Quincke's edema - emergency measures, further treatment and prevention. Quincke's edema (angioedema) Treatment of angioedema

Many people perceive allergies as an incomprehensible, but not dangerous situation. However, pathology in the form of Quincke's edema is a completely different matter. For most, it can be fatal, no matter if it is an adult or a child. What do you need to know about this pathology?

What is Quincke's edema?

An allergy is a disproportionate reaction of the immune system to an external irritant. This provokes the body to produce special substances - histamines and prostaglandins, which are responsible for inflammation. They make blood vessels more permeable, especially small capillaries, which removes lymph from them into the tissue.

Initially, such swelling was called angioedema due to the fact that diffusion of nerves occurred, leading to expansion and contraction of the vascular bed. This pathological process owes its name to the German physiologist Heinrich Quincke, who described it based on an examination of his patients. He also developed the first technology for its treatment.

Quincke's edema (allergic) affects almost all tissues and organs of the body. However, it most often affects the face and neck. Swelling of the limbs and genitals is possible. However, damage to the respiratory organs and membranes of the brain is considered the most dangerous, since they provoke severe complications from cerebral circulation to suffocation. If immediate assistance is not provided, death cannot be ruled out.

An allergic reaction such as Quincke's edema is not common; on average, it occurs in only 2% of all allergy cases. However, it cannot be called exotic; doctors diagnose it in every tenth person in one form or another. There is no specific age for the pathology, but most often it affects young women and children with a tendency to allergies. However, those who are not prone to reactions should not be excluded from the risk group, because anyone can eat a food allergen.

In each individual case, the rate at which edema appears is different; it can be an acute form of pathology with development in 5-10 minutes or a couple of hours, or days. It depends on the type of allergen and how long it has been affecting the body. In rare cases, swelling goes away for a long time, becoming chronic - from 6 weeks.

Children swell due to this reaction from birth. Usually in infants it occurs due to artificial feeding, as a reaction to formula, cow's milk or medications. In children of the first year of life, Quincke's edema is always more severe than in others, and its outcome is usually fatal. It is in children that ventricular swelling of the brain is most often diagnosed, as well as a tandem of allergies with bronchial-type asthma. In pregnant women, urticaria and Quincke's edema occur less frequently. However, their consequences can be fatal for both mother and baby. Giant urticaria occurs more often in them, causing hypoxia in both.

Causes

The clinical picture of Quincke's edema, like any other allergic reaction, develops due to the invasion of the body by an allergen. Most often this is:

• food products and dishes made from eggs, nuts, honey, chocolate, fish, a number of fruits and additives;
• medications, especially antibacterial agents, vitamins, etc.;
• any toxins, poisons including insects;
• vegetable, like pollen;
• wool, things made from it or bird feathers;
• household chemicals, cosmetics;
• dust;
• a number of microorganisms.

Important! For some people, an allergen can be any substance that is not considered an allergy for others. The most severe angioedema occurs when bitten by snakes and insects.

Indirect factors that provoke this swelling are a number of pathologies of internal organs, including endocrine and worms. There are people who are genetically predisposed to angioedema; they only need to get cold or experience severe stress to suffer from it.

Kinds

Doctors divide pathology into two groups.

According to general condition

Concomitant factors and the patient’s health make it possible to distinguish the following types of Quincke’s edema:

• acute - swelling lasts up to 6 weeks;
• chronic - more than 6 weeks;
• acquired;
• hereditary;
• with urticaria;
• isolated.

By type of edema

Types of pathology by nature of occurrence:

1. Allergic, as a reaction of the immune system to an allergen. Most often it is a food irritant.
2. Non-allergic, occurring in people with a congenital pathology that has developed a compliment in the body at the genetic level. When an allergen invades, it activates proteins to suppress it. When protein compounds are spontaneously activated to chemicals, heat or cold, a massive allergy occurs.

With a non-allergic form of Quincke's edema, symptoms affect both the skin and the mucous membranes of the respiratory tract and gastrointestinal tract. Its spontaneity is due to changes in temperature, injury, stress, but in a third of cases it is impossible to determine the cause of swelling.

Characteristic symptoms

Most often, the affected area becomes pale, and swelling may change location. The swelling itself is dense, so that even with pressure the characteristic pit does not form.

With urticaria, Quincke's edema appears as purple itchy spots with clear boundaries, a rash that can merge into a large spot. Urticaria itself is not life-threatening, but with angioedema it is scary, because it affects the throat, pharynx, larynx and trachea. In case of pathology, the clinical picture will be as follows:

• difficulties with respiratory function;
• anxiety;
• barking cough;
• hoarseness of voice;
• blue skin around the lips and eyes;
• pale face;
• loss of consciousness.

Upon examination, the doctor reveals swelling of the palate and palatine arches, and a narrowed lumen of the pharynx. If the swelling spreads to the trachea and larynx, then asphyxia occurs and without urgent medical care the patient will die.

Quincke's edema on internal organs provokes:

• stomach ache;
• vomiting;
• diarrhea;
• tingling of the palate and tongue;
• changes in the condition of the skin and mucous membranes.

If the patient is affected by swelling of the membranes of the brain:

• becomes lethargic;
• the muscles of the back of the head are rigid;
• he feels sick;
• suffer from cramps.

Regardless of the location of Quincke's edema, a person may be agitated or lethargic, experience joint pain or suffer from fever.

Providing emergency assistance

The consequences of Quincke's edema are extremely dangerous, so the patient needs urgent help. While the doctors are on their way, urgent measures are needed.

At home and at work

Call an ambulance immediately, even if the person’s condition is satisfactory and stable, since it is impossible to predict the development of pathology. Without panic, take the following measures:

1. Lay down or sit the person in a comfortable position, trying to calm him down.
2. Eliminate the allergen or contact with it. If you are bitten by an insect with a sting, it must be removed immediately. If this is not possible, wait for help from specialists.
3. Give an injection or an antihistamine tablet such as Diazolin or Diphenhydramine. An injection is better, because there is no guarantee that the swelling did not provoke changes in the gastrointestinal tract.
4. Drink alkaline water to neutralize the allergen and remove it from the body.
5. Give a dose of any sorbent.
6. Apply a cold compress to the inflamed area to relieve itching and swelling.
7. Open all windows, loosen tight clothing so that the patient has free access to fresh air.

Important! In severe cases of Quincke's edema, do not take special measures so as not to worsen the patient's condition.

In the hospital

The first actions of doctors are aimed at eliminating contact with the irritant, as this contributes to the progression of edema. Apply cold compresses to the area of ​​swelling, and in case of an insect, snake bite or medicinal injection, apply a tourniquet above this area, but for no more than half an hour. Subsequently, they carry out:

1. Hormonal therapy with glucocorticosteroids, which eliminate swelling and normalize breathing. If it is giant urticaria, then Prednisolone is chosen. If it is combined with Quincke's edema, then Dexamethasone is used.
2. Desensitizing treatment with antihistamines to reduce the body's sensitivity to re-invasion of the irritant. Usually these are intramuscular injections of Suprastin, Tavegil or Diphenhydramine.

Diagnostics

First of all, diagnostic measures are aimed at establishing the factor that provoked the swelling. Therefore, collecting anamnesis and interviewing those present during the attack and the patient himself is so important.

For research, blood is taken for specific immunoglobulins and allergy tests are performed. Additionally, tests are carried out with urine and blood for biochemical components, as well as analysis of elements from the complement system, such as worms and protozoa. Autoimmune pathologies and diseases of the blood and gastrointestinal tract are excluded.

Treatment

Therapy for angioedema consists of two stages:

• stopping the body’s acute reaction;
• eliminating the root cause of the process.

Which hospital department the patient will be sent to depends on the severity and nature of the swelling. If this is a severe shock condition, then this will be resuscitation, as in the case of Quincke's edema in the larynx. But if it is not severe, then perhaps the patient should be admitted to the ENT department. In case of abdominal syndrome, the patient is hospitalized in surgery, and in case of moderate angioedema - in the therapy or allergy department.

With giant urticaria, removing the irritant is paramount. For physical allergens, photoprotective creams are used, especially when reacting to light. Also completely avoid cold drinks and foods that provoke cold allergies.

To eliminate Quincke's edema, the following medications are used:

1. First generation. This could be a dose of Suprastin, Avila, Fenkarol, Clemaxin, which have a beneficial effect within a quarter of an hour. However, they make the patient drowsy and prolong the reaction, therefore they are contraindicated for people whose work requires attentiveness. Their action is directed at H-1 histamine receptors.
2. Second generation, which block histamine receptors and make mast cells stable, preventing histamine from entering the blood. The most commonly used is Ketotifen, which relieves spasm of the respiratory tract well. Therefore, it is recommended to be used for Quincke's edema and bronchial asthma and other broncho-obstructive pathologies.
3. Third generation, which do not affect the central nervous system, but block histamine receptors and normalize the functioning of mast cells, like Claritin, Astemizole or Semprex.

Complications and prognosis

The most dangerous consequence of Quincke's edema is its spread to the larynx and tongue. This leads to the inability of a person to perform respiratory function, and without timely and qualified assistance, the patient will die in a couple of minutes. Therefore, if you detect a barking cough, hoarseness of voice and breathing problems, you should not hesitate. The danger of gastrointestinal edema is the provocation of acute abdominal pathology, which leads to acute pain, symptoms of peritonitis, increased peristalsis and dyspeptic disorder.

With an inflammatory process in the genitals or urological system, signs of acute cystitis and the inability to empty the bladder occur, which can provoke its rupture.

It is more difficult with swelling of the membranes of the brain and most often such cases end in the death of the patient, even with the help of doctors. Therefore, in case of vertigo, acute headache, nausea, vomiting and problems with coordination, it is necessary to urgently take the patient to the clinic.

Statistics on angioedema say that it is diagnosed in infants and children under 3 years of age infrequently, but in 3% of cases of this pathology. Most often, this is a tandem of hives and swelling, when the child is covered with itchy blisters and rashes. In pregnant women, this figure is 4%, but this is precisely why the risk of fetal loss or its abnormal development is extremely high, since hypoxia can give an unpredictable result.

Due to the fact that most drugs are contraindicated for pregnant women, during therapy the life of the mother is put first and only then the child, who usually does not survive after this. This condition is also dangerous for adolescents, since puberty does not provide the opportunity to provide full assistance due to hormonal changes.

How to avoid the development of a pathological condition

In the modern world, a person is surrounded by thousands of potential irritants, encounters with which cannot always be avoided, but can be minimized. Most often, tourists who try exotic dishes or travel to places rich in harmful and dangerous insects and reptiles suffer. You should not take medications and dietary supplements on your own; the latter are more likely than others to provoke allergies, although many consider them safe.

It is important to read the instructions for medications contained in food products, identifying potentially dangerous substances in them. This is especially important for people prone to allergies. But even a person without a predisposition has no guarantee that he will not suffer from allergies. The thing is that with age the immune system changes, especially after suffering a severe infectious disease.

Quincke's edema is insidious, because it can occur not only during the first contact with an irritant, but also during subsequent ones, when the patient does not expect such a reaction. Therefore, it is important to always have a dose of a product with you that will help relieve swelling.

It is important to be able to recognize pathology in time in order to ask for help or provide it to yourself. Quincke's edema often occurs in places where medical assistance will not be provided soon, but it is the speed that determines whether a person will survive.

Therefore, when traveling to exotic countries, you should always have an enhanced-action antihistamine on hand, especially if you have children. Recent pediatricians do not recommend taking them on extreme holidays abroad, to tropical countries, since the children's body is most susceptible to allergic reactions, which only increases the chances of developing giant urticaria or Quincke's edema. It is important to monitor their diet, because even ordinary adult meals are dangerous for them.

Quincke's edema or angioedema is a disease of allergic etiology, manifested by severe swelling of the mucous membranes and subcutaneous fat. More often, Quincke's edema appears in the face and neck, on the arms; in rare cases, there may be swelling of the internal organs.

Quincke's edema occurs more often in people with allergic diseases. Angioedema most often appears in childhood, as well as in women.

Causes

Quincke's edema can be allergic and pseudo-allergic.

Allergic Quincke's edema appears upon contact with an allergen. For an allergic reaction to develop, the body must already be sensitized - there has already been an encounter with the allergen, and the body has developed antibodies. When this allergen re-enters the site of contact, inflammation is caused: small vessels dilate, their permeability increases, and as a result, tissue swelling occurs.

Allergens can be:

• Food products (citrus fruits, chocolate, eggs, fish products, various berries).
• Medications. The most common reaction is to antibiotics, painkillers, and vaccines. The reaction can range up to anaphylactic shock, especially if the drug is administered by injection. Vitamins and oral contraceptives rarely cause anaphylactic shock.
• Pollen.
• Various insect bites.
• Wool and animal waste products.
• Cosmetics.

Pseudoallergic edema is a hereditary disease; patients have a pathology of the complement system. This system is responsible for triggering an allergic reaction. Normally, the reaction starts only when an allergen enters the body. And with pathology of the complement system, activation of inflammation also occurs from thermal or chemical exposure, in response to stress.

Sometimes it is impossible to identify the exact cause of the appearance of Quincke's edema, then they speak of the idiopathic development of edema.

The following pathologies may predispose to the development of Quincke's edema:

• chronic diseases of the gastrointestinal tract;
• autoimmune diseases;
• helminthiasis.

Also, these diseases contribute to the development of a relapsing course.

Symptoms of Quincke's edema

The disease is characterized by a sudden onset of symptoms. An increase in clinical manifestations is observed within a few minutes.

Swelling appears on the mucous membranes and subcutaneous fat. Most often, swelling of the eyelids, lips, cheeks, tongue, and scrotum appears. The patient feels tissue tension and a slight burning sensation.

When swelling spreads to the vocal cords and larynx, the patient experiences hoarseness, breathing becomes noisy, and a “barking” cough. The patient complains that he has difficulty breathing. Swelling of the larynx can lead to acute respiratory failure if medical attention is not provided in time.

With the development of swelling of the internal organs, abdominal pain may appear if there is swelling, for example, of the intestinal mucosa.

All manifestations of Quincke's edema disappear on their own within a few hours or a few days.

If swelling appears in the facial area or on the mucous membranes of the oral cavity, it is necessary to urgently provide the patient with first aid and call an ambulance. This is necessary to prevent the development of acute respiratory failure and the progression of an allergic reaction.

First aid

After signs of Quincke's edema appear, you need to urgently call an ambulance.

Even if the patient thinks that the symptoms are mild, it is still necessary to consult a doctor.

First aid measures for angioedema include:

• elimination of allergen exposure;
• cold on the area of ​​swelling;
• to remove the allergen from the body, give the patient activated carbon or polysorb;
• give any antihistamine under the tongue (suprastin, zyrtec, zodak, fenistil, clarotadine);
• in case of swelling of the mucous membranes of the nasal cavity, drip vasoconstrictor drops (naphthyzin, rhinonorm).

Upon arrival of the ambulance team, the patient will be given hormonal drugs - prednisolone or dexamethasone. The drugs are administered by injection.

Suprastin is also injected as an antihistamine.

After first aid is provided, the patient is hospitalized in the allergy department.

Treatment of Quincke's edema

Treatment of Quincke's edema is carried out in the allergy department.

First of all, it is necessary to establish why the patient developed such a reaction.

During treatment, a hypoallergenic diet is prescribed, with the exception of citrus fruits, chocolate, honey, and berries.

The patient is prescribed antihistamines - Zyrtec, Fenistil, Cetrin, Loratadine, Suprastin. Usually the course of treatment is 7-10 days.

For a short time, hormonal drugs are prescribed - prednisolone, dexamethasone.

To remove the allergen from the body, polysorb, enterosgel, is prescribed for 3 days.

Drugs are prescribed that reduce the permeability of the vascular wall - ascorutin.

To normalize the activity of the nervous system, ascorbic acid and calcium are prescribed.

Non-allergic Quincke's edema is treated with special medications that are strictly prescribed by a doctor.

Consequences

If first aid and treatment are provided on time and fully, then there will be no consequences for the body. If assistance is not provided in a timely manner, a severe allergic reaction of the body may develop - anaphylactic shock. The consequences of shock can even lead to death.

If you follow measures to prevent recurrence of the process, there are no negative consequences.

To identify the allergen, allergy tests are performed on the patient.

Prevention measures include:

• avoiding the consumption of foods to which allergies are possible;
• exclusion of external exposure to the allergen;
• if you are allergic to plant pollen, then the patient is prescribed courses of antihistamines during flowering;
• exclusion of drugs and agents to which an allergic reaction has been established;
• timely treatment of chronic diseases.

Important! The article was written on the basis of the Federal standard of emergency medical care for angioedema, urticaria

The disease Quincke's edema (angioedema) is the most severe manifestation of an allergic reaction in the human body. The disease occurs suddenly and also develops rapidly. Is a local edema (limited or diffuse) of the subcutaneous tissue and mucous membranes. Sometimes this disease is called angioedema or giant urticaria.

One of the types of Quincke's edema

The pathology occurs in approximately 2% of people at a young age, mainly in women and children. It occurs like a normal allergy, but is very dangerous and the patient can end up in intensive care. In addition, serious complications can occur, including death.

This condition was first published by the scientist Heinrich Ireneus Quincke, after whom the disease was named. Back in 1882, he discovered it and described the symptoms in detail. Many patients may experience a combination of swelling and acute urticaria. In this material we will try to explain and tell in detail what angioedema is and what effective treatment methods are available. In addition, we will consider photos, symptoms and causes of the disease, as well as general recommendations and preventive measures.

Quincke's edema (angioedema) is an acutely developing local swelling of the skin, mucous membranes, and subcutaneous tissue. The disease may be pseudoallergic or allergic in nature. The disease can often be observed on the face (swelling of the lip, eyes, eyelids, tongue, cheeks), neck, legs and even nose. In some cases, dangerous pathology appears in the groin area, in the respiratory tract, in the gastrointestinal tract and in the genitourinary organs.

If Quincke's edema develops in the tongue and throat (larynx), in this case there is a possibility of obstruction of the airway with a subsequent threat of asphyxia. In such cases, the patient needs urgent resuscitation, as there is a risk of death. The hereditary form of angioedema is diagnosed in approximately 25% of patients, the acquired form in 30% of patients, and in other cases the cause of the disease cannot be identified. In half of the cases, swelling occurs in combination with urticaria.

The occurrence of severe swelling in the tongue

The pathogenesis of edema development is associated with increased permeability of vascular walls and uneven distribution of fluid throughout the tissues of the body. The spread of an allergic reaction begins with the antigen-antibody stage. Allergy mediators begin to affect nerve trunks and blood vessels, seriously disrupting their working function. As a result, the vessels begin to expand, increasing their permeability. As a result, plasma enters the intercellular space and local edema develops. Nerve cells do not work actively, leading to paralysis of the nerve trunks. The vessels cannot return to their usual tone, and this leads to even greater relaxation of their walls.

Quincke's edema can occur acutely and quickly, and the duration of the reaction can be 2-3 days. It all depends on the amount of allergen and the duration of its exposure. Following the clinical manifestations, if this is acute edema, then the duration of the course is less than 1.5 months. The chronic course of the disease can last from 1.5 to 3 months or even longer. Doctors distinguish angioedema, both isolated and combined with urticaria. Knowing the causes of allergies, treatment of angioedema can occur without serious consequences.

Photo of Quincke's edema on the face

Photos of Quincke's edema on the hands

Symptoms of Quincke's edema

Main symptoms of edema

In many cases, the main symptoms of Quincke's edema are an increase in size and swelling of the soft tissues of the face, neck and head. The patient's face may swell so much that the head will look like a balloon, and instead of eyes there will be only slits and it is impossible to even lift the eyelids. In addition, the disease can appear on the hands, especially on the fingers, on the legs in the foot area and on the upper chest.

With Quincke's edema, the allergy manifests itself sharply and develops very quickly within a few minutes (less often, several hours). Giant can develop on parts of the body and organs with a developed layer of subcutaneous fat.

The main signs of the development of Quincke's edema:

Quincke's edema in a child is a fairly common phenomenon. In addition, at such a young age, the pathological process, as a rule, has its own characteristics, especially in newborns and infants. Edema in children in most cases reaches larger sizes than in adults. The resulting disease may be of a migratory nature, occurring in one place or another. If you feel the area of ​​swelling, it will seem quite homogeneous and dense. If you press, the indentations do not appear. In approximately half of the cases of angioedema in children, urticaria will occur.

In a child, swelling of the larynx and throat is especially dangerous. Pathological processes in a child, as a rule, develop very quickly compared to adults. That is why if you have even the slightest suspicion, immediately call an ambulance.

Quincke's edema in a child

If the reaction affects parts of the gastrointestinal tract, the child will be bothered by sharp and severe pain in the abdomen, tingling of the palate and tongue. Diarrhea or vomiting may begin, which will appear a little later.

If swelling develops only on the skin, children may suffer from severe joint pain and fever. The child may be agitated and may faint.

If parents know that their child is prone to allergies, they must know the causes of the disease and what exactly can cause life-threatening angioedema:

– These may be some medications. Various antibiotics, anti-convulsants, acetylsalicylic acid, B vitamins, drugs that contain iodine;

– Some food products that can provoke an allergic reaction and all kinds of food additives;

– Bites of various insects. Wasps, mosquitoes, hornets, gadflies, bees;

– Pollen that is released during the flowering period of some plants.

Symptoms of Quincke's edema in children

Signs of angioedema in young children are often not so easy to recognize and parents should be prepared for this. The syndrome in a child is more dangerous than in adults, and the baby will not be able to tell what happened to him and how he feels.

If a child appears pale on the skin, a bluish tint in the nasolabial area, rapid heartbeat and intermittent breathing, it means that the body feels a lack of oxygen associated with swelling of the larynx. The cyanosis may subsequently spread to other areas of the skin, and increased sweating is observed. After this, suffocation may occur with a decrease in pulse rate and loss of consciousness.

The rate of development of the disease, both in adults and in children, may vary in individual cases. Swelling can completely disappear in a few minutes, and sometimes it can progress for several days. Everything will depend on the amount of allergen entering the body and the duration of its action. The duration of swelling may also vary. If several weeks do not go away, the swelling becomes chronic.

Causes (etiology) of angioedema

What causes angioedema? To prevent a dangerous allergic condition, you should always know what exactly causes swelling. It’s impossible to say for sure here, since these are individual circumstances for each person. Absolutely any substance that can be dangerous for one person, but poses no threat to others, can act as an allergen. There are quick and particularly strong allergic reactions that develop in response: this is the venom of insects and snakes.

Attention!
In approximately 30% of cases of angioedema, angioedema is diagnosed as idiopathic, when it is not possible to determine the root cause of the disease.

Knowing the cause, the doctor at the clinic will be able to prescribe the most effective treatment for Quincke's edema. However, a situation may arise when the patient requires emergency care. In this case, you need to act quickly and most importantly, do not panic.

First aid for Quincke's edema

The disease Quincke's edema can develop very unpredictably and pose a great danger to the patient's life. The first thing to do is to call an ambulance, even if the patient’s general condition is stable and satisfactory. Don't panic, do everything clearly and quickly.

Before the first aid team arrives

1. The patient should be seated in the most comfortable position and reassured. You should also calm down yourself.

2. Limit direct contact with the allergen. If it is a wasp, bee or other insect bite, then you need to remove the dalo from the skin. If it is not possible to do this on your own, wait for the doctors to arrive.

3. Emergency treatment includes taking antihistamines. Give fenkarol, diphenhydramine or diazolin. Injectable forms of antihistamines are the most effective, since there is a possibility of developing edema of the gastrointestinal tract, and a malabsorption of substances has occurred. In any case, take 1-2 tablets of the drug if it is not possible to get an injection. When injecting, follow the dosage level. Thanks to medications, you can alleviate the patient’s condition and weaken the reaction until the ambulance arrives.

4. First aid includes mandatory drinking plenty of water: per 1000 ml of water you need 1 gram of soda, or mineral water such as Borjomi or Narzan. By drinking liquid, you can remove the allergen from the body.

5. Use sorbents. You can use regular activated carbon or enterosgel.

6. To reduce itching and swelling, apply a cold compress, ice, or a heating pad with cold water to the affected area.

7. Fresh air is a must, remove objects that may make breathing difficult.

8. Freeing the victim from tight clothing, belt, girdle, tie;

If this is a very severe degree of edema, then in this case do not take any measures on your own so as not to worsen the patient’s condition and wait for the medical team. The main rule is to do no harm.

The medical team can provide first aid in a timely manner

After the emergency ambulance arrived

Providing first emergency aid should be aimed at implementing such tasks as:

1. Stop exposing the patient’s body to a possible allergen. This is necessary to ensure that the disease does not progress. For first aid, a cold compress has an excellent effect. You can use a heating pad with water or ice. If Quincke's edema occurs due to an insect bite, then injections will help, as well as a tourniquet applied slightly above the bite/injection for about 30 minutes.

2. Conduct hormonal therapy. In order to eliminate swelling and normalize breathing, treatment with glucocorticosteroids is used. For giant urticaria, you can use the drug Prednisolone. If a combination of edema and urticaria is diagnosed, then Dexamethasone can be used in treatment.

3. Use desensitizing therapy. Antihistamines will help reduce the body's sensitivity if there is repeated exposure to the allergen. Medicines such as Diphenhydramine, Pipolfen, Tavegil or Suprastin are administered intramuscularly.

Naturally, the patient will need urgent hospitalization in the allergy department. It is possible that after an attack the patient must be in intensive care. In severe cases, urgent assistance and treatment from qualified doctors is required. The count can go on for minutes.

Video about the disease:

Classification of Quincke's edema

In modern medicine, Quincke syndrome, taking into account associated factors, is classified into several types:

– acute edema. This disease with severe symptoms persists for up to 45 days;

– chronic edema. Signs of swelling will persist for approximately 6 weeks. In addition, relapses may occur periodically;

– acquired. During the entire observation period, only 50 such cases were recorded in people whose age exceeded 50 years;

– hereditary angioedema. According to statistics, 1 case per 150 thousand cases is recorded;

– Quincke's edema accompanied by symptoms of urticaria;

– isolated. Accompanied without any additional conditions;

– idiopathic edema. When the cause of the disease cannot be identified.

As a rule, doctors focus more on two types of disease that are similar in appearance:

– angioedema;

– Hereditary(non-allergic) swelling.

Completely different factors can cause the same symptoms of the disease. In these cases, an inexperienced doctor may make an inaccurate diagnosis. And this is fraught with quite serious complications and the use of the wrong treatment regimen and further therapy, both in the hospital and on an outpatient basis. It is important at the stages of providing medical care to correctly determine the type of pathology present in the patient.

What complications can occur with Quincke's edema?

If a person is not helped in a timely manner, Quincke's edema can develop further and lead to serious complications. Let's consider the main consequences that can arise as a result of this pathology:

• The most dangerous thing that can happen is swelling of the larynx. Gradually, the patient will begin to show signs of respiratory failure. There will be symptoms such as: hoarseness, barking cough, difficulty breathing;
• If swelling of the gastrointestinal mucosa occurs, acute abdominal pathology will occur. Quite severe pain in the abdomen will occur, peristalsis will increase, dyspeptic disorder will appear, and in some cases a symptom of peritonitis will appear;
• With swelling of the urogenital system, signs of acute cystitis may occur, and this will provoke urinary retention;
• With this syndrome, there can be dangerous complications on the face. The meninges may be involved in the process of edema, causing the appearance of symptoms of meningeal diseases. Signs of Meniere's syndrome will appear. If first emergency aid is not provided, then this will lead to death;
• Acute urticaria can be combined with Quincke's reaction.

Diagnosis of the disease

To diagnose the disease, it is necessary to determine the etiological factor that contributes to the provocation of symptomatic signs. For these purposes, it is necessary to conduct a very thorough survey of the patient and allergy tests: allergy tests

After the crisis has been overcome and the threat to the patient’s life has been completely eliminated, doctors can prescribe laboratory tests such as:

1. Determination of any disorders in the complement system, analysis of function for the diagnosis and control of autoimmune diseases.

2. Carrying out tests to identify specific IgE. The normal range is 1.31-165.3 IU/ml.

3. Measuring the amount of total immunoglobulin (IgE), which reacts with the allergen and provokes the development of immediate allergic symptoms. It is necessary to conduct an ICL (immunochemiluminescence) study; the results of the IgE indicator should normally be in the range of 1.31-165.3 IU/ml.

After the patient has recovered, when several months have passed and the antibodies that caused the allergic reaction are still present in the body, the following studies need to be carried out:

1. Allergy skin tests. The classic method is used when a possible allergen is applied to the skin. If there is susceptibility, the skin will show mild inflammation around the applied agent.

2. An immunogram is analyzed or the patient’s immune system is examined.

3. Search for any systemic diseases that can trigger the development of Quincke's edema.

4. If a pseudo-allergic reaction occurs, then you should conduct an examination of the whole body and prescribe an extensive set of tests (bacteriological, biochemical), do an ultrasound, and also an x-ray of the organs.

After the danger to the patient’s life has been eliminated, the specialist can prescribe treatment for angioedema and some preventive measures that will contribute to the patient’s full recovery.

Treatment of Quincke's edema

If the patient exhibits swelling of the throat, trachea or larynx, then emergency hospitalization and referral to a hospital for treatment are necessary. This group also includes the following categories of patients:

• Children;
• Patients experiencing swelling for the first time;
• Patients with drug-induced edema;
• People with severe disease;
• Recently vaccinated;
• Patients who have suffered a heart attack, stroke, acute respiratory viral infection;
• Patients with pathologies of the respiratory system and cardiovascular system.

Treatment in hospital

If a patient experiences swelling of the larynx, trachea or throat, he is immediately sent to a hospital for treatment. Treatment measures are carried out in two stages:

– elimination of an allergic reaction;

– eliminating symptoms, determining causes, prescribing treatment.

Emergency care during an acute period in a hospital is aimed at eliminating (relieving) dangerous symptoms and ensuring the normal functioning of vital functions if a state of shock is observed. Doctors need to reduce the body's reaction to the allergen.

When treating Quincke's edema in a hospital, the patient may be placed in the allergy department, in the intensive care unit, or in the intensive care ward (if there is a severe case). Therapy consists of infusions of antihistamines, diuretics and glucocorticosteroids. In addition, it is necessary to carry out procedures to cleanse the patient’s blood of allergens using sorbents. Elimination of food allergens is carried out using enterosorbents.

In addition to first-generation antihistamines, it is possible to use other drugs from this class that have a more complex effect on the immune system and minor side effects. This includes Ketotifen, which is effective not only for edema, but also for bronchial asthma. The drug "Loratalin" can be used during pregnancy and for children over one year of age. To treat angioedema in infants, you can use Fenistide.

If there are clear signs of laryngeal edema, the dose of drugs can be increased: Prednisolone up to 120 mg, Dexamethasone up to 16 mg. In addition to administering the required medications, emergency or hospital workers can use oxygen inhalations. If a severe case is observed, then incubate the trachea.

Antishock therapy

If the patient has anaphylactic shock, then epinephrine must be administered immediately. If necessary, the dose of the medicine can be re-administered. Remember, the break between injections should be at least 20-25 minutes. If unstable dynamics are observed and the likelihood of death is high, the doctor may administer epinephrine intravenously. Simultaneously with the administration of the medicine, blood pressure, respiration and heart rate are monitored. In an adult, blood pressure should not be lower than 100 mm Hg. Art. For a child, this figure should be at least 50 mm. rt. Art.

In case of anaphylactic shock, several rules must be followed at the time of emergency care:

1. The patient should be in a supine position.

2. The head must be turned to the side and it should lie below the level of the legs.

3. The lower jaw needs to be advanced and the removable dentures removed from the oral cavity.

If it is not possible to ensure air passage through the mouth, a tracheostomy is performed.

Tracheotomy is carried out in the form of cutting the skin and cartilaginous rings of the trachea along the midline of the neck, and any strong air-conducting object, for example, the rim of a pen, is inserted into the hole formed.

Standards and general treatment regimen for Quincke's edema

As a rule, general treatment of Quincke's edema should take place in several areas:

– It is necessary to completely eliminate from the victim’s life all allergens that have a potential danger. You can give specific recommendations and direct you to the right treatment only after determining the exact cause of the swelling. The patient should avoid eating foods containing large amounts of salicylates. These include: raspberries, cherries, peaches, strawberries, wild strawberries, grapes, apples, plums, apricots, potatoes, tomatoes, carrots. You also need to give up medications such as: indomethacin, baralgin, paracetamol, citramon and others.

– Drug therapy. This direction of treatment for Quincke syndrome should consist of the doctor prescribing corticosteroids and antihistamines. If there is a high sensitivity to any particular food, then enzyme preparations, for example, Festal, can be used to reduce the reaction.

– The patient will definitely need to adjust his lifestyle. Patients who have suffered from edema should stop smoking and abuse alcoholic beverages. In addition, if possible, avoid stressful situations, hypothermia and overheating. To protect a person who has suffered from Quincke's edema, he must always have a syringe with adrenaline solution with him in case a severe form of the disease reoccurs.

Drug treatment for Quincke's edema

What medications should be used to effectively treat the disease? The first generation of drugs include: chloropyramine (suprastin), promethazine (pipolfen, diprazine), fenkarol (hifenadine), pheniramine (avil), dimethindene (fenistil), tavegil (clemastine), mebhydrolin (omeryl, diazolin). Some tablets act quite quickly, in about 15-20 minutes. Very effective in eliminating swelling but may cause drowsiness, prolonging reaction time (contraindicated for drivers). Act on H-1 histamine receptors.

The second generation includes drugs that can block histamine receptors and stabilize mast cells, from which histamine enters the bloodstream. Ketotifen (zaditen) can act effectively by relieving spasm in the airways. Used for the combination of angioedema with bronchial asthma and other bronchial diseases.

Third-generation antihistamines stabilize the mast cell wall, block histamine receptors and do not depress the central nervous system. These include: Loratadine (Clarisens, Claritin), Astemizole (Astelong, Hasmanal, Istalong), Semprex (acrivastine), Terfenadine (teridine, Trexyl), Allergodil (acelastine), Zyrtec, Cetrin (cetirizine), Telfast (fexofenadine).

If emergency care is needed for the patient, then in this case the following drugs are used: Prednisolone, Dexamethasone, Prednisolone. If the cause of the disease has not been determined, the patient must be treated with antihistamines that have a long-lasting effect, such as Kestin and Rupafin. This category of medications is not the main method of treatment, and they can only temporarily eliminate the symptoms of the disease.

Prednisolone for Quincke's edema

The drug Prednisolone is a systemic glucocorticoid and is used to provide first aid for angioedema. The medicine can have antihistamine, anti-inflammatory and decongestant effects. Prednisolone counteracts allergies due to several effects:

1. Reduces the production of antibodies, inhibits growth and differentiates cells;
2. Prevents mast cell degranulation;
3. Effectively inhibits the secretion and synthesis of allergic reaction mediators;
4. It reduces vascular permeability well and thanks to this, swelling is relieved, pressure increases, and bronchial patency is significantly improved.

The drug Prednisolone

For edema, Prednisolone should be administered intravenously at a dosage of 60-150 mg. For a child, the dose should be calculated based on body weight: 2 mg per 1 kg of body weight.

1. Seaweed bath. Dried seaweed (kelp) in a volume of 150-200 grams is poured with slightly warmed water. After the algae swells and increases in size, they are poured into the bath. The treatment procedure lasts for half an hour. The elements that are found in seaweed can have an anti-edematous effect and contribute to the rapid removal of allergic substances from the patient’s body.

2. Tea made from birch leaves. 15 grams of dried and crushed birch leaves are poured into a glass of boiling water, the resulting mixture is infused for 20 minutes and drunk. This tea is used two or three times a day. The plant has a pronounced diuretic effect and can relieve swelling in tissues. Birch leaves are also recommended to be used for arterial hypertension, for acute or chronic pathologies in the urinary system.

Remember!
Treatment of the disease with the help of medicinal herbs and plants must be carried out under the supervision of the attending physician in order to prevent the development of complications.

Treatment at home using traditional medicine is carried out in order to strengthen the general condition of the body.

To prepare the herbal mixture, you can use plants such as:

• Wheatgrass;
• Chicory;
• Chamomile or horsetail;
• Mint;
• Immortelle.

Medicinal plants must be mixed very thoroughly. One spoon of herbal mixture is filled with 250 ml of water and infused for three hours. An infusion of 100 ml is taken 2 – 3 times a day.

It is important to know!
If there is no medical supervision when treating with traditional medicine at home, this can lead to quite serious consequences. Don't be lazy, contact a specialist.

– If any products are excluded, they must be correctly replaced. Thanks to this, you can adjust the quantitative and qualitative composition of the menu;

– There must be “functionality”. All consumed dietary products should bring only benefits and help strengthen the patient’s body.
By following the rules and advice on therapeutic nutrition, positive dynamics in treatment will be observed. Of course, the diet will be effective if any food product is an allergen. Thanks to the patient's examination data and knowing information about food intolerance, allergenic foods can be eliminated from the diet. You can simplify the task with the help of a food diary, which you need to keep constantly.

However, the body must receive the full range of necessary substances, so fasting should not be too long. Products must be introduced smoothly, usually from one type, for example:

1. The patient begins to consume semi-liquid mashed potatoes without adding oil. The serving is 100 g on an empty stomach, then 200 g 4 times a day.

2. When the body adapts to the need to fully digest food, other products are added to the potatoes in the same way. It is important that the dishes do not contain any additives (exclude butter, milk, fruits, vegetables).

3. Before introducing each product, a “provocation” is first carried out: on an empty stomach you need to eat 100 g of this dish.

There is a conventional order in which hypoallergenic products should be introduced. The plan for including additional dishes depends on the patient's dietary characteristics (identified dangerous foods). The following sequence is considered the most rational:

Potato;
carrot;
dairy products;
bread (preferably stale);
cereals;
beef;
fish;
poultry meat;
eggs.

The outcome of Quincke's pathology in most cases will depend on the level of edema and the speed of first aid. It is necessary to properly support the chosen treatment, which can significantly reduce the risk of recurrent allergies. Preventive measures to prevent angioedema depend on the type of pathology.

If this is an allergic genesis, then in this case you need to properly follow a proper diet and exclude potentially dangerous medications and drugs. If the allergy is hereditary, then it is necessary, if possible, to avoid viral infections, taking ACE inhibitors, injuries, and stressful situations.

You should always be prepared and have with you the necessary medications to help cope with allergy symptoms, and also be able to promptly recognize Quincke's edema and the symptoms characteristic of it. You need to know how first aid is provided for Quincke's edema. Unfortunately, it is not always possible to count on quick medical assistance or go to a clinic, and the patient’s life may depend on the speed of providing first aid to a patient.

Quincke's edema (other names - acute angioedema, giant urticaria, trophoneurotic edema, angioedema) is a suddenly developing limited or diffuse edema of subcutaneous fatty tissue and mucous membranes. Both adults and children are susceptible to Quincke's edema, but the disease most often occurs at a young age, especially in women. Rarely observed in children and elderly people.

Causes of Quincke's edema

At the core allergic edema is an allergic antigen-antibody reaction. Biologically active substances - mediators (histamine, kinins, prostaglandins) released in a previously sensitized body cause local expansion of capillaries and veins, an increase in microvascular permeability occurs and tissue edema develops. The cause of allergic edema may be exposure to specific foods (eggs, fish, chocolate, nuts, berries, citrus fruits, milk), medications and other allergens (flowers, animals, insect bites).

In some cases, the cause of Quincke's edema cannot be determined (so-called idiopathic edema).

Symptoms of Quincke's edema

The disease begins suddenly. Within a few minutes, less often hours, pronounced swelling develops in different parts of the face and mucous membranes. Local swelling of the lips, eyelids, scrotum, as well as the mucous membranes of the oral cavity (tongue, soft palate, tonsils), respiratory tract, gastrointestinal tract, and genitourinary area may be observed. Swelling is rarely accompanied by pain; more often, patients complain of a feeling of tissue tension. In the area of ​​edema, tension in the tissues of elastic consistency is noted; with pressure, no pit remains; palpation (feeling) of the swelling is painless.

Most often, Quincke's edema is located on the lower lip, eyelids, tongue, cheeks, larynx, and swelling of the larynx and tongue can lead to the development of asphyxia - difficulty breathing occurs, aphonia, and cyanosis of the tongue develop.

When edema spreads to the brain and meninges, neurological disorders appear (epileptiform seizures, aphasia, hemiplegia, etc.).

Quincke's edema can last for several hours or days, then disappears without a trace, but can periodically recur.

Complications of Quincke's edema

The most threatening complication may be the development of laryngeal edema with increasing symptoms of acute respiratory failure. Symptoms of laryngeal edema include hoarseness, barking cough, and progressive difficulty breathing.

Swelling of the gastrointestinal mucosa can simulate acute abdominal pathology, and dyspeptic disorders, acute abdominal pain, increased intestinal motility, and sometimes symptoms of peritonitis may be observed.

Damage to the urogenital system is manifested by symptoms of acute cystitis and can lead to the development of acute urinary retention.

The most dangerous localization of edema is on the face, since the meninges may be involved in the process with the appearance of meningeal symptoms or labyrinthine systems, which is manifested by signs of Meniere's syndrome (dizziness, nausea, vomiting). In the absence of urgent qualified assistance, such swelling can lead to death.

A combination of acute urticaria and Quincke's edema is possible.

Examination for Quincke's edema

Differential diagnosis is carried out with lymphostasis, collateral edema during periostitis, erysipelas, Melkerson-Rosenthal syndrome. In Melkerson-Rosenthal syndrome, along with chronic swelling of the lip, folded tongue and neuritis of the facial nerve are detected. With erysipelas of the lip, there is hyperemia (redness) in the affected area in the form of flames.

Emergency first aid for angioedema

• When blood pressure decreases, 0.1–0.5 ml of a 0.1% adrenaline solution is injected subcutaneously;
• For asphyxia (swelling of the mucous membrane of the respiratory tract), adrenaline injections;
• Hormonal therapy: glucocorticoids (prednisolone 60-90 mg IM or IV; dexazone 8-12 mg IV;)
• Desensitizing treatment: antihistamines (Suprastin 2% - 2.0 IM, Claritin, Zyrtec, Erius, Telfast).
• Diuretics: Lasix 40-80 mg IV in 10-20 ml saline solution;
• Protease inhibitor drugs: contrical - 30,000 units IV in 300 ml of physiological solution, epsilon-aminocaproic acid 5% - 200 ml IV drip, then 100 ml after 4 hours or 4 g per os 4-5 times a day the day until the reaction is completely relieved;
• Detoxification therapy - hemosorption, enterosorption;
• Hospitalization in the allergy department.

Treatment of edema in stages:

• Eliminating contact with the allergen;
• prescribing drugs to increase the tone of the sympathetic nervous system (calcium preparations, ascorbic acid, ephedrine);
• decrease in parasympathetic activity (atropine) and histamine levels (diphenhydramine, suprastin, tavegil);
• Vitamin therapy is necessary - ascorutin is prescribed to reduce vascular permeability;
• Desensitizing therapy (ACTH, cortisone, prednisolone) and a course of treatment with B vitamins and gamma globulin are indicated
• The basis for the treatment of the hereditary form of Quincke's edema are medications that enhance the production of the missing C1 inhibitor in the body.

Treatment with hormones in the absence of contraindications to hormone therapy is recommended to be carried out in a hospital.

Prevention

The only reasonable prevention is to avoid contact with allergens.

Content

An allergic reaction such as Quincke's edema is characterized by rapid development. The first symptoms of the disease appear just a few minutes after human cells come into contact with the antigen. Delayed treatment of the syndrome can lead to serious consequences, to avoid which you should read the following material.

What is Quincke's edema

The impact of certain chemical and biological factors on the body can trigger the development of allergies. In this case, Quincke's edema, or angioedema, is considered the most dangerous manifestation of the immune response. The reason for this is the high risk of damage to the brain and larynx. Experts, answering the question, Quincke's edema - what it is, as a rule, try to give a comprehensive answer. As a result, the patient receives very voluminous information with a great variety of complex medical terms. Meanwhile, the reader can familiarize himself with a simpler explanation of this phenomenon below.

Thus, Quincke syndrome occurs due to contact of a sensitized (sensitive) organism with an allergen. In this case, edema develops due to increased vascular permeability, which is accompanied by the release of a large amount of fluid into the intercellular space. Actually, this is what causes the increase in different parts of the patient’s body.

The first symptoms of Quincke's edema

Signs of an imminent allergy are considered to be swelling of the mucous epithelium and tingling in any part of the body. At the same time, touching on the topic “Angioedema - symptoms,” experts stipulate that each type of this disease is characterized by some special features. Given this fact, doctors, in addition to the allergic nature of the disease, also distinguish between hereditary and acquired reactions to biological or chemical factors. Depending on whether a person has a certain type of disease, signs of angioedema may be as follows:

Clinical picture (diagnostic options)	Type of edema
	Allergic	Hereditary/Acquired
Onset of reaction and its duration	Develops in 5-20 minutes. It goes away in a few days.	Occurs within 2-3 hours. Disappears in a few days.
Localization	For the most part, swelling affects the neck, face, limbs, and genitals.	Develops in any part of the body.
Characteristics of edema	Pale or slightly red dense swelling that does not form a pit after pressure.	Pale tense swelling, after pressing on which there is no pit left.
Peculiarities	Accompanied by urticaria and itching.	Not accompanied by urticaria.

Symptoms and treatment in children

Today, the number of young patients hospitalized due to severe allergic reactions significantly exceeds the number of adult patients. This fact is due to the poor environmental situation and the modern views of parents who advocate early weaning of the child and the use of all kinds of chemical-based baby hygiene products.

Quincke's edema in children, as a rule, is manifested by swelling of the face, lips, genitals, feet and is not accompanied by urticaria. The most dangerous consequence of an allergy is the spread of the syndrome to the larynx area. At the same time, the child has difficulty speaking and has a sore throat. Subsequent rapid progression of edema can lead to the most severe conditions requiring emergency medical care. Less serious manifestations of the disease can be treated at home by using antihistamines in the form of injections or tablets.

In adults

The nature of the clinical manifestations of the disease does not depend on the age of the person suffering from allergies. Adult patients experience symptoms completely identical to the symptoms of the disease in children. Meanwhile, it should be noted that in each specific medical history, the syndrome develops due to various reasons, which are identified through laboratory tests. In addition, developing the topic “Allergic angioedema - symptoms in adults,” it is important to say that the active part of the population often experiences symptoms of abdominal syndrome:

• uncontrollable vomiting;
• sharp pain in the abdomen;
• diarrhea.

Treatment of Quincke's edema in adults is somewhat different from the therapeutic measures used for the development of the disease in children. The difference lies in the use of medications with greater frequency and dosage. In a situation where the swelling progresses, you should call an ambulance. Before the specialists arrive, you need to inject the person with Prednisolone or Dexamethasone and put an antihistamine under his tongue.

How to treat Quincke's edema

From a medical point of view, it is somewhat absurd to believe that this disease can be dealt with without the intervention of specialists. However, the frequency of the search query “Treatment, angioedema” proves the opposite. The population relies more on their own brains than on doctors. As a result, it must be said that in severe cases of allergies (when the throat swells), it is vitally important for a person to receive medical care in a timely manner. Ignoring this fact is fraught with serious consequences. In general, therapy for angioedema may be accompanied by:

1. The use of medications in the form of antihistamines, hormonal drugs, diuretics, vitamins.
2. Using folk remedies;
3. Surgical intervention - tracheostomy.

First aid for Quincke's edema

As a rule, allergy sufferers have a clear idea of ​​how to relieve the syndrome. Self-help or mutual assistance for Quincke's edema is to take antihistamines. If there is progress in the pathology, the patient must be taken to the nearest medical facility from home. In addition, in medical reference books there are entire sections devoted to the topic “Quincke’s edema - emergency care.” However, only an ambulance or hospital staff can perform such a complex algorithm of actions. You can find out what other actions you should take before the doctors arrive:

1. Interrupt contact with the allergen.
2. Free the patient's chest and neck from constricting clothing and jewelry.
3. In the absence of antihistamines, you need to pour 2-3 drops of Naphthyzin into the mouth of an adult or child.
4. Perform artificial respiration on the patient if he has lost consciousness.

Treatment at home

In a situation where the allergy has affected a small area of ​​the body remote from the head, you can try to relieve the syndrome in your own home. Experts, answering the question of how to relieve angioedema at home, advise patients to take a warm bath with kelp infusion at the first manifestations of the disease. Due to the beneficial effects of this algae on skin receptors, swelling disappears within a couple of hours. At the same time, in order to prevent exacerbation of the pathology, patients are recommended to adhere to a special diet that excludes the main allergens from the diet.

Folk remedies

The experience of the older generation has more than once helped to cope with the most severe illnesses. Traditional medicines in the section “Quincke's edema, help” contain a large number of recipes with which you can quickly relieve the syndrome. However, before using any product, it is imperative to check its components for allergenicity. Among the most effective folk methods for eliminating Quincke's edema are:

1. Milk with soda. A well-known remedy for sore throat can also be used to relieve allergy symptoms. Add ¼ tsp to a glass of warm milk. soda It is recommended to drink this healthy drink throughout the day. Continue treatment until the swelling subsides and the patient looks better.
2. Nettle infusion. 100 grams of dry herb should be poured with a glass of boiling water and left under the lid in a dark place for 2 hours. The finished product must be filtered. The infusion should be consumed ½ glass three times a day until the swelling completely disappears.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Quincke's edema - symptoms and treatment at home