Quincke at children – the sharp, suddenly developed, mainly allergic reaction which is followed by the expressed hypostasis mucous and hypodermic cellulose swelled. Clinically Quincke at children swelled the century, lips, all person, a neck, the top half of a trunk, feet and brushes, genitals is shown by swelling; the most severe form of a disease is throat hypostasis. Kliniko-immunologichesky inspection at Quincke's hypostasis at children includes collecting an allergoanamnez, determination of level of the general and allergenspetsifichesky immunoglobulins E, an immunogramma research, carrying out skin and provocative tests. At Quincke's hypostasis to children antihistaminic medicines, plentiful alkaline drink, enterosorbents are appointed; in hard cases – a kislorodoterapiya, an intubation and IVL.
Quincke at children swelled
Quincke at children (angioneurotic hypostasis, trofonevrotichesky hypostasis) - a morphological kind of a small tortoiseshell (huge urticaria) proceeding with dense hypostasis terms and a hypodermic and fatty layer swelled. In pediatrics and children's allergology Quincke swelled it is diagnosed for 2% of children, is more often at girls. Quincke often swelled develops at children with an allergic small tortoiseshell, however can arise also without the previous urtikarny rash. Communication of hypostasis of Quincke at children and with other diseases of the allergic nature - bronchial asthma, pollinozy, atopic dermatitis is noted. At Quincke's hypostasis at the child develops in 20-25% of cases the most dangerous complication – throat hypostasis.
On the basis of clinical characteristics allocate sharp (up to 6 weeks) and chronic (over 6 weeks) angioneurotic hypostasis; isolated or combined with a small tortoiseshell. Taking into account the probable mechanism of development Quincke swelled at children can be allergic, hereditary (pseudo-allergic), idiopathic.
The reasons of hypostasis of Quincke at children
Allergic swelled Quincke at children represents reaction of immediate type. The contact with allergen leads to emission of mediators from corpulent cages (a histamine, kinin, prostaglandins), to increase in permeability of hypodermic and submucous capillaries and faded with development of massive hypostasis of surrounding fabrics.
Not allergic swelled Quincke at children is caused by genetic determinancy of pathological reactions which are inherited on prepotent type. In this case in serums of blood of patients there is reduced level of inhibitors of a kallikrein and C1-esterazy. In such conditions activation of system of a complement and education C1-esterazy leads to splitting of components of a complement of C2 and C4 that is followed by formation of the kininopodobny peptide responsible for development of hypostasis of Quincke in children.
Foodstuff (chocolate, eggs, fish, citrus, berries, nuts, milk), medicines (aspirin, group B vitamins, iodine medicines, penicillin) and other allergens (pollen, dust, stings of insects) can serve as the immediate causes leading to the cascade of immunopathological reactions and development of hypostasis of Quincke in children.
At not allergic hypostasis of Quincke at children can act as triggers as the allergens which are listed above and the nonspecific reasons: infections, intoxications, physical factors (cold, sunlight), stress. Regarding cases the reason of hypostasis of Quincke at children remains unspecified (idiopathic angioneurotic hypostasis).
Presence at children of the accompanying chronic pathology of a thyroid gland (hypothyroidism), a liver (hepatitis), autoimmune, limfoproliferativny, parasitic diseases (a lyamblioz, an askaridoz), the chronic centers of an infection (caries of teeth, chronic tonsillitis) contributes to the recidivous course of hypostasis of Quincke.
Symptoms of hypostasis of Quincke at children
Quincke at children swelled can develop in various clinical forms: as hypostasis of mucous membranes and hypodermic cellulose, hypostasis of a throat, an abdominal syndrome, neurologic violations.
At defeat mucous and hypodermic cellulose hypostasis develops suddenly and several hours or keep days. Increase of hypostasis of Quincke at the child occurs promptly, within several minutes. In places as favourite localization of hypostasis of Quincke at children serve lips, eyelids, cheeks, a forehead, feet, brushes, a scrotum. When developing hypostasis of a mucous oral cavity and language at the child the speech and swallowing sharply is at a loss. At survey of a pharynx puffiness of a soft palate, a throat, small uvula is noted. In case of the isolated hypostasis of almonds the picture can remind catarrhal quinsy.
Puffiness of fabrics is followed by the small pressure, tension and a pricking; the skin itch, as a rule, is absent. The palpation of area of hypostasis of Quincke at children is painless, when pressing on edematous fabrics of a pole does not remain.
Quincke proceeding with involvement of a throat swelled, poses a serious threat for life of children. Hypostasis of a throat is characterized by lightning development. At the same time because of sudden difficulty of breath the child becomes uneasy, his face becomes blue, there is an aphonia. The blood spitting caused by multiple hemorrhages in mucous oral cavities, drinks and throats can be noted. Can lead Bystry progressing of this clinical form of hypostasis of Quincke to asphyxia and death of children if the urgent trakheostomiya is not executed. At a throat hypostasis combination to hypostasis of a trachea and bronchial tubes, the state reminds an attack of bronchial asthma more; at a combination to hypostasis of a mucous cavity of a nose – clinic of allergic rhinitis.
The abdominal syndrome at Quincke's hypostasis at children is caused by defeat mucous a gullet, a stomach and intestines. At the same time puffinesses of hypodermic cellulose can not be that considerably complicates recognition of hypostasis of Quincke at children. The attack develops suddenly and is characterized by sharp belly-aches, unrestrained vomiting, a profuzny diarrhea with blood impurity.
Less often at Quincke's hypostasis at children brain covers and substance of a brain are surprised. In these cases Quincke swelled proceeds with epileptiformny attacks, disorders of sight, a hemiplegia, tranzitorny aphasia, dizziness, a rigidnost of occipital muscles. At children defeats of uric ways (a dizuriya, a sharp delay of urine), hearts (paroksizmalny tachycardia), joints belong to exclusively rare displays of hypostasis of Quincke (, artralgiya, fever).
At an allergic form Quincke at children swelled takes a face, genitals, hands, feet, mucous membranes of an oral cavity, a throat and a GIT more often; sometimes is followed by urtikarny rash. Not allergic Quincke at children usually swelled it is shown already at early age and proceeds with severe damages of a throat and an abdominal syndrome.
Diagnosis of hypostasis of Quincke at children
At Quincke's hypostasis in the field of hypodermic and fatty cellulose and visible mucous the diagnosis does not raise doubts. Difficulties arise at the isolated hypostasis of brain covers and a GIT at children. An essential role in diagnostics is played by the allergologichesky anamnesis (allergic reactions, heredity), effect of use of adrenaline and antihistaminic medicines, special methods of a research.
In the sharp period definition of the general and specific immunoglobulins E in blood is carried out. For detection of hereditary hypostasis of Quincke at children the major role is played by definition of concentration of components of a complement of C2 and C4 and level of Clq-inhibitor in blood serum. For the purpose of an exception or confirmation of hypostasis of a throat the laringoskopiya is carried out. Search of specific allergen is carried out under the leadership of the children's allergist-immunologist and includes maintaining "the food diary", purpose of diagnostic eliminative diets, statement skin (in 2-3 months after knocking over of hypostasis of Quincke at children).
The abdominal syndrome at Quincke's hypostasis at children needs to be differentiated from intestinal impassability, peritonitis, pancreatitis, appendicitis. At hypostasis of hypodermic cellulose it is necessary to exclude contact dermatitis, , the erysipelatous inflammation, periostit, Melkersona-Rosenthal's syndrome. In case of prevalence of neurologic symptomatology differential diagnostics with meningitis is carried out.
Ambiguity of interpretation of the diagnosis of hypostasis of Quincke demands an exception of other medical emergencies by means of consultations of the children's neurologist, children's gastroenterologist, children's urologist, children's rheumatologist from children.
Treatment of hypostasis of Quincke at children
In case of diagnosis of hypostasis of Quincke at children, first of all, it is necessary to stop contact with estimated allergen. For elimination of the allergen which already got to an organism the child needs to give plentiful alkaline drink, enterosorbents (, absorbent carbon).
Medicines of the first row at allergic hypostasis of Quincke at children are antihistaminic medicines (, , , , ). Along with them system corticosteroids (dexamethasone, Prednisolonum, a hydrocortisone), diuretics (furosemide, acetazoleamide) can be applied. For the purpose of decrease in permeability of vessels appoint .
Further, for prevention of developing of repeated allergic hypostasis of Quincke at children the specific hyposensitization can be carried out by the known allergen. An important stage of treatment of recurrent hypostasis of Quincke children have to have an elimination of the centers of a chronic infection, therapy of chronic gastrointestinal diseases, a liver and bilious ways, expulsion of helminths.
At hereditary hypostasis of Quincke introduction of the fresh plasma containing C1-esterazy inhibitor, inhibitors of proteases is shown to children (an aprotinina, aminocaproic acid).
At development of hypostasis of a throat, except the listed actions, inhalation nebulayzerny therapy with adrenomimetika (salbutamol), kortikosteroidny medicines is carried out; kislorodoterapiya, haemo sorption. In case of increase of respiratory insufficiency the immediate intubation or a trakheostomiya and IVL is necessary.
The forecast and prevention of hypostasis of Quincke at children
Allergic swelled Quincke at children, as a rule, has a good-quality current and the favorable forecast. Predictively is adverse often recidivous Quincke at children proceeding with development of hypostasis of a throat and internals, a bronchospasm, anaphylactic shock swelled.
Prevention of angioneurotic hypostasis of Quincke demands observance of the low allergy mode from children (an exception or reduction of contact with allergen), an eliminative diet, periodic reception of antihistaminic medicines. The solution of a question of performing preventive vaccination to the children having in the anamnesis Quincke swelled, demands individual approach and the weighed assessment of degree of risks.