Mkb 10 angioedema angioedema. ICD code allergic reaction type of angioedema

One of the varieties of an allergic reaction, which has a more pronounced and large-scale course, is angioedema or, in other words, Quincke's edema.

Worldwide Quincke's edema in ICD 10 has the code T78.3, which implies a certain plan of methods and means of diagnostics, as well as therapeutic measures.

Severe swelling of the face, mucous membranes, lower or upper limbs manifested as a consequence of exposure to the human body of any allergen of chemical or biological origin.

Quincke's edema has many similarities with urticaria and in most cases becomes its complication.

Quite often, these forms of manifestation of an allergic reaction pass into each other, but in International classification 10 reading diseases, there are various ciphers, for example, urticaria is determined by the code L50, which excludes its giant form, that is, angioedema.

Such an aggressive form of the body's reaction to an allergen poses a potential threat to human life, which determines the code T78.3, which contains nosological data with the registration of a certain percentage of mortality. The informativeness of the T78.3 code provides for first aid and a further plan for managing patients with a severe form of an allergic reaction, accompanied by a giant form of urticaria.

Quincke's edema in the international classification of diseases considered in class XII "Diseases of the skin and subcutaneous tissue", in the block of urticaria and erythema. The presence of a pathology code implies a single unified protocol for treating a patient in all countries of the world. Local protocols characterize reasonable deviations from the unified ones in a single medical institution.

Pathological signs of angioedema

The development of Quincke's edema is indicated by a number of specific symptoms and subjective sensations of the patient. Usually doctors register the following clinical manifestations:

the presence of pronounced puffiness is noted in places with developed subcutaneous tissue, that is, on the cheeks, lips, eyelids, in the genital area;
the color of the skin and mucous does not change;
itching is extremely rare and disappears on its own after 2-6 hours from the onset of progression of the giant form of urticaria;
swelling, which in most cases tends to spread to the mucous membrane of the larynx, which poses a real danger to the patient's life;
a pronounced feeling of anxiety and fear, accompanied by severe tachycardia;
hoarseness of voice;
the appearance of a cough that resembles a barking dog;
labored breathing;
promotion blood pressure;
the skin of the swollen face is hyperemic at first, but then becomes pale, with pronounced cyanosis;
develop dyspeptic disorders in the form of nausea, vomiting, pain in abdominal cavity due to increased intestinal peristalsis;
subfebrile condition.

The angioedema code also suggests symptomatic therapy to eliminate concomitant clinical manifestations, along with the main methods of stopping the lightning-fast form of allergic urticaria. https://youtu.be/rhqvtaDKssQ

Angioedema- acutely developing, rapidly passing edema of the skin and subcutaneous tissue or mucous membranes.

Code according to the international classification of diseases ICD-10:

D84.1
T78.3

Etiology. Angioedema is a polyetiological disease that can be caused by both immune and non-immune factors.

. Allergic- manifestation of an allergic reaction of type I; develops as a manifestation of sensitization to drugs (usually antibiotics), foods and additives, the poison of stinging insects (bees, wasps and hornets).
. Pseudoallergic- as a result of a direct non-immune histamine-releasing action of certain drugs (salicylates and other NSAIDs, ACE inhibitors, dextrans, etc.), foods or additives (see Food Allergy).
. Complement - dependent- can be inherited or acquired (usually in patients with lymphoproliferative malignant neoplasms, which is associated with an acceleration of the metabolism of the C1 esterase inhibitor of the complement component by 2-3 times).
. idiopathic- etiology is unclear.

The reasons

Risk factors. atopic predisposition. Reception of ACE inhibitors (in 0.2% of cases). Presumably taking omeprazole (a proton pump inhibitor) and sertraline (a selective serotonin reuptake inhibitor).
Genetic aspects. Hereditary angioedema (*106100, deficiency of complement esterase inhibitor C1, 11p11.2-q13, deletion of the C1NH gene in type 1, point mutation in type 2, ) is characterized by recurrent episodes of edema of the skin, upper respiratory tract and gastrointestinal tract (up to to intestinal obstruction).
. C1q inhibitor is a highly glycosylated serum protein synthesized in the liver and inhibits the proteolytic activity of the C1r and C1s subcomponents, thus preventing the activation of the C4 and C2 components of the complement.
. Deficiency of the C1q inhibitor leads to uncontrolled activation of early complement components and the formation of a kinin-like factor, which causes an increase in vascular permeability and leads to the development of angioedema.
. Most often (in 80-85% of cases) the cause of hereditary angioedema is a quantitative deficiency of C1q inhibitor (type 1), in other cases, with a normal amount of inhibitor, the cause of hereditary angioedema is its functional inferiority of C1 - inactivator due to a point mutation in the reactive center of the molecule (type 2).

Pathogenesis similar to the pathogenesis of urticaria and is associated with dilatation and increased vascular permeability (mainly venules) of the deep (unlike urticaria) layers of the dermis and submucosal layer caused by allergy mediators (histamine, Pg, leukotrienes), as well as complement components (primarily C3a and C5a ) and kinins.

Pathomorphology. Edema, vasculitis and/or perivasculitis involving only subcutaneous tissue.
Clinical picture. Localized edema of the skin, subcutaneous tissue and/or mucous membranes, with or without urticaria. Often - an integral component of a generalized anaphylactic reaction (anaphylactic shock). Can develop anywhere on the body; the usual localization is the face (usually lips, eyelids), limbs, external genitalia. The greatest danger to life is laryngeal edema and asphyxia caused by it. Rapid onset and rapid spontaneous resolution. Characterized by a feeling of numbness, itching, expressed much weaker compared to urticaria.

Diagnostics

Laboratory research. In the allergic form - determination of IgE by means of a radioallergosorbent test (primarily in case of allergy to penicillin, as well as food allergens). Determination of levels of C1q - inhibitor, as well as C2 and C4 components of complement in hereditary angioedema. with types 1 and 2 .. In patients with acquired forms of insufficiency of C1 - inactivator, C1 is also reduced (in contrast to congenital forms).

Differential Diagnosis. Diffuse subcutaneous infiltrative process. contact dermatitis. Lymphostasis ( lymphedema) . Thrombophlebitis. Local edema in somatic pathology. Granulomatous cheilitis. Erysipelatous inflammation with marked edema. Cellulite.

Treatment

TREATMENT
Diet. Exclusion of known food allergens (egg, milk and wheat proteins, fish, nuts, tomatoes, chocolate, bananas, citrus fruits) up to the transition to a basic hypoallergenic diet.
Tactics of conducting. Protection from exposure to known provoking factors. Cold compress to reduce itching. Intubation for upper airway obstruction.
Drug therapy. Drugs of choice - see Urticaria. Special care! Angioedema of the larynx and the resulting asphyxia are potentially life-threatening and require active therapy. Epinephrine 0.3 ml 0.1% r - ra s / c, as well as topically in the form of an aerosol. GC - dexamethasone 4-8 mg IM or IV, or 30-60 mg prednisolone; in hereditary angioedema, the effectiveness of HA is doubtful. Antihistamines - intravenous dimethindene, diphenhydramine, intramuscular clemastine 1-2 ml.

Complications. Asphyxia caused by airway obstruction.
Course and forecast. In most patients with angioedema, the general condition suffers little, except in cases of airway obstruction. At chronic forms the course and prognosis depend on the etiology and pathogenesis.

Concomitant pathology. Anaphylaxis. Hives.
Prevention. Avoid contact with the causative factor. ACE inhibitors are contraindicated. Before carrying out procedures that can provoke the development of hereditary angioedema (dental interventions, intubation, endoscopy, etc.), danazol is recommended at 200 mg 3 times a day 3 days before the procedure, and immediately before it, the introduction of 2 standard packs of fresh frozen plasma. For long-term prophylaxis: .. Danazol 200-600 mg daily for 1 month, then for 5 days every 5 days. Danazol is ineffective in other forms of C1 inhibitor esterase deficiency; contraindicated in children, pregnant women, nursing mothers, with porphyria; can cause headache, weight gain, hematuria .. Aminocaproic acid 1 g 3 r / day.

Synonyms. Quincke's disease. Quincke's edema.

ICD-10. T78.3 Angioedema D84.1 System defect

There is a single regulatory document called the International Classification of Diseases, where each unique code contains a detailed description of a particular disease. The ICD is reviewed, corrected and supplemented every 10 years. At the moment, the ICD 10th revision (abbreviated as ICD-10) is used. According to this classification, Quincke's edema has the code T78.3.

What is the classification of diseases for?

The ICD is unified throughout the world and is used to record the incidence and analytical data on health problems in people from different regions, countries, with its help, the influence of various factors is considered. Also, this document is convenient for transforming the language characteristics of the disease into an alpha-code, understandable to doctors around the world without translation. For example, according to ICD 10, Quincke's edema contains a brief description, and in any hospital a patient with this manifestation can be treated according to one scheme. After all, the course of the disease itself does not differ from the country in which the patient lives.

It is known that Quincke's edema is one of the most unpleasant reactions of the body to an allergen. It is always difficult, restless, and causes a lot of inconvenience to the patient. Quincke's edema according to ICD 10 is classified as an adverse effect caused by an incompletely specified cause. Often the disease appears simultaneously with urticaria. But according to the clinical classification, there are two types of angioedema - allergic and non-allergic.

The diagnosis of "angioneurotic edema" according to ICD 10 is established on the basis of anamnesis data and clinical picture, if all similar in terms of clinical manifestations illness.

Specific diagnostic methods are not used.

Quincke's edema can be found in ICD 10 in Class XII "Diseases of the skin and subcutaneous tissue" (L00-L99) in the block "Urticaria and erythema" (L50-L54) in the subsection "Urticaria L50" under the code T78.3.

Quincke's edema as a subspecies of urticaria

A severe form of urticaria is also called angioedema or Quincke's edema. Outwardly, the disease looks like a giant swelling of the mucous membrane or subcutaneous tissue on the face (eyelids, lips, tongue, throat) and on other parts of the body (arms, legs, scrotum), therefore, in ICD 10, this disease is in the urticaria subspecies. There are similarities between these allergic manifestations, but also differences. For example, Quincke's edema does not itch, it has a defined area of appearance of a light red color, there is no fossa when pressed, it is not hot to the touch.

With angioedema, the victim has the following symptoms:

may increase blood pressure and temperature;
he feels anxiety, headache, tingling in the area of the disease;
abdominal pain, possible nausea and vomiting, fever and delirium.

Quincke's edema quickly appears and disappears just as quickly, leaving no consequences, after a few hours or days.

Why does Quincke's edema have such an ICD code

However, there is a section in the International Classification of Diseases called "Adverse effects not elsewhere classified (T78)". This part of the document is referred to when coding an indeterminate, unknown, or ill-defined cause of a particular disease.

ICD 10 does not provide for an indication of the direct cause of Quincke's edema. Such allergic reaction can be caused by a wide variety of allergens, because every year their number is growing and it is impossible to list absolutely all risk factors. That is why the Quincke edema code according to ICD 10 consists of the T78.3 cipher.

Setting the Quincke edema code according to ICD 10 makes it easier for the doctor and his colleagues in further work with the patient. And since angioedema belongs to the group of life-threatening diseases, this contributes to accurate and correct treatment.

Quincke's edema is a rapidly developing painful reaction of the body to a number of chemical or biological factors, it is an allergic reaction. Code according to the International Classification of Diseases (ICD-10) - T78.3.

Description

Angioedema or Quincke's edema occurs due to the ingestion of an allergen. It is localized in places with developed subcutaneous tissue - lips, oral mucosa, eyelids, cheeks, less often - on the legs or arms.

The patient's skin color does not change, and there is no itching sensation. If the swelling is not strong, it can go away on its own in a few hours. In more serious cases, it remains clear up to 2-3 days.

The acute form of Quincke's edema can spread to the larynx, which causes difficulty breathing. In this case, the patient has a sharp blanching of the face, a hoarse voice, cough. If emergency care is not provided in time, overconcentration of CO2 in the body and a decrease in oxygen content may occur. As a result - hypercapnic coma, which will lead to death.

In addition, the following symptoms are observed:

nausea;
sharp pain in the abdominal region (in the region of appendicitis);
active motility of the digestive tract.

Also, the patient has a state of anxiety, loss of consciousness is possible. Quite often Quincke's edema affects not only the facial area, but also the cerebral cortex. This is manifested by various neurological disorders:

convulsions;
loss of concentration;
slurred speech;
epilepsy.

The reasons

An immediate hypersensitivity reaction (allergy) occurs suddenly. This usually happens 10-25 minutes after the allergen enters the body, sometimes even faster.

The principle of the beginning of this reaction is “antigen-antibody”. Allergy mediators affect the nerve trunks and blood vessels, causing their dysfunction. The permeability of the walls increases significantly, the vessels expand and the plasma begins to penetrate into the intercellular space. This is what causes swelling.

The most common allergens that can cause acute angioedema are:

preservatives that are present in food;
plant pollen;
animal hair;
dust and bird fluff;
citrus;
medicines;
insect bites.

In addition to this form, there is also congenital Quincke's edema. In such patients, complement proteins are present in the blood, which are in "sleep mode". Usually their activation occurs due to stressful situations, overwork or chronic fatigue. Proteins begin to perceive host cells as antigens and attack them. As a result, angioedema occurs, requiring urgent medical attention.

The video below provides more detailed information about what Quincke's edema is and how it occurs.

Treatment

After examining the patient and establishing the allergen that caused the swelling, a number of drugs are prescribed to prevent relapses.

Antiallergic drugs - help to cope with various edema and inflammation, eliminate bronchospasm (Zirtek, Telfast, Benadryl).
Corticosteroids - inhibit the activity of enzymes that destroy tissues and have an anti-inflammatory effect (Celeston, Kenalog, Medrol).
Diuretic drugs - remove excess fluid from the body, which relieves the swelling that has arisen (Furosemide, Kanefron, Trifas).

An important stage of treatment is the intake of vitamins for general strengthening of the body. Patients with angioedema are recommended vitamins C and B12. The use of ascorbic acid will significantly reduce the level of histamine, and B12 will strengthen the walls of blood vessels.

Important! Quercetin is also prescribed to inhibit the development of allergic reactions, and Bromelain is prescribed to reduce inflammation.

Urgent care

For a patient who has acute form Quincke's edema, it is very important to provide first aid in time.

The first step is to call ambulance.
Next, you need to eliminate the allergen that caused the reaction. For example, if the edema is due to a bee sting, you need to take out its sting and apply a tourniquet (so that the poison does not begin to spread throughout the body).
Should be created by the patient comfortable conditions- put it on horizontal surface and reassure: this will help to avoid the occurrence of panic attacks.
Need to open access to fresh air This will make it easier for the patient to breathe.
Prior to the arrival of doctors, it is necessary to provide a plentiful drink for an allergic person. This will help flush out the allergen from the stomach lining. Also for these purposes, you can use adsorbing preparations - activated carbon, Smecta or Enterosgel.
To remove the primary allergic reaction, you can give the patient elementary antihistamines - Diazolin or Suprastin.
If the swelling has spread to Airways, you should drip your nose with vasoconstrictor drugs.

In the video below you can see the advice of doctors on first aid to the patient.

After the arrival of doctors, the moment of emergency care comes.

If the patient has high blood pressure and the first signs of asphyxia are detected, 0.1-0.5 ml of adrenaline is injected under the skin.
To destroy the allergen are introduced hormonal preparations- Prednisolone, Dexamethasone, Hydrocortisone. Also for these purposes, an injection of Suprastin (2%), Diphenhydramine (2%) and Diprazine (2.5%) is given.
Diuretics are used to remove fluid and salts accumulated at the site of edema - Lasix or Mannitol is administered intravenously.

Angioedema, giant urticaria dangerous disease, which can result in death. Allergic angioedema affects large areas of the skin, connective tissues, and muscles. The mechanism of development is based on the release of plasma into the intercellular tissue due to an increase in vascular permeability. When Quincke's edema occurs in the larynx, it is required emergency help because a person can die from suffocation. Angioedema is observed mainly in children and women, but no one, regardless of gender and age, is immune from the development of the disease.

Causes

ICD code 10 places Quincke's edema in class XII, subsection Urticaria. Pathology is classified as a disease of the skin and fat. The predisposition to a violent reaction to stimuli may be innate. The cause of Quincke's edema is based on an instant-type allergy. High vascular permeability is explained by the release of irritant mediators from sensitized (sensitive) tissue basophils.

The causes of giant urticaria are as follows:

Pollen.
Dust (domestic).
A bite of an insect.
food allergens. Exotic fish, marinades, dried fruits, sausages, sausage, chocolate, strawberries. In children under three years old, allergies are caused by products that are harmless to older ones.
Smells of washing powders, perfumes and more.
Medications - penicillin antibiotics, salicylates, anticonvulsants, iodates, hyperimmune sera, steroids.
Dyes, preservatives.
Animal fur.
Cold.
Sun.

Development mechanism

An acute allergic reaction is the result of three mechanisms: allergenic, non-allergenic, combined type:

With the allergenic mechanism, the allergen invades for the first time - food, medicine, pollen, the body perceives it as an antigen and develops antibodies. Increased sensitivity to stimuli occurs. Re-introduction of the allergen destroys the cell containing the antibodies. Histamine is released and edema develops.
In a non-allergenic mechanism, histamine is released in response to an insect venom, drug, food or olfactory stimulus.
Congenital angioedema is a combined form. Complement proteins are present in the blood in an inactive state. A stressful situation can serve as an activator. Complements accept host cells as antigens. There is swelling.

Symptoms of manifestation

Urticaria and angioedema are observed on surfaces lined with loose fatty tissue. These are lips, cheeks, eyelids, mucous membranes of the mouth, skin of the scrotum. Code - ICD 10, does not establish the cause of the immediate occurrence of edema. The reaction develops to different allergens. The number of factors that can cause an inadequate response of the body is constantly increasing.

Symptoms of angioedema persist for several hours or days, and immediate treatment is required. Often the urticaria disappears on its own. It is characterized by a violent beginning, a rapid continuation.

Symptoms of Quincke's edema:

Angioedema of the larynx is characterized by hoarseness, shortness of breath, cough. Note the patient's anxiety. The skin of the face first becomes bluish, then pale. Loss of consciousness is not ruled out. Lack of treatment is fraught with death.
Local swelling of different parts of the face. Swollen lips, cheeks, eyelids. Eyes tear.
Swelling of tonsils, palate, tongue.
Edema of the urogenital formations. An agonizing state of urinary retention. Such symptoms, especially in children, are accompanied by excruciating pain in the lower abdomen.
Edema of the brain. It is characterized by neurotic disorders and convulsions.
Moisture retention in the digestive organs. "Acute belly". Dyspepsia. Peritonitis.

Symptoms in adults repeat those of children. But, the main cause of giant urticaria is medication.

Diagnostic methods

The diagnosis is made on the basis of the clinical picture and the records of the medical history. Of particular importance are information about the tolerability of medications in preparation for surgery or treatment of diseases.

The doctor is guided by the data of the anamnesis:

the presence of allergies in relatives, in the patient, the seasonality of the manifestation, the presence of animals at home;
whether relatives had allergies; did not respond to vaccinations. Whether there was an allergy before. If so, what is its seasonality?

In the acute phase, laboratory diagnostics is carried out:

During the weakening period, intradermal tests with 12-13 types of allergens.
Redness of the injection site is considered a positive result. The presence and intensity of the reaction indicates four variants of the result: negative, doubtful, weakly positive, positive.

Test contraindications:

Exacerbations of sluggish infections.
Hormone therapy.
Age>60.

If the edema is not allergenic, microbiological tests, biochemical, standard blood tests are carried out.

First aid

Quincke's edema is a dangerous disease with a possible fatal outcome. The situation is changing every second. What to do with angioedema and how to help the victim? Immediately
invite an ambulance. If possible, interrupt the action of the allergen, bring the victim to a comfortable position, give an antihistamine. First aid for swelling of the larynx consists in the speedy transportation of the victim to the hospital, otherwise - death from suffocation.

Types of treatment

Signs of urticaria and angioedema oblige the doctor to make immediate decisions. If laryngeal edema is detected, potent anti-allergic drugs are immediately administered, for example, calcium gluconate or chloride, intravenously, a “hot injection” allows you to remove angioedema. The patient is admitted to the intensive care unit or intensive care unit.

Therapeutic measures are carried out in two stages: the elimination of the acute phase, the destruction of the cause of the disease. The choice of how to treat an allergic manifestation is determined by the severity of the edema.

If anaphylaxis develops, the patient goes to resuscitators, laryngeal edema - ENT. The abdominal symptom complex sends to surgeons. If there is no threat to life, they are sent to allergists or therapists.

After the Quincke's edema, contact with the detected allergen is interrupted - food, dust, feathers, wool, insects, medicines. If the irritant is a physical phenomenon, goggles are used, cold drinks are refused.

Treatment of developing angioedema is carried out with antiallergic drugs. Treatment of edema of a non-allergic nature is carried out on the basis of a deep examination of the patient and determination of the cause of the pathology. Treat the underlying disease.

Therapy of congenital angioedema consists in the introduction of aminocaproic, transcamic acids, or blood plasma. Untimely identified hereditary edema or improper treatment leads to the death of the patient.

The use of prednisolone

Prednisolone is a systemic corticoid with anti-inflammatory, anti-edematous action. It is used when providing first aid for Quincke's edema.

The antiallergic effect of prednisolone is manifested in the following:

The immunosuppressive effect is the destruction of antibodies, blocking the growth and specialization of cells.
Prevention of loss of granules by tissue basophils.
Inhibition of the synthesis of mediators of an allergic reaction
Decreased vascular permeability. The edema decreases, the pressure increases, the lumen of the bronchi expands.

Prednisolone is administered intravenously, according to the instructions.

How to treat at home

Patients are prescribed a diet that limits the intake of foods that promote the production of histamine. Edema that occurs with systemic disorders of the connective tissue relieves medicines used in rheumatology.

Treatment at home is possible in the remission phase. Patients take drugs prescribed by a doctor that prevent exacerbations.

Prevention of giant urticaria

Prevention is provided by diet, elimination of contact with irritants, treatment of chronic ailments, constant use of antihistamines.

www.immunallergo.com

Mucous edema

The mucous membranes are very sensitive to the ingress of an allergen into the body, so swelling begins immediately. Eyes, nose, oral cavity, mucous membranes of the genital tract quickly undergo changes when Quincke's edema occurs. The result of this reaction:

the person cannot open his eyes;
nasal breathing practically stops;
there is a feeling of pressure, itching of the mucous genital organs.

A person with Quincke's edema feels an increase in the tongue in size. There is a feeling of something foreign in the mouth. As a result, articulation suffers. In addition to the tongue, the palatine arches and palatine uvula are enlarged.

Cellular swelling

The subcutaneous fat layer with the development of Quincke's edema swells mainly on the face, legs, arms, neck, upper body. At the same time, the density of edema can be noted, with palpation there are no traces on the skin. The skin in this area is significantly different from the unchanged areas: it is pale, tense. There is a pronounced border with unused areas. The person may experience itching and burning.

Hives

The development of Quincke's edema can be complicated by urticaria. In this case, urticaria affects areas of the body where there are no manifestations of the Quincke reaction. Typical symptoms:

blisters of various sizes and shapes;
severe itching;
bright red rash.

Edema of the mucous membranes of the internal organs

Symptoms of allergic Quincke's edema with damage to the internal hollow organs include:

nausea;
vomit;
diarrhea;
abdominal pain;
violation of urination.

Swelling of the throat can be very dangerous. This is due to the fact that a narrowing of the lumen of the larynx develops. In addition, swelling affects other tissues that are located around the larynx, which can lead to asphyxia. The main stages of this process have specific symptoms.

Stage of compensation

At this stage, the first signs of respiratory failure appear. This is expressed by difficulty in inhaling and catarrhal phenomena in the larynx. A slight shortness of breath develops, which is invisible to others, but the patient begins to worry, get nervous. He is fussy, trying to lean on something with his hands to take a full breath. Since the narrowing of the larynx leads to a violation of sound formation, a barking cough and hoarseness appear.

Stage of subcompensation (partial compensation)

The patient is worried, he has a fear of death. He needs to make more and more efforts to take a full breath. In this situation, on a nervous basis, the symptoms will be more pronounced: shortness of breath intensifies, noisy and frequent breathing is heard around. Lack of oxygen to peripheral tissues manifests itself in the form of cold, pale skin. Voices are almost inaudible.

Stage of decompensation (development of asphyxia)

The most severe stage of laryngeal edema, which can lead to death. The person is passive and indifferent. Breaths are superficial. The skin becomes gray in color, cold sweat appears. There is tachycardia and severe shortness of breath. The lumen of the larynx does not allow the necessary air flow. This condition requires urgent care.

Quincke's edema during pregnancy

During pregnancy, a fairly large number of women (10-15%) suffer from Quincke's edema. This is due to the fact that during pregnancy, women have some tendency to allergic reactions. This is especially true for women who have a hereditary tendency to allergies and have already had a case of Quincke's edema.

In the second half of pregnancy, such an unpleasant complication as toxicosis, or gestosis, can develop. This pathology is characterized by fluid retention in fatty tissue. In addition, during pregnancy, vascular permeability is increased, and more fluid enters the intercellular space. Clinical signs preeclampsia: loss of protein in the urine, high blood pressure, swelling. These symptoms contribute to the development of angioedema. During pregnancy, an increase in pressure can occur on a nervous basis, which will lead to a more massive release of fluid into the intercellular space.

Symptoms of allergic Quincke's edema during pregnancy are superimposed on the symptoms of preeclampsia, and these pathological processes mutually burden each other. Features of symptoms:

pronounced swelling of the face;
eyes completely closed;
often there is swelling of the larynx.

It is very important to note that the standard therapy for angioedema is not suitable during pregnancy. Many drugs can harm the fetus. Moreover, unpredictable reactions to the administered drug may develop. Such a complication during pregnancy is very dangerous for both the mother and the fetus, therefore, urgent delivery is often resorted to.

otekam.net

What is the classification of diseases for?

It is known that angioedema is one of the most unpleasant reactions of the body to an allergen. It is always difficult, restless, and causes a lot of inconvenience to the patient. Quincke's edema according to ICD 10 is classified as an adverse effect caused by an incompletely specified cause. Often the disease appears simultaneously with urticaria. But according to the clinical classification, there are two types of angioedema - allergic and non-allergic.

Specific diagnostic methods are not used.

Read also about urticaria according to ICD 10.

Quincke's edema as a subspecies of urticaria

A severe form of urticaria is also called angioedema or Quincke's edema. Outwardly, the disease looks like a giant swelling of the mucous membrane or subcutaneous tissue on the face (eyelids, lips, tongue, throat) and on other parts of the body (arms, legs, scrotum), therefore, in ICD 10, this disease is in the subspecies of urticaria. There are similarities between these allergic manifestations, but also differences. For example, Quincke's edema does not itch, it has a defined area of appearance of a light red color, there is no fossa when pressed, it is not hot to the touch.

With angioedema, the victim has the following symptoms:

may increase blood pressure and temperature;
he feels anxiety, headache, tingling in the area of the disease;
abdominal pain, possible nausea and vomiting, fever and delirium.

Quincke's edema quickly appears and disappears just as quickly, leaving no consequences, after a few hours or days.

Why does Quincke's edema have such an ICD code

ICD 10 does not provide for an indication of the direct cause of Quincke's edema. Such an allergic reaction can be caused by a wide variety of allergens, because every year their number is growing and it is impossible to list absolutely all risk factors. That is why the Quincke edema code according to ICD 10 consists of the T78.3 cipher.

Setting the Quincke edema code according to ICD 10 makes it easier for the doctor and his colleagues in further work with the patient. And since angioedema belongs to the group of life-threatening diseases, this contributes to accurate and correct treatment.

proallergen.ru

Quincke's edema - what is it and how does it look in the photo?

Quincke's angioedema is manifested by the expansion of the entire surface of the face, part of it or (less often) limbs. Allergic disease got its name from the name of the first person who spoke in detail about it. German doctor G. Quincke.
The main manifestation of Quincke's edema is the development of puffiness in areas where subcutaneous tissue is especially developed. These places include:

lips;
cheeks;
eyelids;
chin part of the face;
tonsils;
language;
soft sky;
genitals.

Important!Puffiness of the genitourinary system is accompanied by severe anuria and symptoms of cystitis (inflammation of the bladder). With the disease, symptoms often appear on the face.

Quincke's edema - ICD code 10

Quincke's edema code according to ICD-10 - T78.3.

Symptoms of angioedema

It is characteristic that the pigmentation of the skin in the affected areas does not change, and there is no sensation of itching of the skin of the face. In some cases, angioedema subsides on its own and without a trace in the interval from several hours to 2-4 days. A hypersensitivity reaction often develops within minutes and requires immediate treatment. Often, swelling extends to the mucous membrane of the larynx. In this case, the patient has difficulty breathing. In parallel, hoarseness of the voice, a cough (“barking” character) and noise during inhalation and exhalation develop. The complexion changes literally before our eyes. At first, it becomes hyperemic, and then quickly acquires a bluish (cyanotic), and then a pale hue. In a patient with Quincke's edema, the concentration of CO2 in the blood rises sharply and the oxygen content drops, i.e., a hypercapnic coma develops. This condition can be fatal, so active treatment is required. Other symptoms include:

pain syndrome in the abdominal region (there is a similarity with appendicitis);
nausea;
vomit;
increased motility of the digestive tract.

Quincke's edema is fundamentally different from another common allergic reaction - urticaria - only in the depth of damage to the skin of the face and other parts of the body. Angioedema and urticaria can either alternate or, in some cases, occur in parallel. The patient is characterized by an anxious state, loss of consciousness may occur. Often, with this pathology, edema develops not only of the face, but also of the brain. It is manifested by a variety of neurological disorders: most often there are convulsions. Edema of the gastrointestinal tract can be manifested by advanced symptoms acute abdomen”, even with phenomena characteristic of peritonitis - pain in the right iliac region, nausea, vomiting, tension abdominal wall. Spread of angioedema to the lower part facial area lead to difficulty breathing and threaten asphyxiation. Swelling of the upper face threatens to affect meninges. With this diagnosis, immediate intervention of qualified specialists and complex treatment - pathogenetic and symptomatic - are necessary.

Causes of angioedema

The causes of Quincke's edema, which manifests itself on the face and other parts of the body, is the "classic" cascade of immediate-type hypersensitivity reactions (allergy). "Giant urticaria" is characterized by the fact that it is dominated by the vascular component. An antigen-antibody reaction begins. Mediators affect the nerve trunks and blood vessels causing their dysfunction. The vessels expand significantly, and the permeability of their walls increases. Serum (plasma) enters the space between the cellular elements, which causes the formation of edema. An additional negative effect on the nerve trunks immobilizes (paralyzes) them. The nerves no longer affect the vessels, which further reduces the tone of the latter. The most common allergens:

It is also customary to consider a hereditary form of angioedema caused by a deficiency of one of the complement system factors (C1 inhibitor). This form is more typical for male patients. She has a family history. The hereditary form develops against the background of stress and minor traumatic injuries. Important!Hereditary angioedema angioedema is treated according to other principles than an allergic reaction. One of the causes of allergic edema can be chronic inflammation of the liver (hepatitis). There are edema of non-allergic genesis, developing, for example, in pathologies digestive system. The likelihood of developing edema increases sharply in patients with pathologies of the internal secretion organs (in particular, the thyroid gland). Edema can be triggered by neoplasms and blood pathologies. The reaction is possible on pharmacological agents (analgesics, sulfonamides and antibiotics of the penicillin and cephalosporin series). It is not excluded the development of puffiness under the influence of physical phenomena (vibration, temperature, pressure, etc.).

Diagnosis of angioedema

The diagnosis is made on the basis appearance patient (symptoms are quite characteristic, the face has a specific appearance), history and possible contact with a substance that could provoke an allergic reaction. Important!In 30% of cases I diagnose the so-called. "idiopathic" form, i.e., a variety in which a specific cause of the pathology cannot be established.

Treatment of angioedema

To stop pathological condition with Quincke's edema, the attending physician primarily uses antihistamine pharmacological agents (Diphenhydramine, Pipolfen, Phencarol, Suprastin, Diazolin) and administers drugs from the group of glucocorticosteroid hormones (to restore respiratory function). In this case, the drug of choice is Prednisolone. If angioedema is combined with urticaria, the administration of Dexamethasone to the patient is recommended. Antiallergic drugs are more effective in the form of injections; otherwise, the likelihood of edema of the gastrointestinal tract increases. If there is a decrease in heart rate, every 10 minutes (if necessary), 0.3-0.5 mg of atropine is administered. With bronchospasm, a nebulizer is activated, through which bronchodilators are administered. Important!In extremely rare cases, epinephrine and ephedrine may be administered according to indications. To prevent a drop in blood pressure and restore the normal volume of circulating blood during treatment, colloidal and saline solutions are required. Most often, 500 ml of hydroxyethyl starch, 500-1000 ml of saline or 400 ml of polyglucin are administered. As the fluid volume is restored, vasoconstrictors are indicated - 0.2-2 ml of norepinephrine per 500 ml of 5% glucose or dopamine (400 mg) per 500 ml of 5% glucose solution. Doses are adjusted until the patient's systolic pressure reaches 90 mm Hg. Art. Oxygen (through a special pillow) is supplied with respiratory disorders and cyanosis.
Therapeutic measures include not only drug treatment, but also the mandatory identification of the allergen (as well as other provoking factors) with subsequent elimination. Patients diagnosed with moderate and severe forms are subject to placement in a specialized department of a hospital. The choice of department depends on the severity and type of pathology. If severe anaphylactic shock occurs, the patient is sent to the intensive care unit. If the patient has laryngeal edema - either in the intensive care unit or in the ENT department. Diagnosis of abdominal syndrome is an indication for hospitalization in the Department of Surgery. With moderate edema and no threat to life, the patient is sent either to the therapeutic or to the allergological department. A mild form of the disease can be treated on an outpatient basis.

First aid for angioedema

Angioedema is a critical condition that poses a significant threat to the patient. In this regard, timely emergency care for Quincke's edema is extremely important. Important! Your first action if you suspect a giant urticaria is to call an ambulance team and describe the situation in detail to the duty officer. After calling an ambulance, try to help the patient yourself. Wherein:

If the allergen substance is known, then the contact of the patient with it should be urgently stopped. When an insect bites, it is advisable to remove the sting to minimize contact of the body with poison. If this is not possible, then it is advisable to wait for the arrival of specialists.
The patient should be placed in the most comfortable position.
It is highly desirable to give the victim 2 tablets of an antihistamine, such as Diphenhydramine or Claritin.
Provide the patient with a plentiful alkaline drink (mineral waters of Borjomi or Narzan). In extreme cases, you can dilute 1 g of ordinary baking soda for 1 liter of water. This will speed up the release of the allergen from the body and facilitate further treatment.
If angioedema has developed after an insect bite or after intramuscular injection pharmacological agent then a pressure bandage should be applied above the skin lesion. If the injection or bite area does not allow this, it is recommended to apply a local ice pack or heating pad - this will slow down the absorption of the allergen, since the local blood vessels will narrow reflexively.
The patient's clothing should be loosened as much as possible (including the waist belt and top button).
Before the doctors arrive, it is advisable to give a sorbent - Enterosgel or activated carbon dissolved in water to a patient who was called an ambulance.
A person with edema should be tried to calm down - a restless state can increase hypercapnia.
The room must be well ventilated so that the patient can breathe freely.

Remember that after calling an ambulance, with pronounced swelling, it is better not to take active steps so as not to worsen the condition of the victim.

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The reasons

The main cause of the condition is an allergic reaction, in which the body, in response to an allergen, releases mediators into the blood, provoking the expansion of veins and capillaries, capillary permeability and the development of tissue edema.

The reasons for this condition can be very different:

The manifestation of the disease

Angioedema develops rapidly, and this is its danger to humans. Edema affects those organs and parts of the human body that have subcutaneous adipose tissue. This syndrome affects mainly children and adult young women.

Typical symptoms of angioedema:

Laryngeal stenosis: The person develops wheezing, sore throat, difficulty breathing, and a dry, barking cough. Against this background, the person turns blue, and then the face turns pale. With damage to the respiratory system, the risk of asphyxia (suffocation) increases, which, if not provided in time, can lead to the death of a person.
Quincke's edema affects different parts of the face, mainly the eyelids, upper lip and cheeks.
Mucosal lesions oral cavity(tonsils, soft palate, tongue).
An allergic reaction from the organs of the genitourinary system: in women there are manifestations of acute cystitis, and in men there is swelling of the scrotum.
Angioedema can affect the abdominal organs, causing a person to experience acute abdominal pain, vomiting, nausea, and impaired stools.

A dangerous complication of such a reaction is swelling of the meninges. At the same time, a person develops such signs as a strong headache, vomiting, neck stiffness and convulsions. This complication is more common in adults than in children.

As for the edema itself, it is localized in a specific area of the face (body) of a person, or it changes its location over time. Quincke's edema is a dense formation on the skin that remains elastic even with pressure. Often this is combined with urticaria, so there is such a sign as purple spots on the skin, which cause pain and itching to a person. Fever and joint pain may also occur.

Depending on the symptoms, Quincke's edema can be classified as:

acute - lasts up to 6 weeks;
chronic - over 6 weeks;
hereditary;
acquired;
associated with urticaria;
independent of any other syndrome.

It should be noted that a person who has manifestations of such a reaction needs urgent help:

The patient is seated comfortably and reassured. It is recommended to remove tight clothing from the victim and ventilate the room.
If possible, protect the person from further exposure to the allergen.
Give to the sick antihistamine Claritin, Zyrtec, Fenistil or other. If there are manifestations from the digestive organs, the tablet is replaced by an injection.
Organize frequent and plentiful drinking. Soda can be added to the water (1 teaspoon per liter of liquid) or given to the patient mineral water medium mineralization.
Give a person an enterosorbent preparation, for example, activated charcoal.
To eliminate itching and swelling, apply a cold compress or ice to the affected area.

If there are manifestations of pathology on the part of the respiratory organs and the brain, a patient diagnosed with Quincke's edema is hospitalized in the intensive care unit of the hospital.

Diagnostics, treatment and nutrition

Diagnosis of the syndrome includes:

The study of the patient's history (the doctor clarifies whether the patient had similar reactions in the past, what allergens he was in contact with in the past) recent times what drugs he was treated with, etc.).
Analysis of blood and urine.
Blood test for allergens.
Analysis of feces for helminths.
Research aimed at eliminating diseases that provoke edema.

Quincke's edema requires complex treatment aimed at eliminating the symptoms of the syndrome, preventing further development of the condition, as well as desensitizing the body (reducing sensitivity to the allergen). To stop the effect of the allergen on the body, cold compresses are used. However, if angioedema has developed due to an insect bite or drug injection, a tourniquet is applied above the skin puncture site.

To normalize breathing and eliminate edema, they are treated with Prednisolone, a universal drug that has an antihistamine, anti-edematous and anti-inflammatory effect. Prednisolone is a systemic glucocorticoid that has an immunosuppressive effect, inhibiting the secretion of mediators and reducing vascular permeability. Prednisolone is administered intravenously. Contraindications to the introduction of Prednisolone are:

hypertension of the third degree;
stomach or duodenal ulcer;
kidney failure.

If edema is combined with urticaria, Prednisolone is prescribed together with Dexamethasone.

Desensitizing treatment includes intramuscular injections of Tavegil or another antihistamine.

When answering the question of how to treat Quincke's edema, one should take into account symptomatic treatment disease that improves the patient's well-being. So:

To prevent the occurrence of hypotension, the patient is administered saline and colloidal solutions.
Atropine injections are prescribed for bradycardia.
When obstruction of the bronchi, inhaled bronchodilators are prescribed.
Treatment with oxygen is prescribed for cyanosis and dyspnea.

If the edema has developed for non-allergic reasons, the treatment tactics will be different, depending on the disease that provoked the syndrome. The most difficult task is the treatment of hereditary Quincke's edema. A person with this disease needs a plasma transfusion, as well as the introduction of aminocaproic and tranexamic acid. If the face and neck are swollen, treatment with the diuretic Furosemide and Dexamethasone is indicated.

A diet for Quincke's edema is an integral part of therapy. Potentially allergenic foods are excluded from the patient's diet first of all and replaced with those that cannot cause allergies. Preference is given to food that is nutritious and rich in vitamins and microelements.

The diet for Quincke's edema excludes the use of:

nuts;
citrus fruits;
milk;
cocoa and chocolate;
tomatoes;
marine fish and shellfish;
lentils, peas, beans;
products with preservatives, dyes and flavors.

Prevention

Limiting contact with allergens, timely treatment of diseases that can provoke such a reaction will help prevent the occurrence of giant urticaria. Adults need to follow the safety rules when working with chemicals. If a person suffers from allergies, he should always carry an antihistamine with him.