Quincke's angioedema

Quincke's angioedema, also known as Quincke's urticaria, is a rare and potentially serious condition characterized by swelling of the subcutaneous tissue, mucous membranes and sometimes muscles. It is usually caused by an allergic reaction to certain foods, medications, or bee stings, although the cause sometimes remains unknown.

Epidemiology

The epidemiology of Quincke's angioedema may vary by country and region, as well as factors such as the availability of medical care and the prevalence of allergic reactions. It is important to note that accurate statistics on the prevalence of this condition may be limited due to its rarity and variety of causes.

Here is some information about the epidemiology of angioedema Quincke's angioedema:

1. Prevalence: Quincke's angioedema is considered a relatively rare condition. Its exact prevalence may vary from country to country and region to region.
2. Age: Quincke's angioedema can occur at any age, including children and adults. However, some people may experience their first symptoms in childhood or young adulthood.
3. Allergens: Foods and medications are among the most common allergens that can cause Quincke's angioedema. Certain foods such as nuts, milk, eggs, and seafood can be frequent sources of allergic reactions.
4. Family history: Some people may have a family history of allergic reactions, including angioedema Quincke's angioedema. This may indicate a genetic predisposition to these conditions.
5. Gender: Quincke's angioedema can occur in both men and women, and there are no significant differences in prevalence between the sexes.
6. Severity: The condition can vary in severity from mild short-term cases to more serious cases, including life-threatening cases.

For accurate epidemiologic information and prevalence data on Quincke's angioedema, it is recommended that you consult medical studies and statistics provided by health care organizations and research institutions in your area.

Causes of the quincke's edema

Quincke's angioedema is usually caused by an allergic reaction to certain allergens. Here are some of the main causes of this condition:

1. Food Allergens: One of the most common sources of Quincke's angioedema is allergic reactions to certain foods. Nuts, milk, eggs, fish, seafood, and other foods can cause allergic reactions in susceptible individuals.
2. Medications: Some medications can be allergens and can cause angioedema Quincke's angioedema. These can be antibiotics, few anti-inflammatory drugs, and other medicines.
3. Bee and wasp stings: Bee or wasp stings can cause an allergic reaction, including angioedema Quincke, in some people who are allergic to bee and wasp stings.
4. Pollinosis (seasonal allergic rhinitis): Some people may develop angioedema Quincke's angioedema in response to plant pollen (pollen), especially during flowering seasons.
5. Latex allergy: Latex used in medical gloves, condoms, and other products can cause an allergic reaction in some people.
6. Idiopathic angioedema: In some patients, the cause of Quincke's angioedema remains unknown, and this is called idiopathic angioedema.

It is important to note that Quincke's angioedema can be a rapid and serious condition, especially if it affects the throat or tongue, as it can lead to difficulty breathing. People who are prone to allergic reactions or at risk of developing Quincke's angioedema should know their allergens and take precautions, and seek immediate medical attention if they experience symptoms that require medical attention.

Risk factors

Risk factors for Quincke's angioedema include the following:

1. Allergies: A major risk factor is having allergic reactions to certain allergens, such as certain foods (nuts, milk, eggs, fish, seafood), medications, bee or wasp stings, latex, and other allergens.
2. Family history: If family members have had allergic reactions or Quincke's angioedema, this may increase the risk of other family members developing this condition.
3. Positive history of food allergies: If a person has a history of food allergies, especially if they have previously experienced allergic reactions to certain foods, they may have an increased risk of angioedema Quincke's angioedema.
4. History of allergic reactions: People who have ahistory of allergic reactions, including Quincke's urticaria or angioedema, may be more at risk of developing this condition in the future.
5. Latex Allergy: People with latex allergies may be more at risk for angioedema Quincke's angioedema when exposed to latex.
6. Idiopathic angioedema: In some people, the cause of Quincke's angioedema remains unknown. In such cases, the risk of developing this condition may also be considered low but is not excluded.

It is important to remember that having risk factors does not necessarily mean that a person will develop Quincke's angioedema. However, knowing these factors can help people take precautions and monitor their reactions more closely when they may come into contact with allergens. If you are at high risk for allergic reactions or Quincke's angioedema, you should discuss this with your doctor and consider carrying an automatic epinephrine (Adrenalin) injector with you for emergency treatment if needed.

Pathogenesis

The pathogenesis of Quincke's angioedema is related to the allergic reaction and changes in blood vessels and tissues that lead to the development of edema. The process develops in several stages:

1. Initiation of an allergic reaction: Angioedema Quincke's angioedema most often begins after contact with an allergen, which can be a food, drug, insect venom (such as a bee or hornet), or other allergen. In people with allergic sensitization, IgE antibodies begin to form in response to contact with the allergen.
2. Activation of mastocytes and basophils: Upon subsequent contact with the allergen, IgE binds to mastocytes and basophils, types of white blood cells. This leads to the activation of these cells.
3. Mediator release: Activated mastocytes and basophils release allergic mediators such as histamine. Histamine causes vasodilation (vasodilation) and increased vascular permeability (vasopermeabilization).
4. Increased vascular permeability: As a result of allergic reaction mediators, the permeability of capillaries (small vessels) increases, causing fluid to escape from the vessels into the surrounding tissues.
5. Swellingand symptoms: The release of fluid from the blood vessels leads to tissue swelling, which manifests itself as swelling of the skin, mucous membranes, lips, throat and other areas. This is accompanied by symptoms such as itching, redness, flushed skin and soreness.
6. Symptomdevelopment: Symptoms of Quincke's angioedema can develop quickly, usually within minutes to hours after contact with the allergen. In some cases, they can become serious and life-threatening, especially if the swelling affects the throat and airways.

The pathogenesis of Quincke's angioedema is related to the allergic reaction and can be a very rapid and dynamic process. It is therefore important that people at risk of developing allergic reactions and Quincke's angioedema are aware of their allergens and know how to obtain urgent medical attention if necessary.

Symptoms of the quincke's edema

Quincke's angioedema is characterized by the development of swelling of internal and external tissues, which can cause a number of characteristic symptoms. The main symptoms of Quincke's edema are:

1. Edema: The main symptom of Quincke's angioedema is the rapid development of tissue swelling. The swelling can affect different areas of the body, including the face, lips, eyes, throat, tongue, arms, legs, and abdomen. The swelling may be swollen, enlarged, and cause discomfort.
2. Urticaria: Some patients with Quincke's angioedema develop a skin rash that resembles urticaria. Skin rashes may be red in color, covered with white patches, and often very itchy.
3. Itching: Swelling and skin rashes may be accompanied by severe itching that can be very bothersome.
4. Skin redness: Areas ofskin affected by Quincke's angioedema may become red and hot to the touch.
5. Pain and discomfort: Swelling and skin symptoms can be painful and cause discomfort.
6. Breathing problems: In cases where swelling affects the throat, tongue or airways, it can cause difficulty breathing and noisy breathing. This is a serious symptom and requires urgent medical attention.
7. Other symptoms: Some patients may experience pain in the area of the swelling, a feeling of pressure and discomfort.

Symptoms of Quincke's angioedema can develop very quickly, usually within minutes to hours after contact with the allergen. It is important to know that Quincke's edema can be a dangerous condition, especially if it affects the respiratory tract. If you develop symptoms of angioedema Quincke's that require medical attention, you should contact your doctor or call an ambulance immediately.

Forms

Quincke's angioedema can take several forms, depending on which tissues and organs it affects. The main forms of Quincke's edema include:

1. Quincke's skin edema: This is the most common form in which swelling develops in the skin and mucous membranes. Patients with this form may experience swelling of the face, lips, eyes, throat, tongue, and other areas. The skin becomes swollen and may become very itchy. A skin rash resembling hives may also develop.
2. Form of Quincke's angioedema with abdominal swelling: This form may include abdominal swelling, which can manifest as increased abdominal volume, soreness, and discomfort. The swelling may involve the stomach wall or intestines, and this condition requires medical evaluation and treatment.
3. Aform of Quincke's edema with difficulty breathing: Swelling of the throat and airways can cause difficulty breathing and noisy breathing. This is a serious and potentially dangerous symptom that requires immediate medical attention.
4. Aform of Quincke's edema with swelling of the extremities: Quincke's edema can also affect the extremities, such as the hands and feet. The swelling may be moderate or severe and cause discomfort.

It is important to remember that Quincke's angioedema can manifest in different forms and have varying degrees of severity. Quincke's edema can be a very rapid and dynamic process, so it is important to see a doctor or call an ambulance if symptoms requiring medical attention occur.

Complications and consequences

Quincke's angioedema, especially in its severe forms, can pose a serious threat to health and even life. Complications and consequences of Quincke's edema may include the following:

1. Shortness ofbreath: If Quincke's edema affects the throat or airways, it can lead to difficulty breathing and even asphyxiation (choking). This condition is a medical emergency and requires prompt medical attention.
2. Asphyxia: If Quincke's edema severely restricts airway clearance, sufficient oxygen may not be delivered to the body. This can lead to asphyxia, which is a life-threatening condition.
3. Swelling of the throat and tongue: Quincke's edema affecting the throat and tongue can cause difficulty swallowing and can even be life-threatening.
4. Anapylactic shock: In some cases, Quincke's angioedema may be accompanied by anaphylactic shock, which is a severe allergic reaction leading to a drop in blood pressure, respiratory distress and loss of consciousness.
5. Recurrent attacks: In some patients, Quincke's angioedema may become a chronic or recurrent condition.
6. Psychological consequences: Patients who have experienced severe cases of Quincke's edema may develop psychological sequelae such as anxiety and fear of a recurrent allergic reaction.

Diagnostics of the quincke's edema

Diagnosis of Quincke's angioedema involves a physical examination and evaluation of symptoms. Additional tests may be needed to make an accurate diagnosis and identify the cause of the edema. Here are some steps a doctor may take when diagnosing Quincke's edema:

1. Physicalexamination: The physician will examine the patient and assess the nature and spread of the swelling, as well as the presence of associated symptoms such as itching, skin rashes, pain, or difficulty breathing.
2. History taking: It is important to obtain the patient's history and determine if there have been allergic reactions in the past, what allergens may have caused the swelling, if there have been insect bites, etc.
3. Ruling out other causes: Your doctor must rule out other conditions that can cause swelling, such as infections, medication reactions, circulation problems, and other medical problems.
4. Allergytests: Allergy tests such as skin tests or blood tests to determine IgE antibody levels and identify allergens may be performed to determine the allergic nature of Quincke's edema.
5. Airway Examination: If swelling of the throat or airway is suspected, additional investigations such as fibrogastroscopy or laryngoscopy may be required.
6. Other laboratory tests: In some cases, additional laboratory tests, such as blood and urine tests, may be required to assess the patient's general condition and to detect signs of inflammation.

Differential diagnosis

Differential diagnosis of Quincke's edema involves identifying this condition and ruling out other possible causes of edema and allergic reactions. Here are some of the conditions and diseases that may resemble Quincke's edema and require differential diagnosis:

1. Allergic urticaria: Urticaria is a skin condition characterized by the appearance of red, itchy, rising rashes on the skin that look like nettle stings. Urticaria and Quincke's edema may accompany each other, and the doctor must determine whether they are part of the same allergic reaction or different conditions.
2. Angioedema without allergy: Sometimes angioedema can develop without allergic reactions. In such cases, the cause of the edema may not be clear and requires a more thorough examination.
3. Swellingafter insect stings: Insect stings such as bees, wasps, or ants can cause swelling of the skin and reactions similar to Quincke's edema. It is important to determine if there was contact with insects and if there were any stings before symptoms appear.
4. Medication reactions: Some medications can cause swelling and allergic reactions that may be similar to Quincke's edema.
5. Physical irritants: Contact with physical irritants such as cold, heat, pressure, or friction may cause skin reactions and swelling.
6. Infections: Infections, such as respiratory tract infections or dental problems, can cause swelling in the throat or face area.

The differential diagnosis is made by the doctor based on the history, clinical picture and the results of additional investigations such as allergy tests or laboratory tests. This makes it possible to rule out other possible causes of edema and determine whether it is Quincke's angioedema.

Treatment of the quincke's edema

The treatment of Quincke's angioedema involves several aspects, depending on the severity of the symptoms and the patient's overall condition. It's important to remember that Quincke's angioedema can be a serious and even life-threatening condition, so if symptoms develop that require medical attention, you should seek immediate medical attention or call an ambulance. Here is a general approach to treating Quincke's edema:

1. Discontinuing contact with an allergen: If an allergen is known to be the cause of Quincke's edema (such as an insect sting or eating a certain food), contact with that allergen should be stopped immediately.
2. Epinephrine (adrenaline): If symptoms are severe, such as difficulty breathing or anaphylactic shock, epinephrine (adrenaline) may need to be given into the muscle or intravenously. Epinephrine constricts blood vessels, improves breathing, and relieves allergic swelling. This medicine can be life-saving and should be available in patients at risk of developing Quincke's edema.
3. Antihistamines: Your doctor may prescribe antihistamines such as cetirizine or loratadine to relieve itching and reduce allergy symptoms. These medications can be taken either orally or as topical creams or ointments.
4. Glucocorticosteroids: In some cases, your doctor may prescribe glucocorticosteroids, such as prednisolone, to reduce inflammation and swelling. These medications are usually taken in pill form or intravenously.
5. Observation and hospitalization: In case of severe symptoms, especially if the respiratory tract is affected or the patient's general condition worsens, hospitalization for observation and more intensive treatment may be required.
6. Future allergen avoidance: After an episode of Quincke's edema, it is important to identify and avoid allergens that could cause a reaction in the future. Patients with recurrent episodes of Quincke's edema may be advised to carry an automatic epinephrine injector for emergency use if needed.

Treatment of Quincke's edema should be supervised by a physician, and even after symptoms have disappeared, it is important to obtain long-term allergy management and maintain urgent safety precautions in case of recurrences.

Prevention

Prevention of Quincke's angioedema is aimed at preventing allergic reactions and minimizing the risk of developing this condition. Here are some preventive measures:

1. Allergen Identification: If you have known allergies, try to identify and avoid allergens that could cause a reaction. This may include foods, insects, pollen, mold, and other possible allergens.
2. Usecaution with medications: If you know you are allergic to certain medications, tell your doctor and pharmacist. If necessary, use a medical alert bracelet or necklace with allergy information.
3. Avoid insect bites: Wear protective clothing and use insect repellents to protect against insect bites, as bites can cause allergic reactions.
4. Training on the use of the Automatic Epinephrine Injector: If you have been diagnosed with an allergy, especially if it is associated with a risk of Quincke's edema, get instructions on how to use the Automatic Epinephrine Injector. Learn how to use it correctly in the event of an allergic reaction.
5. Allergytesting: If you suspect an allergy, see an allergist for allergy testing. This will help to pinpoint the allergen and develop a plan of action in case of an allergic reaction.
6. Adhere to your treatment plan: If you are prescribed antihistamines or other medications to control allergies, follow your doctor's recommendations and take them as prescribed.
7. See anallergist: If you have an increased risk of developing allergic reactions or if you have a history of Quincke's edema, see an allergist. The specialist can help you develop an allergy management plan and suggest additional preventive measures.
8. Learning First Aid: If you have allergies, you and your loved ones should know how to administer first aid in the event of an allergic reaction, including the use of an automatic epinephrine injector.

Forecast

The prognosis of Quincke's angioedema can vary depending on several factors, such as the severity of symptoms, the speed of treatment initiation, and the presence of past allergic reactions. In most cases, with timely and adequate treatment, the prognosis of Quincke's edema is favorable and most patients recover without serious consequences. However, there are a few key points to keep in mind:

1. Speed of treatment: Prompt initiation of treatment, including the use of epinephrine, is critical in the treatment of Quincke's edema. The sooner medical attention is provided, the better the prognosis.
2. Severity of symptoms: The severity of symptoms of Quincke's edema can range from mild to severe. If difficulty breathing or anaphylactic shock develops, the prognosis may be more serious.
3. Cardiovascular problems: Some patients with Quincke's edema may have concomitant cardiovascular problems that can worsen the prognosis. Therefore, it is important to perform a screening and risk assessment.
4. Recurrent cases: In some patients, Quincke's edema may become a chronic or recurrent condition. In such cases, the prognosis may be less predictable and require more careful management.
5. General condition of the patient: The patient's general condition, age, presence of other medical problems, and response to treatment also affect prognosis.

The importance of patients at risk of developing Quincke's edema being trained in first aid measures and knowing how to use an automatic epinephrine injector in the event of an allergic reaction is emphasized. Periodic evaluation and consultation with an allergist or immunologist to identify allergic agents and develop a plan of action is also recommended.

Literature used

Clinical Allergology, Authors:V. V. Skvortsov, A. V. Tumarenko, 2016

Quincke's edema or angioedema. Modern view of the problem, Bulletin of Otorhinolaryngology. Authors: Plavunov N.F., Kryukov A.I., Kadyshev V.A., Sidorov A.M., Tovmasyan A.S., Lapchenko A.A., Gorovaya E.V., Kishinevsky A.E., Tsarapkin G.Y., 2020;85(5):61-64