Angioedema

Angioedema is an edema of the deep layers of the dermis and subcutaneous tissues. It can be caused by medications, poison (especially animal origin), food or extracted allergens. The main symptom is a diffuse, painful edema, sometimes limited. The diagnosis is based on a general examination. Treatment is aimed at eliminating or canceling the allergen and the appointment of H2-blockers.

[1], [2], [3], [4], [5]

Causes of angioedema

Acute angioedema is virtually an anaphylactic reaction of subcutaneous tissue. Sometimes it is accompanied by urticaria rash (localized blisters and erythema on the skin); in both cases, the causes are similar (for example, drugs, poisons, food and extracted allergens). Anginaurotic edema is pathogenetically associated with urticaria, which manifests itself at the level of the epidermal-dermal junction.

Chronic (> 6 weeks) angioedema in rare cases is lgE-mediated, more often - difficult to explain violation. The cause is usually unknown (idiopathic edema), but sometimes the cause is chronic use of non-frightening medications or other synthetic products (penicillin in milk, over-the-counter medicines, preservatives, other nutritional supplements). In some cases, angioedema is congenital.

[6], [7], [8], [9], [10]

Symptoms of angioedema

With angionevroticheskom swelling can be noted (or absent), an easy itch. This condition is characterized by limited diffuse and painful edema of soft tissues, which can be asymmetric; especially the edema of the eyelids, lips, face, tongue, as well as the back of the hands and feet, genitals. Swelling of the upper respiratory tract can cause respiratory distress, and the stridor is sometimes mistaken for asthma. Complete airway obstruction may occur.

Diagnosis of angioedema

The reason is often obvious, and diagnostic tests are rare, because the reactions are self-contained and do not recur. No tests are particularly necessary for diagnosis. Erythropoietic protoporphyria can be masked for allergic forms of angioedema and is diagnosed by measuring the amount of porphyrins in the blood and feces.

[11], [12], [13], [14]

Treatment of angioedema

In the case of acute angioedema, treatment consists of eliminating or avoiding the allergen and prescribing symptomatic drugs (eg, H2 blockers). In the most severe cases, prednisolone 30-40 mg once a day is prescribed. Local therapy with glucocorticoids is useless. If the cause is not obvious, you must stop taking all the secondary drugs. With edema of the pharynx or larynx, ephedrine 0.3 ml in a solution of 1: 1000 is administered subcutaneously. Treatment can be supplemented by intravenous administration of antihistamines (diphenhydamine 50-100 mg). Long-term treatment may include the appointment of H1 - and H2-blockers and sometimes glucocorticoids.

H1-blockers for oral administration

A drug	Dosage for adults	Dosage for children	Available dosage forms
Azatidine maleate	1-2 mg 2 times a day	<12 years: not recommended. > 12 years: in adult dosage	Tablets 1 mg
Brompheniramine maleate	4 mg every 4 to 6 hours or 8 mg every 8 to 12 hours	<6 years: 0.125 mg / kg every 6 hours (maximum dose of 6-8 mg per day). 6-12 years: 2-4 mg every 6-8 hours (maximum dose of 12-16 mg per day). > 12 years: in adult dosage	Tablets 4, 8, 12 mg. Elixir 2 mg / 5 ml. Tablets 8.12 mg (prolonged action)
Chlorpheniramine maleate	2-4 mg every 4 to 6 hours	<6 years: not recommended. 6-11 years: 2 mg every 4-6 hours (maximum dose of 12-16 mg / day). > 12 years: in adult dosage	Chewable tablets 2 mg. Tablets 4, 8, 12 mg. Syrup 2 mg / 5 ml. Tablets or capsules 8, 12 mg
Clemastine fumarate	From 1.34 mg 2 times a day to 2.68 mg 3 times a day	6-12 years: 0.5 mg every 12 hours (maximum dose of 3 mg / day) 3	Tablets 1.34; 2.68 mg. Syrup 0.67 mg / 5 ml
Cyproheptadine HCI	4 mg 3 or 4 times a day [maximum dose 0.5 mg / (kg-day)]	2-6 years: 2 mg 2 or 3 times a day (maximum 12 mg / day). 7-14 years: 4 mg 2 or 3 times a day (maximum 16 mg / day)	Tablets 4 mg. Syrup 2 mg / 5 ml
Dexchlorpheniramine maleate	2 mg every 4 to 6 hours	2-5 years: 0.5 mg every 4-6 hours (maximum dose of 3 mg / day). 6-11 years: 1 mg in 4-6 hours (maximum dose of 6 mg / day)	Tablets 2 mg. Syrup 2 mg / 5 ml. Tablets 4.6 mg. (prolonged action)
Diphenhydramine	25-50 mg every 4 to 6 hours	1.25 m g / kg every 6 hours (maximum dose of 300 mg / day)	Capsules or tablets 25, 50 mg. Syrup 12.5 mg / ml. Elixir 12.5 / 5 ml
Diphenylpyrazine	5 mg every 12 hours	No data	Capsules 5 mg (long-acting)
Hydroxysin HCI	25-50 mg 3 or 4 times a day	0.7 mg / kg 3 times a day	Capsules 25, 50,100 mg. Tablets 10,25,50 and 100 mg. Syrup 10 mg / 5 ml. Oral suspension 25 mg / 5 ml
Metidilazine HCI	8 mg every	> 3 years: 4 mg every	Tablets 8 mg. Chewable tablets 4 mg. Syrup 4 mg / 5 ml
Promethazine HCI	12,5-25 mg 2 times a day	<2 years: contraindicated. 2 years: 6.25-12.5 mg 2 or 3 times a day	Tablets 12.5; 25; 50 mg. Syrup 6.25 and 25 mg / 5 mL
Trimeprazine tartrate	2.5 mg 4 times	6 months -3 years: 1.25 mg at night or 3 times a day. > 3 years: 2.5 mg per night or 3 times a day	Tablets 2.5 mg. Syrup 2.5 mg / 5 ml. Capsules 5 mg (long-acting)
Tripelenamine citrate	25-50 mg every 4 to 6 hours	1.9 mg / kg 4 times a day (maximum 450 mg / day)	Elixir 37.5 mg / 5 ml (1 ml citrate = 5 mg HCI salt)
Tripelennamine HCI	25-50 mg every 4 to 6 hours	1.25 mg / kg 4 times a day (maximum 300 mg / day)	Tablets 25; 50 mg. Tablets 100 mg (prolonged action)
Triprolidine HCI	2.5 mg every 4-6 hours (maximum 10 mg / day)	4 months - 2 years: 0.313 mg every 4-6 hours (maximal 1.25 mg / day). 2-4 years: 0.625 mg every 4-6 hours (maximum 2.5 mg / day). 4-6 years: 0.938 mg every 4-6 hours (maximum of 3,744 mg / day). 6-12 years: 1.25 mg every 4-6 hours (maximum 5 mg / day)	Tablets 2.5 mg. Syrup 1.25 mg / 5 ml

Without sedation

A drug	Dosage for adults	Dosage for children	Available dosage forms
Acryvastin	8 mg 2 or 3 times	<12 years: not recommended. 12 years: in adult dosage	Capsules 8 mg
Cetirizine	5-10 mg 1 time	> 12 years: in adult dosage	Tablets 5.10 mg
Desloratadine	5 mg once a day	> 12 years: in adult dosage	Tablets 5 mg
Ebastin	10-20 mg once a day	6-12 years: 5 mg. 12-17 years: 5-20 mg once a day	Tablets 10 mg
Fexofenadine	60 mg 2 times a day or 180 mg once a day	6-11 years: 30 mg 2 times a day. 12 years: in adult dosage	Tablets 60.180 mg
Levocetirizine	5 mg once a day	No data	Tablets 5 mg
Loratadin	10 mg 1 time	2-5 years: 5 mg once a day. 6 years: in adult dosage	Tablets 10 mg. Syrup 1 mg / 1 ml
Misolastine	10 mg 1 time	No data	Tablets 10 mg

Anticholinergic properties are noted in all antihistamines with a sedative effect. They are usually not used in the elderly and in patients with glaucoma, benign prostatic hyperplasia, delirium, dementia and orthostatic hypotension. When taking these medications, dry mouth, reduced vision, urinary retention, constipation, orthostatic hypotension are noted.