What are the symptoms of hives and angioedema. How are hives and angioedema diagnosed. What are the different types of hives and angioedema. How are hives and angioedema treated. What are the potential complications of hives and angioedema.

Understanding Hives (Urticaria) and Angioedema

Hives, also known as urticaria, are itchy, raised, reddish areas on the skin that can appear suddenly and affect about a quarter of the general population at some point in their lives. Angioedema, on the other hand, refers to swelling below the surface of the skin and fatty tissue, often occurring in conjunction with hives. Both conditions can be uncomfortable and, in some cases, potentially dangerous.

Key Characteristics of Hives

• Itchy, raised, reddish areas on the skin
• Can appear anywhere on the body
• Range in size from a few millimeters to several centimeters
• Usually fade within 24 hours without leaving marks or bruising

Key Characteristics of Angioedema

• Swelling below the skin surface and in fatty tissue
• Often painful
• Commonly affects face, throat, hands, and feet
• Can also occur in the abdomen or other body areas
• Throat swelling can be life-threatening

Can hives and angioedema occur together? Yes, hives and angioedema can occur simultaneously or independently. Understanding the underlying mechanism of swelling or the specific disease is crucial for determining the most effective treatment.

Classification of Hives and Angioedema

Doctors classify hives based on their duration, which helps in identifying potential causes and determining appropriate treatment strategies.

Acute Urticaria

Acute urticaria refers to hives that last less than 6 weeks. These are often caused by:

• Viral infections
• Food or drug allergies
• Adverse drug reactions (e.g., to opioids or NSAIDs)

Chronic Urticaria

Chronic urticaria describes hives that persist for more than 6 weeks. This condition is further divided into two categories:

1. Chronic spontaneous urticaria: Often autoimmune in nature
2. Chronic inducible urticaria: Triggered by specific environmental factors

Is chronic urticaria dangerous? While chronic urticaria can be frustrating and uncomfortable, it is generally not considered dangerous. However, it’s important to note that the cause of chronic urticaria often cannot be identified, which can be frustrating for patients.

Types of Chronic Inducible Urticaria

Chronic inducible urticaria encompasses various forms of non-allergic hives triggered by specific environmental factors. Understanding these types can help in managing symptoms and avoiding triggers.

• Dermatographic urticaria: Triggered by scratching or rubbing the skin
• Pressure urticaria: Caused by pressure or tight clothes
• Cholinergic urticaria: Induced by sweating or increased body temperature
• Cold urticaria: Triggered by cold exposure or ice
• Vibration-induced angioedema: Swelling caused by vibration
• Solar urticaria: Triggered by sunlight exposure
• Aquagenic urticaria: Caused by contact with water

How can one identify their specific type of chronic inducible urticaria? Identifying the specific type of chronic inducible urticaria often involves observing patterns in symptom occurrence and working closely with a healthcare provider to conduct appropriate tests and assessments.

Angioedema Without Urticaria: A Special Consideration

In some cases, angioedema can occur without the presence of hives. This situation requires special attention and may indicate underlying conditions that need further evaluation.

Potential Causes of Angioedema Without Hives

1. Medication-induced:
   • Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
   • ACE inhibitors (a class of blood pressure medications)
2. Hereditary angioedema (HAE):
   • A rare genetic disorder affecting the C1 Inhibitor protein
   • Can cause fluid shifts from blood to tissues, resulting in swelling
   • Often begins before age 12
   • Requires specialized treatment
3. Acquired angioedema:
   • An acquired form of C1 inhibitor deficiency
   • Typically occurs in individuals over 40
   • Not hereditary or passed to children

Why is it important to distinguish angioedema without urticaria? Identifying angioedema without urticaria is crucial because it may not respond to typical treatments like antihistamines. The underlying mechanism of swelling in these cases often differs from that of hives, necessitating alternative treatment approaches.

Diagnosis and Evaluation of Hives and Angioedema

Proper diagnosis of hives and angioedema is essential for effective management and treatment. Healthcare providers employ various methods to assess these conditions and determine their underlying causes.

Diagnostic Approaches

• Medical history: Detailed discussion of symptoms, duration, and potential triggers
• Physical examination: Assessment of skin lesions and swelling
• Allergy testing: Skin prick tests or blood tests to identify potential allergens
• Blood tests: To check for underlying conditions or autoimmune markers
• Skin biopsy: In some cases, to rule out other skin conditions

How do doctors differentiate between acute and chronic urticaria? The primary factor in distinguishing acute from chronic urticaria is the duration of symptoms. Hives lasting less than 6 weeks are classified as acute, while those persisting beyond 6 weeks are considered chronic.

Treatment Strategies for Hives and Angioedema

Treatment for hives and angioedema aims to relieve symptoms, prevent recurrence, and address any underlying causes. The approach may vary depending on the type and severity of the condition.

Common Treatment Options

1. Antihistamines:
   • First-line treatment for most cases of hives
   • May be prescribed at higher doses for chronic urticaria
2. Corticosteroids:
   • Used for short-term relief in severe cases
   • Not recommended for long-term use due to potential side effects
3. Omalizumab:
   • A biologic medication for chronic urticaria resistant to antihistamines
   • Administered as injections
4. Cyclosporine:
   • An immunosuppressant used in some cases of chronic urticaria
   • Requires careful monitoring due to potential side effects
5. Lifestyle modifications:
   • Avoiding known triggers
   • Stress management techniques
   • Dietary changes if food triggers are identified

Are there specific treatments for hereditary angioedema? Yes, hereditary angioedema (HAE) requires specialized treatments. These may include C1 inhibitor replacement therapy, kallikrein inhibitors, or bradykinin receptor antagonists. The choice of treatment depends on the specific type of HAE and individual patient factors.

Living with Hives and Angioedema: Management and Coping Strategies

While hives and angioedema can be challenging to live with, there are several strategies that can help manage symptoms and improve quality of life.

Self-Care Techniques

• Keep a symptom diary to identify potential triggers
• Use cool compresses to soothe itchy skin
• Wear loose, comfortable clothing to avoid skin irritation
• Practice stress-reduction techniques like meditation or yoga
• Maintain good sleep hygiene to support overall health

When to Seek Emergency Care

While most cases of hives and angioedema are not life-threatening, certain symptoms require immediate medical attention:

• Difficulty breathing or swallowing
• Swelling of the tongue or throat
• Dizziness or fainting
• Rapid heartbeat
• Severe abdominal pain

How can patients effectively communicate their symptoms to healthcare providers? Keeping a detailed symptom diary, including information about potential triggers, duration of symptoms, and response to treatments, can greatly assist healthcare providers in managing hives and angioedema effectively.

Research and Future Directions in Hives and Angioedema Treatment

The field of hives and angioedema research is continually evolving, with new treatments and diagnostic approaches on the horizon.

Emerging Treatment Options

• Targeted biologics: New medications that target specific pathways involved in hives and angioedema
• Immunomodulatory therapies: Treatments that aim to regulate the immune response
• Personalized medicine approaches: Tailoring treatments based on individual genetic and molecular profiles

Advances in Diagnostic Tools

• Biomarker identification: Developing blood tests to predict treatment response and disease progression
• Improved allergy testing: More accurate and comprehensive methods for identifying triggers
• Genetic testing: Enhancing the diagnosis of hereditary forms of angioedema

What role does patient participation play in advancing hives and angioedema research? Patient participation in clinical trials and research studies is crucial for advancing our understanding of hives and angioedema. By volunteering for studies, patients contribute to the development of new treatments and improved diagnostic methods.

The Psychological Impact of Chronic Hives and Angioedema

Living with chronic hives and angioedema can have significant psychological effects on patients. Understanding and addressing these impacts is crucial for comprehensive patient care.

Common Psychological Challenges

• Anxiety about potential flare-ups
• Depression related to chronic symptoms
• Social isolation due to visible symptoms
• Frustration with the unpredictable nature of the condition
• Sleep disturbances leading to fatigue and mood changes

Coping Strategies

1. Seek support from mental health professionals
2. Join support groups or online communities for individuals with similar conditions
3. Practice mindfulness and relaxation techniques
4. Educate friends and family about the condition to foster understanding
5. Focus on activities and hobbies that bring joy and distraction from symptoms

How can healthcare providers address the psychological aspects of chronic hives and angioedema? Healthcare providers should consider a holistic approach to treatment, including regular assessment of patients’ mental health and referral to appropriate mental health services when needed. Integrating psychological support into the overall treatment plan can significantly improve patient outcomes and quality of life.

Hives (Urticaria) & Angioedema Symptoms, Diagnosis & Treatment

Hives or welts, also known as urticaria, are itchy, raised, reddish areas on the skin. About a quarter of the general population can have hives during their life. Hives often appear without warning and may start at any age.

Angioedema is swelling below the surface of the skin and fatty tissue. Areas of swelling may be painful. Angioedema usually occurs in the face, throat, hands, and feet. Swelling can also occur in the abdomen or other areas of the body. Throat swelling can be life threatening and requires immediate medical attention. It is important to understand that angioedema is a medical term to describe swelling. It can be found with many different disorders. Angioedema can occur with or without hives. There are several different ways swelling can occur. Understanding the underlying mechanism of swelling or the specific disease is critical in determining the best treatment. 

Hives and Angioedema Symptoms & Diagnosis  

Hives are itchy and can occur anywhere on the body including the face, extremities, chest, back or face. Hives range in size from just a few millimeters to several centimeters. An individual hive usually fades within a 24-hour period and the skin returns to normal without leaving any marks or bruising.

Doctors will classify your hives based on how long you have had them. When hives occur for less than 6 weeks, we call this acute urticaria. When hives last longer than 6 weeks, we change the name to chronic urticaria. This helps doctors think about possible causes of your hives. The cause of your hives change based on how long you have had them. Chronic urticaria (hives over 6 weeks) is not dangerous. Sometimes hives occur with angioedema (swelling). Usually the cause of chronic urticaria cannot be identified. Allergy is not typically a cause of chronic urticaria. This is a constant finding of medical authorities and researchers around the world. The absence of an identifiable trigger can be frustrating for patients.

Classifications

Modified from http://www. urtikaria.net/en/forms-of-urticaria/overview.html

Angioedema without Urticaria: A Special Situation

Talk to your doctor if swelling occurs without hives. This may suggest a special situation requiring additional evaluation. Sometimes high dose antihistamines may not improve your swelling. This is because the mechanism (cause) of swelling may be different than that of hives.

Swelling without hives may be due to:

1. Aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) such as ibuprofen

2. ACE inhibitors (a class of blood pressure medications)

3. Hereditary angioedema (swelling)

• Hereditary angioedema (HAE) is a rare genetic disorder in which patients have a defect in the gene that controls a regulatory blood protein called C1 Inhibitor. When C1 Inhibitor does not function properly, fluids can shift out of the blood and into tissues to cause swelling. Antihistamines, corticosteroids and epinephrine will not be effective in treating swelling in patients with HAE, however targeted treatments are available once your diagnosis is established. Over 50% of patients with HAE will have their first swelling episode prior to age 12.

4. Acquired angioedema

• Acquired angioedema (swelling) is an acquired form of C1 inhibitor deficiency that can occur if you are over age 40. This is not hereditary or passed to your children.

Angioedema without Urticaria

Hives and Angioedema Treatment & Management  

The goals of treatment are to:

• Provide relief of itching

• Make hives more tolerable

• Provide complete resolution of your hives

Medications will help your itching and reduce hives. Medications will not “cure” hives but can help to completely resolve them. Antihistamines are the best initial medication to treat your hives. Sometimes, a combination of several antihistamines or an increased dose of one antihistamine may be recommended.

Older antihistamines (sedating antihistamines) may cause you to get sleepy, cause dryness and only last for several hours. Newer non-sedating antihistamines are less likely to make you sleepy. They have fewer side effects and last much longer. Non-sedating antihistamines (shown below) are often the first medication doctors will prescribe for your hives. High dosages, up to 4 times the recommended dose, are often well tolerated and can help control your itching. This will also help to prevent the use of other medications that may have more side effects.

About 50% of chronic spontaneous urticaria (hives over 6 weeks with no identifiable cause) will respond to antihistamine as discussed above. For those who do not improve on antihistamines, 65% respond to omalizumab (Ref 2). Omalizumab is an FDA approved treatment of chronic urticaria. This medication is injected under the skin once a month. Corticosteroids, such as prednisone or prednisolone may help hives. These are not an ideal treatment for long-term use but may have a role to relieve severe symptoms for a few days.  

Your doctor will outline a treatment plan that allows you to increase treatment during an outbreak of hives or swelling and reduce medications when the hives or angioedema are not as bothersome.

Chronic hives can last for many years but will often go away. Hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years. Even if a patient’s hives improve, it is not unusual to see the hives recur months to years later.

Antihistamines commonly used to treat urticaria:

References

1. Bernstein JA, Lang DM, Khan DA et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133:1270-7

2. Kaplan AP. Therapy of chronic urticaria: a simple, modern approach. Ann Allergy Asthma Immunol. 2014;112:419-25

3. Zuraw BL, Bernstein JA, Lang DM et al. A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema. J Allergy Clin Immunol. 2013;131:1491-3

Find out more about skin allergies.

Test your knowledge and see how much you know about hives.

Reviewed: 9/28/20

Hives, Urticaria, and Angioedema: Symptoms, Causes, and Treatment

Written by WebMD Editorial Contributors

• Causes
• Types
• Diagnosis
• Treatment
• 7 Simple Tips
• When Should I Call the Doctor?
• More

Hives are swollen, pale red bumps, patches, or welts on the skin that appear suddenly. On darker skin tones, they can appear skin-colored and can be more difficult to see. They can happen because of allergies or other reasons. Your doctor may call them urticaria.

Hives usually itch, but they may also burn or sting. They can show up anywhere on your body, including the face, lips, tongue, throat, and ears. Hives can change size rapidly and move around, disappearing in one place and reappearing in other places, often in a matter of hours. Hives can often appear and then clear up within a few hours. Some people have one flare-up and never get hives again. It’s also possible to have many flare-ups.

They range in size from a pencil eraser to a dinner plate and may join together to form larger areas known as plaques. They can last for hours, weeks, or even years.

Angioedema is different. The swelling happens under the skin, not on the surface. It’s marked by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours. It’s rare, but angioedema of the throat, tongue, or lungs can block your airways, making it hard to breathe.

Allergic reactions, chemicals in foods, insect stings, sunlight, and medicines can make your body release a chemical called histamine. Histamine sometimes makes blood plasma leak out of small blood vessels in the skin, causing hives or angioedema.

Sometimes, doctors don’t know exactly why hives have formed.

Acute urticaria and/or angioedema: With these conditions, hives or swelling lasts less than 6 weeks. The most common causes are foods, medicines, latex, and infections. Insect bites or a disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs that can cause hives and angioedema include aspirin and other NSAIDs (such as ibuprofen), high blood pressure medications (such as ACE inhibitors), and painkillers such as codeine.

Chronic urticaria and/or angioedema: Hives or swelling that lasts more than 6 weeks. The cause is usually harder to find than in acute cases. The causes can be similar to those of acute urticaria but can also include your immune system, chronic infections, hormonal disorders, and tumors.

Physical urticaria: Hives caused by direct physical stimulation of the skin – for example, cold, heat, sunlight, vibration, pressure, sweating, and exercise. They usually happen right where the skin was affected and rarely appear anywhere else. Most appear within 1 hour after exposure.

Dermatographism: Hives that form after firmly stroking or scratching the skin. You may also have other forms of hives.

Hereditary angioedema: Painful swelling under the skin. It runs in families.

Your doctor will ask you many questions to try to find the cause of hives or angioedema. You’ll also get a checkup.

Your doctor may give you skin tests to find out if you’re allergic to something. You may get blood tests, too.

The best treatment is to identify and remove the trigger. But that’s not always easy.

Your doctor may prescribe antihistamines to ease your symptoms or help prevent them.

If you have chronic hives, you may need antihistamines or a combination of medications, such as steroids or a biologic drug.

For severe hives or angioedema, you may need a shot of epinephrine or a steroid medication.

While you wait for the hives and swelling to disappear:

1. Avoid hot water. Use lukewarm water instead.
2. Use gentle, mild soap.
3. Apply cool compresses or wet cloths to the affected areas.
4. Try to work and sleep in a cool room.
5. Wear loose-fitting lightweight clothes.
6. Use anti-itch medication that you can get without a prescription, such as an antihistamine or calamine lotion.
7. Apply a fragrance-free moisturizer several times a day to keep your skin from getting dry.

If you have hives or angioedema and any of the following symptoms, call your doctor right away:

• Dizziness
• Wheezing
• Trouble breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

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Quincke’s edema: causes, symptoms, treatment

An allergic reaction may present as a mild rash or be more severe and life threatening. If the allergy manifests itself in the form of local painful edema, it is called giant urticaria, or Quincke’s edema. This condition requires urgent medical attention, which must be provided even before the doctor arrives.

What is Quincke’s edema

The German doctor Heinrich Irenaeus Quincke first gave a complete description of the disease and suggested the causes of its occurrence in 1882, for which angioedema was named after him.

Quincke’s edema, or angioedema, is an acute inflammatory reaction of the body that occurs locally in the skin and subcutaneous tissue. According to the mechanism of appearance, it is similar to urticaria, the difference is only in deeper tissue damage.

Allergic reactions are one of the responses of the immune system to foreign proteins. Mast cells take part in them – one of the types of leukocytes that are able to combine with Ig E immunoglobulin proteins. This leads to a cascade release of biologically active substances – inflammatory mediators. These include histamine, prostaglandins, bradykinin, and many others. These substances increase the permeability of blood vessels, reduce their tone, change the water-salt balance.

The peculiarity of mast cells is that they are not constantly in the blood, like other leukocytes, but are localized in tissues:

• in leather;
• subcutaneous tissue;
• on mucous membranes;
• in shells of internal organs.

Therefore, Quincke’s edema has specific manifestations and is observed only on the skin and in places with the most pronounced fiber.

The increase in vascular permeability caused by these substances leads to the release of the liquid part of the blood from the vessels. It impregnates the local area, which is externally manifested by swelling of soft tissues. Fluid loss can be significant, in the vascular bed decreases the volume of blood. The work of the heart suffers from this, rhythm disturbances appear. Adults with a predisposition to heart disease can have fatal consequences.

Symptoms of Quincke’s edema

Quincke’s inflammation occurs rapidly. This is a response to direct contact with the allergen, which develops 15-30 minutes after foreign substances enter the body. Puffiness extends to parts of the body that contain a large amount of fiber. Most often these are:

• eyelids;
• lips;
• larynx;
• soft palate;
• urinary organs.

Swelling of the skin is not accompanied by a change in its color, often it remains pale pink. But sometimes allergies are accompanied by signs of hives. In this condition, the skin begins to itch, turn red.

Classical angioedema, which is accompanied by impaired fluid distribution, is characterized by uneven contours. To the touch, the tissues are dense, when pressed on them, a fossa does not appear. Unlike urticaria, the upper layers of the skin are not involved in the process. Therefore, itching is not characteristic of this disease.

Symptoms of angioedema depend on its location. If the mucous membrane of the mouth, throat and larynx is involved in an allergic reaction, then hoarseness appears. In the absence of medical care, pathological signs become aggravated, swallowing is difficult at first, and then breathing. Later, the bronchi swell, there are signs of asphyxia, or suffocation.

Sometimes allergic edema becomes the first symptom of severe anaphylactic shock. This life-threatening condition develops rapidly as an acute reaction to an allergen. It is characterized by respiratory failure due to bronchospasm, itching all over the body, skin rashes like urticaria. A sign of worsening condition is cramping abdominal pain, nausea and vomiting, and diarrhea. In an adult, blood pressure drops rapidly, a violation of the heart rhythm is manifested. Signs of heart failure quickly appear, convulsions appear, a person falls into a coma or death occurs.

Allergic inflammation often affects only the digestive tract. Signs of pathology in this case will mimic surgical pathologies of the abdominal cavity. There is acute pain in the abdomen, sudden indigestion, diarrhea or vomiting. Sometimes impurities of blood, mucus appear in the feces, so the disease does not look like an allergy.

In some cases, Quincke’s edema appears on the back of the hands. They look swollen, firm when touched.

The occurrence of angioedema on the face is life threatening. Uneven distribution of fluid can lead to its impregnation of the meninges. In this case, meningeal symptoms appear:

• neck muscle tension;
• severe headache;
• nausea and vomiting that does not relieve;
• convulsions;
• loss of consciousness.

Angioedema may develop on the genitals. In women, the labia is affected, in men, swelling extends to the scrotum. Itching is usually absent. To prevent this condition, it is sometimes necessary to abandon latex condoms.

First aid for angioedema

To reduce the chance of serious complications, before the arrival of the ambulance, you need to provide first aid yourself. If it is known that some allergen has become the cause of the inflammatory reaction, it is necessary to try to eliminate it. This is possible if skin contact has occurred.

If the manifestation of the disease began after an insect or animal bite, it is necessary to apply a pressure bandage to this place. It will reduce the inflow and outflow of blood, which will reduce the absorption of a dangerous substance into the blood. Do the same if an allergy develops after an intramuscular injection. Doctors advise putting cold on the injection site to cause vasospasm and prevent the medicine from being absorbed.

If the reaction developed after contact with an unknown plant, insect, after taking a drug, you can take a photo of it. This will help the doctor determine the cause of the pathology.

If breathing is difficult due to swelling of the throat, it is necessary to unfasten clothing so as not to restrict the respiratory movements of the lungs. Indoors, windows should be opened to allow fresh air to flow in.

A child who develops an allergy in the form of Quincke’s edema is usually in an excited state, frightened. So that the inflammation and swelling of the larynx does not begin to develop rapidly due to crying and screaming, you need to try to calm it down. In a small child, the danger is laryngospasm, which further impairs breathing and is very dangerous under the age of one year.

There are several reasons why you should not take allergy medications on your own. The absorption of tablets from the digestive tract may be slowed down due to inflammatory swelling of the mucous membrane of the stomach and intestines. Therefore, it will be ineffective. And the emergency doctor must choose the dose of the drug for the treatment of allergies, taking into account the medication already used.

If the cause of the allergic reaction is food or other substances taken orally, it is possible to slow down their absorption from the stomach and intestines with the help of sorbents. A child can dissolve a sachet of Smecta , powder Polysorb , and for an adult to drink a few activated charcoal tablets. With difficulty swallowing and spasm of the larynx, it is also better to use soluble powders.

In some forms of Quincke’s edema, it is difficult to recognize the symptoms of the disease, it develops slowly over several hours or days. In this case, local swelling is a reason to see a doctor as soon as possible.

Causes

To effectively treat Quincke’s edema and prevent its recurrence, it is necessary to find the cause of the pathology. In a child, an acute allergic reaction most often occurs to a certain product. It can be egg white, nuts, chocolate, fish, honey, citrus fruits. Sometimes the disease does not occur on the product itself, but on the additional substances contained in it. For example, if you are allergic to chicken, the antibiotics that were treated at the poultry farm may be to blame. Foods that are high in artificial flavors, colors, and other chemical additives are more likely to trigger an inflammatory response.

Quincke’s edema, like other allergic reactions, manifests itself upon repeated contact with the allergen. Therefore, eating certain foods at risk for the first time will not cause symptoms.

Other causes of Quincke’s edema can be:

• drugs – antibiotics, sera containing animal proteins;
• hormonal preparations;
• local anesthetics – Lidocaine , Ultracaine ;
• blood products – immunomodulators, interferons;
• animal poisons, their saliva or hair particles, insect scales;
• cosmetics.

Inflammation can show up on latex, which is used for medical gloves, condoms, intravenous catheters.

Angioedema is caused by some biologically active additives, traditional medicines that contain plant allergens, beekeeping products, insect poisons. For people who have had an allergic reaction to honey, it is dangerous to use other components derived from bees.

The peculiarity of Quincke’s edema associated with an allergic reaction is that it does not depend on the dose of the incoming allergen.

Among the causes of angioedema are non-allergic reactions. There is a hereditary disease that is associated with a lack of complement proteins. Normally, they are involved in immune responses. If there is a deficiency in the body or there is a defect in the synthesis of inhibin C1, which inhibits the inflammatory response, then periodic signs of pathology appear, which looks like Quincke’s edema. But the difference is in the rate of development of the disease, it often takes several days and it is impossible to establish a connection with a specific allergen.

If the cause of the pathology is heredity, the symptoms of the disease appear smoothly, urticaria never joins, there is no skin itching and bronchospasm. But the risk of severe swelling of the throat, which leads to death, remains. The skin and subcutaneous tissue is able to independently return to its original state 2-3 days after the first signs of the disease appear. This is due to the gradual depletion of complement proteins.

In older people, the cause of Quincke’s edema in 30% of cases are drugs from the group of ACE inhibitors. They are prescribed for the treatment of heart failure, hypertension and other cardiovascular pathologies. A side effect of ACE inhibitors is an increase in the level of bradykinin, which is one of the mediators of inflammation. This happens at different rates, sometimes several months after the start of therapy, and sometimes after many years.

Classification

Angioedema in 80% of patients is associated with an allergic reaction to foreign substances. But in the practice of doctors there are other forms of this disease. Depending on the duration of the symptoms, two types are distinguished:

• acute angioedema – occurs quickly after contact with the allergen, disappears after treatment and does not recur if the doctor’s recommendations are followed;
• chronic angioedema – signs of pathology recur periodically for 6 months or persist for a long time.

Idiopathic angioedema is isolated separately. It appears suddenly, it is impossible to determine the relationship with the allergen in the laboratory. This type of disease has a chronic course and often recurs.

Quincke’s edema is hereditary and acquired. In the first case, this is a chronic disease, the development of which is difficult to predict. It can show up at an early age. Symptoms often worsen in stressful situations. Studies show that this can be triggered by:

• acute pain;
• eating certain foods;
• hypothermia;
• viral infections;
• pregnancy.

Sometimes minor injuries in the oral cavity during dental treatment, tongue piercing act as a provoking factor.

Acquired Quincke’s edema develops in conditions that lead to a lack of inhibin C1 protein. This process is activated in patients who are treated with drugs from the ACE inhibitor group. Protein suppression occurs in neoplastic diseases – B-cell lymphoma, pathology of immune complexes. In an autoimmune disease, the pathology of immune complexes to the inhibin of the C1 protein produces antibodies that block its functions. A similar process is observed in autoimmune diseases – systemic lupus erythematosus, dermatomyositis.

Acquired angioedema manifests itself in old age, when a person has a large number of comorbidities.

Treatment and prevention

An ambulance must be called to treat Quincke’s edema. The doctor relieves severe symptoms, but in a serious condition, the development of bronchospasm, suspected swelling of the brain or internal organs, treatment is necessary in the appropriate departments of the hospital.

If it was possible to recognize angioedema by external symptoms, it is treated with antihistamines. Most effective Dimedrol , Suprastin, Tavegil . To quickly stop the allergic reaction, drugs are administered intramuscularly.

For children with severe generalized urticaria or acute Quincke’s edema, to prevent laryngeal stenosis and other severe complications, antiallergic drugs are diluted in an isotonic solution according to a special scheme and administered intravenously.

If treatment is not effective, hormones are used. Glucocorticoids (e.g. Dexamethasone ) rapidly inhibit the immune response and can be used in patients of any age. In a critical situation, a doctor will use an adrenaline solution to save a life.

If the patient’s laryngeal stenosis persists, he continues to choke, to prevent this from happening, the ambulance team performs an emergency tracheal intubation and takes the patient to the hospital.

Acute Quincke’s edema should be treated even after symptom relief. The doctor will prescribe anti-allergic drugs in tablets that must be taken on their own, a special hypoallergenic diet. It excludes the use of products that are potentially capable of causing allergies.

After normalization of the condition, it is necessary to determine what caused the pathology. To do this, keep a food diary. It is filled daily a few hours after eating. For the period of studying nutrition, food should be monotonous. A product that could presumably cause an allergy is introduced into the diet every few days. If after 1-2 hours the condition has not changed, it is considered that this is not the cause of the pathology. This process is repeated until all hazardous products have been examined.

Special allergy tests are available to detect allergies to various substances. They are carried out in the period after the subsidence of all symptoms. They help pinpoint the type of substance that caused the angioedema.

Prevention of angioedema consists in the complete exclusion of contact with substances that cause the development of allergies. If the cause was a drug, an anesthetic, you need to remember its name. Otherwise, subsequent dental treatment or a simple operation on soft tissues can end in failure.

If the cause of the angioedema has not been identified and the symptoms recur periodically, antihistamines should always be carried for prevention ( Nosefrine and others).

Angioedema – causes, symptoms, treatment (first aid, drugs) of angioedema

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Prophylaxis

Quincke’s edema, also known as angioedema, is an acute allergic reaction of the immediate type. It is a rapidly emerging swelling of the skin, subcutaneous tissue and mucous membranes in a certain area of ​​the body, most often in the face, neck, genitals. Of particular danger is the defeat of the larynx, which can result in suffocation and death of the patient, as well as swelling of the meninges.

Quincke’s edema requires emergency medical care and often hospitalization of the patient. If there are signs of suffocation, then first of all contact with the allergen is eliminated and resuscitation measures are taken to restore the patency of the airways, then antihistamines, glucocorticosteroids and other drugs are administered.

Causes

Angioedema is the immune system’s way of responding to exposure to foreign proteins. A special type of leukocytes, mast cells, is involved in its development. When interacting with an allergen, they release biologically active compounds into the blood: histamine, prostaglandins, bradykinin, and others. These substances increase the permeability of blood vessels, due to which the fluid from the bloodstream passes into the surrounding tissues and causes them to swell.

Mast cells are not present everywhere in the body, they are concentrated in the skin, subcutaneous fat, mucous membranes and internal organs, which explains the damage to certain parts of the body.

Angioedema can be caused by any allergen. More often, the following factors lead to its development:

• taking medications, especially drugs from the group of ACE inhibitors, antibiotics, NSAIDs;
• invasive cosmetic procedures involving the injection of a substance;
• exposure to food allergens;
• bite of insects or poisonous animals.

There is also a non-allergic form of angioedema, inherited at the gene level. As a result of mutations, an absolute or relative deficiency of the C1 esterase inhibitor of the complement system appears, and an increased formation of bradykinin occurs, which increases vascular permeability. An excess of biologically active substances can also be released in the presence of malignant tumors, autoimmune processes, viral, fungal or parasitic infections.

Classification

According to the clinical course, Quincke’s edema can be acute, if it lasts from 2 hours to 6 weeks, and chronic, if it lasts more than 1.5 months.

More often it appears in isolation, but there is also a form combined with urticaria. Also isolated hereditary angioedema and acquired. It is called idiopathic if the cause of the disease could not be established.

Symptoms

Edema occurs suddenly, rapidly, asymmetrically. The skin in the affected area has a pale pink color, the underlying tissues are dense to the touch, painless, when pressed on them, there is no depression left. The patient is rarely worried about itching, more often a feeling of fullness, tingling, burning.

Symptoms of Quincke’s edema continue to be present from a couple of hours to several days or weeks, after which they usually disappear without a trace.

With Quincke’s edema, those areas of the body that have a lot of subcutaneous tissue swell:

• the periorbital region;
• lips;
• cheeks;
• neck;
• external genitalia;
• brushes.

The mucous membranes of the nasopharynx, tongue, larynx, esophagus, intestines, urinary organs are also affected, which disrupts their normal functioning.

With swelling of the larynx, breathing can be difficult up to asphyxia. The first signs of this process are hoarseness or loss of voice, barking cough. In the future, shortness of breath appears, the skin of the face acquires a bluish tint. The closure of the airway lumen is accompanied by loss of consciousness and, without resuscitation, can lead to death.

It is more difficult to diagnose an isolated lesion of the digestive organs. With it, severe abdominal pain, vomiting, diarrhea or constipation, flatulence, an admixture of blood and mucus in the feces can be observed, which requires care from the doctor and his ability to distinguish the symptoms of angioedema from surgical pathology and manifestations of poisoning.

Meningeal edema leads to severe headaches, neck muscle tension, seizures, nausea, and vomiting.

Complications

In addition to asphyxia in the case of damage to the larynx, the disease can lead to other serious complications. Since the liquid leaves the vessels in a significant amount, the volume of circulating blood in them decreases, and as a result, the work of the myocardium suffers.

Quincke’s edema in adults prone to cardiac pathologies can cause arrhythmias and be fatal. The pathological process in other internal organs with a pronounced violation of their function may be accompanied by the development of coma, renal failure, the picture of “acute abdomen”.

Diagnosis

In all cases of angioedema, consultation with an allergist is indicated. Diagnosis of the classical form of the disease with localization on the face, neck, limbs does not cause difficulties due to characteristic symptoms. It is more difficult to identify Quincke’s edema with an isolated lesion of the internal organs or the brain. To do this, it is necessary to conduct laboratory tests, and sometimes instrumental studies.

To determine the cause of angioedema, the doctor takes a medical history, specifying the presence of similar allergic reactions in close relatives, the circumstances of the onset of symptoms and their relationship to medication, food, use of cosmetics, insect or animal bites.

It is also necessary to find out if the patient had any autoimmune or oncological disease, whether he is taking angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, estrogens.

Laboratory diagnosis of the disease includes the following tests:

1. Clinical blood test. With angioedema caused by allergies, the number of eosinophils is increased.
2. Blood biochemistry. Analysis is necessary to assess the work of internal organs.
3. Determination of the level of total IgE in the blood. Its increase testifies in favor of the allergic nature of the development of edema.
4. Skin tests. Allows you to identify the allergen that caused the swelling.
5. Determination of the concentration and functional activity of the components of the compliment system. A decrease in the C1 inhibitor indicates a hereditary factor in the development of the disease.
6. Genetic study, the purpose of which is to search for mutations in the C1NH gene. It is carried out with a burdened family history for the early detection of hereditary Quincke’s edema.

According to indications, ultrasound of the abdominal organs, gastroscopy, examination of feces for dysbacteriosis, and with swelling of the larynx, laryngoscopy can also be recommended.

Treatment

With Quincke’s edema, in the vast majority of cases, emergency hospitalization in the ENT, allergological or therapeutic department is indicated, and resuscitation may be required if complications develop.

First aid

What to do with Quincke’s edema, you should find out in advance so as not to get confused at a critical moment and help the person before the doctors arrive. The disease can have severe and life-threatening consequences, so you should immediately call an ambulance team. If the allergen that provoked such an immune response is known, it is necessary to break the contact of the patient with it as soon as possible.

First aid for angioedema includes the following measures:

• in case of an insect or animal bite, a pressure bandage is applied to the affected area;
• when the reaction has occurred after an injection of the drug, cold is applied to the injection site;
• when symptoms are localized on the face, neck, swelling of the larynx, clothes are unbuttoned, you also need to open the window;
• in case of swallowing the allergen, you can drink a sorbent, for example, activated carbon or Smecta.

The development of Quincke’s edema in children is accompanied by a restless state of the child, screaming and crying, which, in case of manifestations of the disease on the face and in the larynx, can accelerate the onset of asphyxia. Therefore, it is extremely important to calm such a patient and stay close to him until the doctors arrive.

Inpatient treatment

Non-drug treatment of angioedema includes a diet containing only foods with a low probability of developing an allergic reaction, limiting the intake of medications that increase the release of biologically active substances into the blood. In case of suffocation, emergency intubation or tracheostomy is performed.

Angioedema medications are usually administered intravenously or intramuscularly. To stop an allergic reaction, antihistamines, glucocorticosteroids, enterosorbents, solutions to restore the volume of circulating blood, normalize the acid-base and water-electrolyte balance are used.

In hereditary angioedema, prednisolone and antihistamines are ineffective. In this case, the administration of a C1 inhibitor, fresh frozen native plasma, antifibrinolytic and diuretic drugs, androgens is recommended in the acute period.

Prevention

Prevention of angioedema consists in the complete exclusion of contact with substances that cause the development of allergies. Patients with a hereditary nature of the disease are recommended medication preparation before dental procedures and surgical interventions, which should be discussed in advance with an allergist.

Author of the article:

Ovsyankina Olga Vladimirovna

allergist-immunologist

work experience 11 years

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