Angioedema. Symptoms and Treatment, photos in adults as manifested starts as quickly remove at home

Angioedema, or otherwise - angioedema first described in 1881, since many studies have described its symptoms. His treatment is carried out as a non-drug methods, and pharmaceutical preparations. Angioedema is the swelling of epithelium and submucosal subcutaneous tissue membranes. Development of edema occurs extremely quickly and in an acute form.

Types of angioedema and its causes

Angioedema, symptoms and treatment of which depends on the true origin of the disease is classified as follows:

• Hereditary form angioedema (HAE).
• The acquired angioedema (PAO).
• Allergic angio edema.
• Angio edema nonallergic origin (in the absence of C1 inhibitor pathology).

Classification of angioneurotic edema makes it possible to systematize the particular symptoms of each type and choose the method of treatment. Very often, not having sufficient knowledge, patients confuse the true angioedema with urticaria. Although the latter pathology is accompanied by only 1 type of edema, which is treated simply. The most sophisticated form of edema - hereditary.

She, in turn, is divided into sub-categories:

• hereditary angioedemaswelling type 1 It is about 80-85% of the total amount of this type of diseases. This type is associated with deficiency of C1 inhibitor (from full to not detect 33% of normal). This pathology is inherited, and if at least one parent has a history of it, then the probability of the child's disease is above 50%. Clinical manifestations of this form is characterized by the most severe, lasting and massive defeat submucosa and deeper layers of the epithelium. Swelling capture large areas of relatively stable localization in relapsed.

  

• Hereditary angio edema type 2 It is unlike that observed in patients with levels of inhibitor relative norm. pathology essence lies in the reduced functionality of the latter, or improper structure. Clinical manifestations are less aggressive localization of the affected areas in the bulk - the extremities, less often - on the face.
• HAE type 3 installed and described in detail recently. Like the two previous forms is due to hereditary factors, in particular - blood clotting. Characteristically manifestation of normal levels and functions C1 inhibitor. Dependence manifested exacerbation of estrogen. This form is typical for women only. The main acute effects are during pregnancy, using oral contraceptives and hormone replacement therapy during menopause.

Hereditary forms of urticaria are not accompanied by the JSC. Initially diagnosed at a very early age and subsequently recur regularly.

Acquired angio edema (PAO) is less common. There is usually of malignancy, chronic infectious diseases, and autoimmune pathologies. The first manifestations occur during adult (45-50 years) age followed by the systematic recurrence.

Angioedema (the symptoms and treatment of many mistakenly attached to hives) in allergic forms a completely different etiology. Allergic angio edema in this case is caused by hypersensitivity to certain allergens. As a result, local expansion factor is vascular epithelium and increases the permeability of vascular walls.

This leads to the migration of cells in the deeper layers of the epithelium occur swelling. A separate form should be made with non-allergenic JSC Development Mechanism. This pathology is associated with dysfunction of the immune system activity. Basically, it is in violation of the complement system, which counteracts a foreign agent and is responsible for the formation of inflammation and allergic manifestations.

When revitalization the same processes as in the allergic form, but they are not caused by allergens activities.

In the scientific literature vibration form separately described, which arises because of the vibration, and even minor.

Reasons for the development of children and adults

Angioedema disorders are caused by numerous factors. The reasons should be considered with reference to the classification. As mentioned above, inherited forms basically have genetic factors. Reasons PAO - infectious, oncological and autoimmune diseases.

For the allergic form is characterized by binding to the action of certain groups of allergens:

• various chemicals;
• poisons;
• Food;
• pharmaceuticals;
• pollen;
• insect bites.

Angioneurotic edema formation inhibitor at normal level and its functional characteristics (swelling nonallergic origin) has its own characteristics. Regulation of activity of the complement system occurs due to variations in the level of C1 inhibitor.

When his excessive amount system activity slows down, and the shortage - has a positive dynamics. Scientific developments found that reduction of a source of C1 angioedema nonallergic etiology. The reason lies in raising the level of histamine.

Improving his results from the use of large quantities:

• wine;
• cheese;
• beer;
• other types of alcohol;
• smoked;
• chocolate;
• fish;
• tomatoes;
• spinach;
• separate groups of pharmaceuticals (antibiotics, muscle relaxants, general anesthetics, narcotic analgesics);
• iodine preparations in radiology;
• ACE inhibitors.

It provokes the beginning of the next group of factors for the disease:

• emotional and physical stress;
• thermal effect;
• swim in cold water;
  
• contact with carriers of infection.

In addition, the AO may be associated with abnormalities:

• nervous system;
• of cardio-vascular system;
• gastrointestinal tract;
• Respiratory;
• genitourinary system.

edema formation mechanism

Partially diagram of edema already described above. They begin to form as a result of expansion of vascular lumens, vessels increase in volume and, as a consequence, increase the permeability of vascular walls. As a result of the free cell migration are swelling zone.

Development of edema occurs rapidly (from several minutes to several hours). Localized swelling near the eyelids, lips, near the genitals, on the distal surfaces of extremities, on the submucosa of the respiratory and gastrointestinal tract.

The first symptoms of angioedema

Angioedema, symptoms and treatment of which are described in dozens of sources, not always fit the standard description. Therefore at the beginning of the exacerbation of the disease it is important to notice the early symptoms of edema, because the situation can develop rapidly.

On the face

Localization of swelling on the face is characteristic of all forms of AD. Seals in most cases, are located around the eye, close to the eyelids, around the lips. When massive edema may occur the phenomenon of temporary loss of vision due to compression of the eyelids.

Edema, located in the region of the lips, may spread to the mucous membranes of the mouth, pharynx and larynx. In this respect, they represent the greatest danger.

In the airways

With the defeat of breath swelling of the lips cover the organs, throat, tongue, and just above the larynx. From the outset, there is edema husky voice, with the development of edema passing in whispers with wheezing. Often there is a "barking" cough. In severe cases, there is asphyxia and death of the patient.

In the internal organs

As a rule, the digestive tract is affected in all forms of OA. It manifests systematic sharp pain due to swelling of the intestinal wall. Accompanied by anorexia, diarrhea and vomiting. Clinical manifestations are similar to the symptoms of "acute abdomen", as well as intestinal obstruction. With the defeat of the internal organs, as a rule, there are no symptoms.

When endoscopy determined well-defined swelling of the intestinal mucosa. Swelling of the meninges appear severe headaches, in severe cases - symptoms of cerebral circulation, and in the absence of medical care can lead to death. Swelling of the mucous urinary tract characterized by delay urination.

On the limbs and body

When the localization of edema on the distal surfaces of the upper and lower extremities appear bluish seal. On palpation is not pits and tracks. Maybe itching. Threats yourself this swelling can not be held, but brings considerable discomfort.

The clinical picture in the development of edema

Symptoms and clinical manifestations of angioedema are well known and allow the doctor in a short time to pick up the correct treatment. All forms NAO characterized by the formation of dense and painless swellings of different localization. They can be formed anywhere on the body or mucosa.

Swelling pale color, palpation does not leave traces. Itching and hives are missing.

Apparent reason for the beginning of swelling there is, as a rule.

However, provocative factors may include:

• medications;
• surgery;
• dental procedures;
• infection;
• stressful situations;
  
• menstruation;
• injury.

For HAE is characterized by a constant localized edema in relapsed. Development of edema relatively slow (8 - 30 hours). The use of antihistamines is not effective. Frequency of stability of relapses has not.

Clinical PAO flow pattern identical to that described above but with the characterizing features:

• There are symptoms accompanying cancer, and autoimmune pathologies.
• Onset of the disease is characterized by a later date.
• Not family history.

JSC for allergic urticaria accompanied, itching and symptoms of atopic diseases. Hot area of ​​edema, congestion occurs. There are painful symptoms, paresthesia can occur when nerve compression.

Development of edema accompanied by a lowering of blood pressure and anaphylactic reaction, and bronchospasm. Characteristically rapid development and rapid relief of antihistamines. Swelling go away without treatment in 1-3 days.

Differences forms angioneurotic edema are shown in the table:

symptomatology	hereditary forms	allergic origin
weighed down by history	No	there is
Heredity	there is	Yes
The primary manifestation of	In childhood,	In young years
Dynamics	A slow flow (11 - 36 hr.), The beginning of remission after 1 - 5 days.	The rapid development and rapid disappearance.
provocative factors	Trauma, pressure, stress, infections, drugs, surgical procedures, stress, infection.	Contact with an allergen
Localization	stable location	unstable
Receiving antihistamines	not effective	effective
The presence of hives	Absent	There is often
pain	In most cases	As a rule, there are no
laryngeal edema	present	not typical

First emergency care at angioedema

In the first place it is always necessary to call the ambulance crew. Development of edema can be very fast and unpredictable.

To the provision of medical care:

1. Seat of the victim in a comfortable position, eliminate panic.
2. If the pathology is accompanied by urticaria, the patient can be given antihistamines. It's a little ease his condition.
3. Ensure good access of air and ventilate the area.
4. On the edema region impose a cold pack or ice water bottle (or plastic bottle).
5. Drink plenty of water, best of all - mineral water without gas. If one is not available, it can be added to a liter of water a quarter teaspoon of baking soda.

In severe cases, it is better not to take any measures that are due to lack of skills and qualifications can only worsen the patient's condition.

What to do at home with laryngeal edema?

If you suspect a laryngeal edema, even if it is swelling around the mouth and lips, when you call an ambulance should be pointed out that there is a swelling of the larynx and the patient suffocates. In this case, the nearest team will leave on an emergency basis for health reasons. Independently, in addition to the above measures, it is impossible to take action. In this case, only need skilled medical care.

Treatment in the hospital drugs

The selection of medicines for the treatment is carried out by the clinician after consultations with specialists:

• allergist;
• otolaryngologist;
• gastroenterology;
• oncologist;
• endocrinologist;
• surgeon;
• cardiologist;
• parasitologist;
• rheumatologist.

Tactics of treatment of angioedema:

• mild acute conditions;
• prophylaxis in the current period of remission;
• Long-term preventive measures.

Therapy hereditary edema involves both non-drug measure, and the use of drugs. The first include the provision of respiratory function through a tracheostomy or intubation.

Medications with the NAO and PAO are about the same (dosage and choices made by the attending physician):

• firazir;
  
• Antifibrinolytics;
• fresh or fresh frozen plasma;
• danazol and analogs or methyltestosterone
• C1 inhibitor.

Application antihistaminic drug group with NAO inefficient. Angioedema, its symptoms and treatment of allergic forms and have features and nonallergic.

Before the start of drug treatment:

• Set hypoallergenic diet.
• Canceled medications that can trigger disease.
• Cropped identified infectious and inflammatory processes.

The basis of treatment is antihistamines third generation:

• Zyrtec;
• allergodil;
• Telfast;
• Tsetrin;
• Sempreks.
• astemizole;
• Terfenaddin;
• Loratadine.

They can also be used, and the second-generation drugs:

• cetirizine;
• desloratadine
• Rupatadin;
• ebastine;
• fexofenadine;
• loratadine;
• Levocetirizine.

These pharmaceutical preparations can be used for a long time. Says the best effect when used in the period of remission. the first-generation drugs are not recommended. The reason of multiple side effects. Corticosteroids are recommended in cases of severe illness. Life-saving epinephrine is recommended.

Diet

Issues relating to the diet in each case to be agreed with the attending physician.

In general, try to eliminate from your diet the following products:

• whole milk;
• eggs;
• citrus;
• coffee;
• chocolate;
• caviar;
• cheese;
• smoked;
• fish;
• mustard;
• nuts;
• wheat;
• honey;
• tomatoes;
• mushrooms;
• raspberry;
• cocoa;
• Strawberry;
• spice;
• sauces;
• beet;
• black currant;
• carrot;
• carbonated drinks;
• alcohol.

In most strict diet administered to an acute condition periods, and further - simply excludes products having a causal relationship with the occurrence of edema.

Traditional methods for removing edema

In folk medicine, there are many recipes for removing edema. But to make self-treatment should not be without a definite diagnosis and the recommendation of the attending physician.

V can be used as an aid:

• Infusion of lemon balm. Tablespoon chopped herbs add 0.5 liters of boiling water. Infuse about 1 hour. Drink in 3 doses before meal.
  
• Infusion of birch leaves. Per cup of boiling water - 1 tbsp. l. dried or fresh leaves. Cool naturally and drink. Reception - 3 times a day before meals. The residue is used to compress the infusion after complete cooling.
• Milk with soda. In a glass of warm milk taken a pinch of baking soda on the tip of the table knife. Take 3 - 4 times a day.
• The infusion of nettle roots. Roots chop and pour 1 - 1 tbsp. spoon liter of boiling water. Infuse for one hour and filtered. 3 times a day for 1 st. l.

This is the most simple and affordable way.

Consequences, prognosis and recommendations

Usually just the swelling does not cause difficulties to the treatment. However, in severe cases it requires serious treatment. Hereditary and Acquired forms of edema AO stored life. Therefore, you must systematically undergo a course of preventive treatment during remission, and to comply with all the recommendations of the attending physician.

Swelling of the larynx are the most dangerous of angioedema. Most often, deaths connected with this kind of attack.

In the presence of the disease, followed by urticaria, contact with cold water under certain conditions can cause the development of giant urticaria after bathing. In some cases, it ends the patient's death. It has been observed that if AO, followed by urticaria, has a relapse once every six months, this process will continue for at least 10 years.

There are cases of spontaneous termination of chronic AD, aggravated urticaria. Most often it applies to children. Angioedema - common pathology with high dynamics and often fatal outcomes. Therefore, if there were the symptoms, you should immediately contact the medical institution to be involved in the treatment of doctors.

Registration of the article: Lozinski Oleg

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