel, whom she loved to embroider a cross.
Another future Kaiser Wilhelm, impressed by the Kiel Parade
old vessels ”, only drove up to his palace in the Netherlands, and
in the printing house of the University of Kiel typesetters have already printed
monograph by Professor Kvinka on angioedema of the skin,
subcutaneous tissue and mucous membranes, nearly killed Frau Weber.
Later, the British and Americans began to call the swelling on behalf of the doctor
Quincke, which is completely stuck in the medical world.
Causes of angioedema
The mechanisms of development of angioedema can be twofold:
- allergic reaction
- increased permeability of the vascular wall against the background of inherited
features of the complement system (special blood proteins responsible
for immune protection)
Edema develops by the mechanism of instant reaction. As
provocateurs are various allergens that are divided into:
- infectious (fungi, bacteria, viruses)
- non-infectious, which in turn include:
- household (dust and epidermal mites)
- insect (saliva and insect venom)
- vegetable (pollen of trees and grasses)
- epidermal (dander and animal hair, fish scales)
- food (eggs, coffee, chocolate, honey, citrus, seafood and
- industrial (phenols, menthol, skipdar, etc.)
At the first contact with the allergen, the body responds with preparation
mast cells and basophils, releasing class E immunoglobulins
With repeated inhalation, ingestion – absorption through mucous membranes
or skin allergen and getting it into the blood, basophils and fat
the cells recognize it, break down and throw large into the bloodstream
number of biologically active substances or inflammatory mediators
(histamine and similar substances).
As a result, a spasm of capillaries develops, the output of the liquid part
plasma from vessels into the extracellular space. Especially easy water
penetrates into those areas where there is a lot of loose fiber:
- eyelids, lips, face, neck
- upper chest, hands
- feet, genitals
A massive edema develops. Such a mechanism is more characteristic.
for adults with a mature immune system and allergic
A certain number of people inherit instead of giving or
apartments such a complement system that provokes an immune
response to ingestion:
- foreign substances
- or even at injury
- or powerful stress
As a result of this response, basophils and
emitted inflammatory mediators. Then the same allergens
provoke angioedema already at the first contact with the body, without
pre-activation of mast cells and without release
By this mechanism, angioedema develops in young children up to
three years and in individuals with an overly active complement system.
Most often react to insect bites. and the serpent.
Other factors that contribute to the occurrence of edema
- endocrine diseases
- helminthic invasions or parasitic diseases (see signs
worms in humans)
- some diseases of internal organs
Symptoms of angioedema
Immediately I must say that edema develops extremely quickly:
only a short time (from a few minutes to
half an hour) can pass from getting into the nose a cloud of pollen or
drinking a cup of coffee before the awesome angioneurotic spectacle
With any localization of edema, a person may experience a feeling
anxiety or even fear of death:
- First of all, the face and its parts swell: eyelids, lips, cheeks, tip
- All this becomes puffy, eyes narrowed to slits and
- The skin turns pale, it becomes hot and taut.
- Edema is dense and there are almost no traces of
- Also, swelling can spread to the neck and upper chest.
- In some cases, the hands swell, turning fingers into
sausages and rear hands in the pillows.
- There are also cases of edema of the feet and genitals, as well as
- Of course, the swelling is of varying severity, and someone
patients get away with only minor changes
These are very impressive, but not the most terrible signs of edema.
Quincke. Much worse is the case when, along with the external deformity
- sore throat
- barking cough
- shortness of breath and difficulty breathing (mostly inspiratory)
This suggests that the swelling has spread to the soft
laryngeal tissue, touched the vocal cords and is already falling into
If at this stage you do not begin to take urgent measures,
to easily witness how the patient turns blue before his eyes,
lose consciousness and suffocate to death. But even at this stage
give up, because artificial respiration can be somewhat
push the puffy walls of the respiratory tract, and those who come for it
time the ambulance team will perform all the urgent activities and will have time
cram the laryngoscope blade into the victim’s throat.
Gastrointestinal form of angioedema
It manifests itself in the form of an acute eating disorder and proceeds
with symptoms of allergic gastritis, in which the wall of the stomach
food allergens attack and eosinophils accumulate in it and
basophils, the destruction of which occurs vascular spasm and
puffiness appears. A similar picture is observed in
- An acute pain in the pit of the stomach begins to torment a person or
near the navel, in the lateral parts of the abdomen
- Nausea, tingling of the tongue and palate, vomiting eaten
food, then loose stools
This gives the clinic serous meningitis:
- Headaches, light and sound fear
- Numbness of the occipital muscles, due to which it is difficult to bring
chin to chest (see the first signs of meningitis in children and
- The swelling of the membranes of the brain by edema does not increase without pain
leg of the patient lying flat, but decreases when the patient
throws his head or lies on his side with the above legs (posture
a dog or a gun).
- Nausea and vomiting of a central origin are characteristic, can
To the credit of Professor G.I. Quincke would like to note that the main
diagnostic (and partly therapeutic) procedure for meningitis,
allows you to take a spinal fluid for analysis and reduce it
pressure called spinal puncture was first
offered again to them.
Articular form отека приводит к невоспалительному отеку
synovial membrane of the joints, changing their configuration and
Quincke edema with urticaria
This combination is also not uncommon. In addition to puffiness
skin, mucous membranes and subcutaneous tissue rash appears on the skin
blisters of various sizes, which are accompanied by itchy skin or
burning sensation (see symptoms and causes of urticaria).
Depending on the duration of symptoms of angioedema
subdivided into acute (up to six weeks) and chronic
(longer than six weeks).
Symptoms in children
Children suffer from angioedema quite often.
- The more children fed artificial foods in infancy
- The more drugs they receive, the higher their
risks to the development of angioedema
- Household allergization – washing powders, shampoos and foams for
bath, fabric softener
- supplemented by food – early failure of breastfeeding
and conversion to cow’s milk protein (see if you can drink milk
a child under 2 years old), food rich in dyes and thickeners
- and drug – antibiotics for any reason, vaccinations against
all over the world, do not understand multivitamins for what (see pills for
As a result, angioedema may appear in a child.
first months and even days of life.
For newborns and children younger than 3-4 years more typical
non-allergic nature of edema due to hereditary
predisposition and reaction of complement. In this case, the death
a child from sudden death amid swelling of the larynx can reach
a quarter of all cases.
- Children are more likely than adults to respond to a gastrointestinal clinic.
edema and meningeal symptoms
- But articular syndrome is less characteristic of them.
- Allergic form of angioedema in pediatric practice is often
appears in conjunction with urticaria or asthma, with
this pain in the abdomen for this form of edema is not characteristic
Laryngeal edema – the most terrible sign, at the first manifestations
which you need to call an ambulance. The narrowing of the lumen of the larynx can
go through four stages, which, with Quincke’s edema, are quite smoothed
and stacked in a short amount of time.
- Stenosis of 1 degree is still compensated and allows the child to breathe.
without shortness of breath. But with physical exertion already appears
the upper notch of the sternum and the area above the navel.
- In the second degree, the child turns pale, his nasolabial turns blue
area, palpitations appear. At this time, tissues are tested.
oxygen starvation, the brain suffers. The child is restless, excited.
The entire chest and abdominal muscles are involved in breathing.
- The third degree is respiratory failure (cyanosis
lips, fingers, pallor, sweating). The baby noisily pulls in
air, it is difficult for him to inhale and exhale.
- The fourth degree is the actual choking with a superficial
breathing, slow heartbeat, inhibition or loss
First aid for angioedema
In this part we will discuss self-help and mutual assistance:
- The first event, which is worth while with the development of edema
Quincke is a call to the ambulance brigade. If the ambulance is clearly not
will arrive, and quickly take or drag the patient to the nearest
medical institution – drag, after completing point two
- The second is the reception of an antihistamine drug, which is
at hand (in the age dosage, better under the tongue).
- In the absence of antihistamines or other drugs from
allergies, in the mouth of an adult or teenager we pour banal naphthyzine
(drops in the nose) in a dose of 2-3 drops or drip in the nose
- Calm the patient, open the vents, release the neck and
chest from the clothes, remove the jewelry (chains,
earrings, etc.). We take the child in our arms, do not shout or hysteria.
- If the allergen is known, if possible, remove it.
- Apply to the place of edema cold.
- If a person is unconscious, conduct artificial
- Relatives of patients with recurrent edema are usually aware of
Prednisolone and are able to self-administer this drug.
Remember that from concerted and reasonable action from the first minute
development of angioedema may depend on a person’s life.
Emergency care for angioedema
Here comes the time of qualified medical care from
“Ambulance” or hospital staff or clinic:
- Allergen Termination
- Quincke edema on the background of low blood pressure requires
the introduction of subcutaneously 0.1% solution of adrenaline in a dose of 0.1-0, 5 ml
- Glucocorticoids (Prednisolone Himisuccinate 60-90 mg is administered
intravenously or intramuscularly or dexamethasone from 8 to 12 mg
- Antihistamines: suprastin 1-2 ml or clemastin (tavegil) 2 ml
intravenously or intramuscularly
With swelling of the larynx:
- Termination of allergen exposure
- Oxygen inhalation
- Saline 250 ml intravenously
- Epinephrine (epinephrine) 0.1% -0.5 ml intravenously
- Prednisolone 120 mg or dexamethasone 16 mg intravenously
- With the ineffectiveness of interventions – tracheal intubation. Before that:
atropine sulfate 0.1% -0.5-1 ml intravenous, midazolam (dormicum)
1 ml or diazepam (Relanium) 2 ml intravenously, ketamine 1 mg per kg
- Rehabilitation of the upper disinfectant paths
- A single attempt at tracheal intubation. With inefficiency or
inability to perform – conicotomy (dissection of the ligament between
cricoid and thyroid cartilage), artificial ventilation
In the absence of laryngeal edema, hospitalization is indicated as follows.
- if Quincke edema developed for the first time
- severe course of angioedema
- edema with medication
- patients with severe cardiovascular and respiratory
- Persons who had been vaccinated before.
- recently had acute respiratory viral infection, stroke or heart attack
Treatment of angioedema
In stationary conditions, the suppression event continues.
- administration of antihistamines, glucocorticoids
- intravenous infusion therapy is carried out to increase
blood volume and filtration of allergens through the kidneys, with
using physical solution, protease inhibitors (contrycal),
- Epsilonamino caproic acid is indicated for pseudo-allergic
edema in doses of 2.5-5 g per day by mouth or intravenously
- applied forced diuresis – lasix, furosemide at the end
- in order to reduce vascular permeability can be assigned
- enterosorption is also shown (Polyphepan, Activated carbon,
Enterosgel, Filtrum STI, Polysorb), due to which bind
пищевые аллергены в intestine.
It makes sense to provide data on the latest trends in
antiallergic drugs that are being treated in acute
period of angioedema and between episodes of repeated angioedema
- First generation antihistamines: chloropyramine
(suprastin), promethazine (pipolfen, diprazin), phencarol
(Hifenadine), Pheniramine (Avil), Dimethinden (Fenistil), Tavegil
(clemastine), mebhydroline (omeril, diazolin) act quickly (through
15-20 minutes). Effective in relieving angioedema, but cause
drowsiness, prolonged reaction time (contraindicated for drivers).
Act on H-1 histamine receptors
- The second generation blocks histamine receptors and
stabilizes mast cells from which histamine gets into
blood flow. Ketotifen (zaditen) effectively removes respiratory spasm
ways. Shown in combination with angioedema with
bronchial asma or broncho-obstructive diseases.
- Third-generation antihistamines do not inhibit the central nervous system, blocking
histamine receptors and stabilize the wall of mast cells:
- Loratadine (clarisens, claritin)
- Astemizol (astelong, hasmanal, istalong)
- Semprex (acrivastine)
- Terfenaddin (teridine, treksil)
- Allergodil (Atselastin)
- Zyrtec, Cetrin (cetirizine)
- Telfast (fexofenadine)
- (see list of all allergy pills).
The choice of drugs is carried out with the following
- In children younger than a year: fenistil
- From 12 months to four years: Loratadine, Cetirizine
- From five to twelve: Cetirizine, Loratadine, Terfenadine,
- Для беременных: Astemizol, Лоратадин, Телфаст
- For nursing: Pheniramine and Clemastine
- With liver pathologies: as in children
- With renal failure: as for pregnant women
Thus, angioedema, the symptoms and treatment of which are described
higher, easier to prevent than to stop. In order to prevent
It is advisable to reduce the number of household and food allergens,
try to avoid unnecessary medication, and at first
manifestations of any allergic reactions (dermatitis, urticaria,
seasonal rhinitis, conjunctivitis, or bronchial asthma)
to an allergist.