Quincke's edema in children

Quincke's edema is a morphological variant of urticaria, it is a clearly defined edema of the skin and subcutaneous tissue. In 15-20%, Quincke's edema is observed without urticaria. According to pathogenesis, Quincke's edema can be allergic and pseudo-allergic. Hereditary (idiopathic) angioedema is included in the pseudo-allergic form as an independent syndrome.

Quincke's edema in the larynx is especially dangerous and is diagnosed in approximately 20-30% of cases. When laryngeal edema occurs, the clinical picture of stenosing laryngotracheitis is observed, which is manifested by hoarseness, a "barking" cough with dyspnea of an inspiratory or inspiratory-expiratory nature. Death from asphyxia is possible. Breathing becomes noisy, stridor, with retraction of the compliant areas of the chest. The skin and mucous membranes are cyanotic, acrocyanosis is observed. From the central nervous system, excitement is noted. If the condition worsens, the edema spreads lower, to the mucous membrane of the tracheobronchial tree, to the bronchi and parenchyma of the lungs, causing broncho-obstructive syndrome. Edema of the gastrointestinal mucosa is accompanied by intestinal colic, nausea, and vomiting (the cause of diagnostic errors and unjustified surgical interventions).

Establishing a diagnosis of Quincke's edema is not difficult if Quincke's edema accompanies urticaria in an acute or chronic recurrent form. Difficulties arise when identifying local edemas without urticaria. The clinical picture of hereditary angioedema is characterized by the long-term formation of very dense edemas. In this case, laryngeal edema and abdominal syndrome often occur. In this case, there is no skin itching, urticaria, and there is no effect from the use of antihistamines.

Treatment of Quincke's edema in children

It is necessary to stop further intake of the suspected allergen, and administer antiallergic therapy with antihistamines. In the presence of severe respiratory disorders, dysphagia, and abdominal syndrome, prednisolone is administered intravenously or intramuscularly at a dose of 1-2 mg/kg every 4-6 hours. In case of bronchospasm, zeminophylline (euphyllin) is administered intravenously, as well as salbutamol or the combined drug berodual via a nebulizer; administration of a 0.1% solution of epinephrine is indicated - 0.01 ml/kg.

In severe cases, in the absence of rational assistance, patients may die from asphyxia. In this regard, intensive care is required. including intubation, oxygen therapy and, if respiratory failure increases, artificial ventilation. In mild and moderate cases, laryngeal edema lasts from 1 hour to 1 day.

Treatment of hereditary angioedema consists of maintaining the patency of the upper respiratory tract (tracheal intubation, if this is impossible, cricothyroidotomy or tracheostomy should be performed). Infusion therapy is prescribed: 250-300 ml intravenously by drip of fresh or fresh-frozen native single-group plasma (the effect is associated with the content of C1 inhibitor in the plasma). 100-200 ml intravenously by drip of 5% aminocaproic acid solution (inhibitor of C1 esterase, kininogenase proteases), then 100 ml intravenously by drip every 4 hours, dexamethasone at a dose of 8-12 mg intravenously, betamethasone 1-2 ml intramuscularly is highly effective. Symptomatic therapy is also prescribed: antispasmodics, painkillers.

In order to prevent an attack of Quincke's edema, synthetic androgens (danazol, stanazol) and aminocaproic acid are prescribed.

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