Quincke's edema in children

Quincke edema is a morphological variant of urticaria, it is a clearly limited edema of the skin and subcutaneous tissue. In 15-20% observed edema Quincke without urticaria. According to the pathogenesis of Quincke edema may be allergic and pseudoallergic. In pseudoallergic form as an independent syndrome, hereditary (idiopathic) angioedema is included.

Especially dangerous is the edema of Quincke in the larynx, which is diagnosed in about 20-30% of cases. If there is edema of the larynx, a clinical picture of stenosing laryngotracheitis is observed, which manifests itself in hoarseness, "barking" with a cough with inspiratory or inspiratory inspiratory inspiration. Death from asphyxiation is possible. Breathing becomes noisy, stridorous, with the retraction of the compliant places of the chest. Skin and mucous membranes cyanotic, observe acrocyanosis. From the side of the CNS, excitement is noted. With worsening of the condition, the edema spreads lower, to the mucous membrane of the tracheobronchial tree, to the bronchi and lung parenchyma, causing a bronchoobstructive syndrome. Edema of the mucous membrane of the gastrointestinal tract is accompanied by intestinal colic, nausea, vomiting (the cause of diagnostic errors and unreasonable surgical interventions).

The diagnosis of edema Quincke is not difficult if the edema of Quincke accompanies hives in an acute or chronic recurrent form. Difficulties arise when identifying local edema without urticaria. The clinical picture of hereditary angioedema is characterized by a prolonged formation of very dense edema. This often causes laryngeal edema and abdominal syndrome. At the same time there is no skin itching, hives, and there is no effect from the use of antihistamines.

Treatment of Quincke edema in children

It is necessary to stop further ingestion of the suspected allergen, antiallergic therapy with antihistamine drugs. In the presence of severe breathing disorders, dysphagia, abdominal syndrome, prednisolone is administered intravenously or intramuscularly at a dose of 1-2 mg / kg every 4-6 hours. When bronchospasm is administered intravenously, zaminophylline (euphyllin), as well as salbutamol or a combined preparation of berodual through a nebulizer; the introduction of a 0.1% solution of epinephrine - 0,01 ml / kg.

In severe cases, in the absence of rational care, patients may die from asphyxia. In this regard, intensive care is required. Including intubation, oxygen therapy and with increasing respiratory failure, ventilation. With mild and moderate severity, the laryngeal edema lasts from 1 hour to 1 day.

Treatment of hereditary angioedema is to maintain patency of the upper respiratory tract (intubation of the trachea, if it is impossible to produce cryocothyroidectomy or tracheostomy). Assign infusion therapy: 250-300 ml of intravenously drip fresh or fresh-frozen native monoclonal plasma (the effect is related to the content of the plasma C1 inhibitor). 100-200 ml of intravenous drip 5% solution of aminocaproic acid (inhibitor of proteases of C1-esterase, kininogenase), then 100 ml of intravenous drip every 4 hours, dexamethasone 8-12 mg intravenously, highly effective betamethasone 1-2 ml intramuscularly. Symptomatic therapy is also prescribed: antispasmodic, analgesic.

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

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