ANGIONEUROTIC EDEMA (ACUTE CIRCUMSCRIBED EDEMA)

Synonyms. Acute circumscribed edema, Quincke's disease, Quincke's edema, giant swelling, giant urticaria.
This is an acute evanescent, circumscribed edema that usually affects the distensible tissues, such as the eyelids, lips, lobes of the ears, and external genitals, or the mucous membranes of the mouth, tongue, or diges¬tive organs. The swelling occurs in the deeper ports of the skin or in the subcutaneous tissues and is usually circumscribed, but may be diffuse. The swellings, as a rule, are tender and the overlying skin is erythematous. although it may be unaltered, edematous, or rarely eechymotic.

On the hands, forearms, Feet, and ankles, a diffuse swelling may take place. Fre­quently the condition begins during the night and is found upon awaken­ing. Urticaria is frequently concomitant.

The disease generally results from gustatory indiscretions, and occa­sionally it is associated with febrile states or the ingestion of coal tar products. Due to the action of histamine or similar substances there is a vasomotor lability which leads to sudden transudation from the vessels into the loose tissues. Cases of dietary origin arc not infrequently due to the combined consumption of shellfish and champagne.

The treatment is similar to that described for urticaria. Colonic irri­gations and saline laxatives and antacids, especially the bicarbonate, citrate, tartrate, and salicylate of sodium or potassium, have proved useful.

Antihistaminic remedies may be given intravenously and orally. ACTH and cortisone are temporarily effective. Dramamine, 50 mg. every four hours, has a quieting Influence on nervous patients.

A solution of adrenalin 1: 1000 is given hypodernically (4 to 6 minims), and epinephrine 1:100 in peanut oil is injected subcutaneously in a dose of 0.5 to 1 cc. Ephedrine sulfate, 25 mg., may be given orally three or four times a day. Locally, cracked ice or ice compresses or soothing lotions of zinc or calamine give relief. When the throat is affected and breathing is obstructed, the sucking of ice or intubation has been recommended.