First aid — angioedema: edema of injections in adults

Causes of angioedema and first aid

An allergic reaction is not always manifested by itching and burning sensation of the skin. Angioedema or angioedema – acute reaction of the body due to increased permeability of blood vessels, leading to closure of the airway, as a result, death. First aid for angioedema must be given immediately, a delay of several minutes can cost a patient’s life. Consider the reasons for the development of the disease and characteristic symptoms are harbingers of the threatening condition.

  • Angioedema
  • Causes and symptoms of angioedema
  • First aid for angioedema
  • Treatment of angioedema
  • Prevention of angioedema

Angioedema

Angioedema is developing rapidly, in this lies the main danger for the patient’s life. The response is characterized by pain that has characteristic clinical manifestations.

You should know that: more than 90% of cases of angioedema and requests for emergency help in medical institution connected with the use of drugs, especially angiotensin-converting enzyme (Captopril, enalapril, appointed for the treatment of hypertension).

In 1882 was the first to describe the pathology. In medical practice, diseases are divided into several types, which are caused by etiological factors. Highlight the response associated with genetic predisposition, also acquired a form.

Angioedema associated with other allergic reactions, in most paintings it is with hives. Sometimes diagnosed idiopathic. In other words, the cause of the disease is not established.

Hereditary form develops very rarely, about one person in 150 thousand. In 1888 was first described, as the disease was diagnosed in five generations of members of the American family. All patients with angioedema genetic nature there is a tendency to autoimmune disorders. Along with angioedema is diagnosed systemic lupus erythematosus, the autoimmune nature tiroidite.

An acquired disease is quite rare. In most clinical pictures developing in patients in the older age group from 50 years of age.

Causes and symptoms of angioedema

Hereditary angioedema is manifested by a combination of precipitating factors. Usually the first appearance of swelling is observed at an early age is 7-15 years, a condition that requires immediate assistance.

Factors responsible for genetic swelling:

  • Physical and emotional overload, anxiety, chronic stress;
  • Infectious pathology;
  • Trauma, pain and shock;
  • Surgery, including dental procedures;
  • The time of childbearing;
  • Medication that includes estrogen.
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The acquired form has a few other reasons. The appearance of the swelling cause the condition and pathology, myeloma, lymphosarcoma, chronic form lymphocytic leukemia, lymphoma and. disease. All these pathological condition contribute to the reduction of C1 inhibitor, resulting in greatly increased uncontrolled complement activation with production of the biologically active components.

Important: when angioedema associated with the use of ACE inhibitors, based pathology is the reduction in the concentration of specific enzyme – angiotensin-2, which leads to an increase in the content of bradykin, respectively, diagnosed angioedema in adults. Symptoms seen immediately after applying the medication. Most often (80-90% of cases), it is observed during the first 7 days of treatment with these medicines.

Clinical manifestations depending on the form of swelling:

  • Allergic swelling appears after 5-30 minutes after contact with the source, can locate anywhere. Usually affects face and lips, hands and feet, genitals. The disease is accompanied by hives, severe itching and burning.
  • Acquired and hereditary form. When contact with the irritant affects the eye area, lips, tongue, genitals. There is intense itching, redness of the skin. Urticaria is not detected.
  • Idiopathic form is characterized by the same clinical manifestations as allergic. Urticaria is manifested in 50% of patients.
  • The symptoms depend on the site of swelling. The most dangerous complication – the defeat of the larynx and tongue, accompanied by unproductive cough, sore throat, respiratory distress, increasing hoarseness. If the lesion was localized in the lung area, is the effusion of exudate into the pleural cavity, there is pain in the sternum; on the background of swelling of the lining of the intestines – pain in the abdomen, repeated vomiting, diarrhea; swelling of the urinary tract acute urine retention.

    First aid for angioedema

    Regardless of the localization of allergic hearth ambulance call need anyway, particularly if such reaction is observed for the first time. Indications for hospitalization is the increase of the tongue, difficulty breathing, lesions of the gastrointestinal tract, the absence of effect of first aid in case of angioedema at home.

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    Tactics patient care is somewhat different depending on the type of Allergy. Non-allergic swelling character reacts badly to drugs – glucocorticosteroids, epinephrine, antihistamine tablets, which are used for the therapy of immediate type reactions.

    Note: the three «helper», which should always be at hand – the adrenaline, antihistamine, corticosteroids. As a first aid in case of Quincke edema medication are introduced in a specific sequence – first the adrenaline then injection of hormones, then an antihistamine. With a relatively easy reaction, it is sufficient injections of the hormone and antihistamine.

    There is an emergency when angioedema:

    • Epinephrine is injected intramuscularly. The injection site is third of the outer surface of the femur of the patient. Can be administered intravenously, if possible. The dose administered depending on age. Adult traditional dosage 0.3-0.5 ml of 0.1% solution for children expect – 0.01 mg per kg of body weight;
    • As the use of corticosteroids Prednisolone, Dexamethasone. Injected into the buttocks, possibly in Vienna. If no skills of administration, the vial may be opened and drink. The dose of Dexamethasone varies from 8 to 32 mg (one vial contains 4 mg), and Prednisolone – 60-150 mg (one ampoule 30 mg);
    • Antihistamine drugs are administered intramuscularly. Pills can also be taken, but they are slower. Drugs relieve swelling, normalize breathing, relieve itching, burning, redness.

    In non-allergic form of angioedema use of aminocaproic acid – 7-10 g orally, or drugs with male hormones – Danazol (800 mg maximum dose).

    In the treatment of angioedema should be considered that medicines described above have certain contraindications and side effects. Before applying are encouraged to read the instructions and usage.

    Treatment of angioedema

    Depending on the severity of the condition and clinical manifestations of the patient is directed to the required Department for further treatment of angioedema. For example, if diagnosed with a severe form, it is sent to the intensive care unit. In mild or moderate form that is not life threatening – Department of Allergology either a normal medical ward.

    Treatment of allergic diseases in the hospital:

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  • The drugs of choice are adrenaline, corticosteroids, antihistamines medicines.
  • Detoxification treatment – introduced intravenous solutions (eg, ringer Lactate).
  • If a food Allergy is assigned to the chelators. Appropriate use of activated charcoal, Enterosgel.
  • Symptomatic treatment is driven clinic.
  • Note, in non-allergic form of the drugs of choice – purified C1 inhibitor concentrate, fresh frozen plasma, medicines, is included in the male hormones, aminocaproic acid.

    The duration of treatment in stationary conditions is based on the severity of the pathological process. Typically, the patient length of stay ranges from 5 to 7 days.

    In severe swelling, which led to the overlap of the respiratory tract, the incision is perstneschitovidnaya ligament, then installed the tube, advocating an alternative way of breathing. In some cases, a patient connected to a respirator.

    Prevention of angioedema

    If the etiology of the development of angioedema lies in an allergic reaction, you have to eliminate the irritant and any contact with the sword. Additionally, it is recommended to comply with hypoallergenic diet.

    Preventive measures:

    • If a family history of angioedema, with cautious use of angiotensin-converting enzyme, receptor antagonists angiotensin-2;
    • Patients with genetic edema you need to avoid injuries and surgical interventions, respectively.

    To prevent edema associated with reduction of inhibitor of C1, it is recommended that the use of drugs with androgens – Danazol. They contribute to the active development of C1 inhibitor. It is impossible to take medication during the period of pregnancy, during lactation, Oncology prostate, do not give to children.

    Before the surgery are short-term preventive measures. Drugs of choice include fresh frozen plasma androgens and a concentrated solution of the inhibitor of C1.

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