Dermatology - diseases of the skin

Angioedema


Angioedema

Angioedema (other names – acute angioneurotic edema, giant urticaria, trophoneurosis swelling, angiotech) is an emerging suddenly limited or diffuse edema of the subcutaneous adipose tissue and mucous membranes. Edema Quincke vulnerable adults and children, but most often the disease occurs at a young age, especially in women. In children and the elderly is rare.

Causes of angioedema

Causes of angioedemaAt the heart of allergic edema is an allergic reaction antigen-antibody. Released in pre-sensitized body biologically active substances – mediators (histamine, kinins, prostaglandins) cause local dilation of capillaries and veins, there is an increase in the microvascular permeability and tissue edema. Cause allergic edema may be the impact of specific food products (eggs, fish, chocolate, nuts, berries, citrus, milk), medicinal and other allergens (flowers, animals, insect bites).

In patients with non-allergic edema Quincke disease due to heredity. Inheritance is the dominant type. In serum of patients with decreased levels of inhibitors of esterases and kallikrein. Angioedema thus, similar allergic edema develops under the influence of substances that cause the formation of histamine – the same allergens. Edema develops sensitized body under the influence of specific allergens: flowers, animals, food, medicines, cosmetics or nonspecific: stress, intoxication, infection, hypothermia. Predisposing factors may include liver disease, thyroid (especially when its reduced function), stomach, blood diseases, autoimmune and parasitic diseases. Often in this case the disease acquires a chronic relapsing course.

In some cases the cause of the angioedema can’t be set (the so-called idiopathic edema).

Symptoms of angioedema

Symptoms of angioedemaThe disease begins suddenly. Within a few minutes, rarely hours on different areas of the face and mucous membranes develops pronounced swelling. There may be a local swelling of the lips, eyelids, scrotum and mucous membranes of the oral cavity (tongue, soft palate, tonsils), respiratory tract, gastrointestinal tract, urogenital region. Edema is rarely accompanied by pain, most patients complain of a feeling of tension of the tissues. In the area of edema is noted fabric tension elastic consistency, at a pressure of pits does not remain, palpation (feeling) the lump is painless.

The most commonly angioedema is located on the lower lip, eyelids, tongue, cheeks, throat, and edema of the larynx, and tongue may lead to the development of asphyxia occurs difficulty breathing, develop aphonia, cyanosis of the tongue.

With the spread of edema on the brain and meninges appear neurological disorders (epileptiform seizures, aphasia, hemiplegia, etc.).

Angioedema may last for hours or days, then disappears, but may occasionally recur.

Complications of angioedema

The most threatening complication can be the development of laryngeal edema with increasing symptoms of acute respiratory failure. The symptoms of edema of the larynx – hoarseness, barking cough, progressive shortness of breath.

Edema of the mucosa of the gastrointestinal tract may simulate acute abdominal pathology, while there may be diarrhoea disorders, acute abdominal pain, increased peristalsis of the intestine, sometimes the symptoms of peritonitis.

The lesions of the urogenital system is manifested by acute symptoms of cystitis and may lead to the development of acute urinary retention.

The most dangerous is the localization of edema on the face, because with the possible involvement of the meninges with the appearance of meningeal symptoms or labyrinthine systems that show signs of Meniere’s syndrome (dizziness, nausea, vomiting). In the absence of immediate skilled care such swelling can cause death.

Perhaps a combination of acute urticaria and angioedema.

Examination when angioedema

Differential diagnosis is carried out with lymphostasis, collateral edema in the abscess, erysipelas, syndrome Melkersson-Rosenthal. The syndrome Melkersson-Rosenthal, along with swelling of lips chronic revealed folding of the language and the neuritis of the facial nerve. Erysipelas lips there is hyperemia (redness) in the affected area in the form of flames.

Emergency first aid for angioedema

  • When reducing the AD — injected subcutaneously with 0.1–0.5 ml of 0.1% solution of adrenaline;
  • asphyxia (swelling of the mucous membranes of the respiratory tract) adrenaline injection;
  • Hormone therapy: corticosteroids (prednisone 60-90 mg/m or in/in; deksazon 8-12 mg/in;)
  • Desensitizing treatment: antihistamines (suprastin 2% — 2.0 V/m, claritin, Zyrtec, Aerius, Telfast).
  • Diuretics: lasix 40-80 mg IV stuynye in 10-20 ml of physiological solution;
  • Drugs protease inhibitors: contrycal — 30000 U/in 300 ml of physiological solution, Epsilon-aminocaproic acid 5% — 200 ml/drip, then 100 ml in 4 hours or 4 g per os 4-5 times a day until complete relief response;
  • Detoxification therapy – hemosorption, enterosorption;
  • the Hospitalization to the Allergy Department.

Treatment of angioedema:

  • Treatment of angioedemaElimination of contact with the allergen;
  • prescriptions to improve the tone of the sympathetic nervous system (calcium, ascorbic acid, ephedrine);
  • decrease in parasympathetic activity (atropine) and histamine (diphenhydramine, suprastin, tavegil);
  • Essential vitamin — appoint ascorutinum to reduce vascular permeability
  • Shown desensitizing therapy (ACTH, cortisone, prednisolone) therapy with B vitamins and gamma globulin
  • the mainstay of treatment hereditary forms of angioedema are medicinal preparaty enhancing products in the body of the missing C1 inhibitor

Hormone treatment in the absence of contraindications to hormone therapy is recommended in the hospital.

Prevention of angioedema

The only legitimate prevention is the avoidance of contact with allergens.