(Acute circumscribed edema; Quincke’s disease; Giant swelling)
Definition. A comparatively rare affection characterized by the rapid appearance of one or more large, circumscribed, edematous swellings.
Symptoms. The eruption chiefly attacks the face, comes on suddenly, developing within the course of a few minutes or hours. The person attacked may retire in normal condition and awake the next morning with an eye completely shut, or an ear twice its size, or a largely overdeveloped lip. LArge areas or an entire arm or leg may be involved, and commonly, if the lesions are near a mucocutaneous junction, the mucous membrane may be attacked, causing an interference with breathing or swallowing. Subjective symptoms are not so pronounced as in urticaria, but the objective symptom are, as Osler has written, “urticaria writ large.” As with most angioneurotic disturbances, there is a tendency to recurrence, principally due, I believe, to the inability of the patient or investigator to discover the cause and hence prevent another attack.
Etiology and Pathology. The disease may occur at any age, but it is most common in adult life and among men. It seems that a predisposition of the nervous system to this affection may be in some cases hereditary. In general, the causes of urticaria and erythema multiforme, especially the formation of intestinal toxins, seem to explain the majority of cases. The pathology is not clear, although there is little doubt that the acute, temporary derangement in the peripheral circulation resulting in a sudden serous effusion is brought about through the vasomotor nervous system.
Diagnosis of the disease may need to be made from giant urticaria, hysterical edema and the various forms of secondary edematous swelling; but this should not be difficult if the characteristics of angioneurotic edema-absence of pitting on pressure, sudden appearance and disappearance, regions typically involved, history of previous attacks or family tendency or urticarial outbreaks-can be found.
Prognosis and Treatment. The former may be said to be good in a large majority of case, and, although apt to recur and prove most annoying, it seldom present the fatal termination recorded in the rare case of involvement of the larynx and glottis. The treatment is that of urticaria both as regards general and local measures. A diet based upon the careful comparison of the patient’s food and its elimination is necessary, and laxatives, antacids, antiferments and intestinal antiseptics may be useful. Pilocarpin or atropin may be given hypodermically if the acute swelling endangers life. While the indicated remedy might be found among those suggested under urticaria, I have often found the folloiwng useful: Agaricus, Antipy., Apis, Helleb, nig., and Urtica urens.