Quincke's edema on the lips, eyes and face: how it manifests and why it is dangerous

Everything was as usual in the morning, and suddenly the lip became twice as large, the eyelid drooped, and the face lost its familiar contours. This is how Quincke's edema begins — a sudden deep swelling under the skin. Below — what it looks like, where it comes from, and at what point it becomes truly dangerous.

What Quincke's edema is

Angioedema, or Quincke's edema, is a sudden swelling that develops under the surface of the skin rather than on it. In essence it is the same urticaria, only deeper: in urticaria the surface of the skin swells, while in Quincke's edema the subcutaneous tissue and mucous membranes swell. Both conditions can occur simultaneously or alternate. The name honors the German physician Heinrich Quincke, who described the condition in 1882.

What edema of the lips, eyes and face looks like

Areas with well-developed subcutaneous tissue swell: lips, eyelids, cheeks, the oral mucosa. The skin in the area of edema usually does not change color, and there is no itching — unlike urticaria, which itches very intensely. The edema itself may be painful. Additionally, edema of the eyes and ocular mucosa, edema of the tongue, and, when the intestines are involved, abdominal pain, nausea, vomiting, and increased peristalsis are possible. In typical cases the edema resolves without a trace after several hours, sometimes up to 2–3 days.

How allergic facial edema differs from ordinary edema

If the edema is caused by an allergic reaction, there is often a clue nearby — raised, itchy rash (urticaria). But angioedema can also occur without urticaria. Quincke's edema arises suddenly, develops under the skin, the skin does not change color, and there is no itching. Briefly about the differences:

• Appeared suddenly — more likely Quincke's edema.
• There is an itchy urticarial rash — may indicate an allergic reaction.
• The skin in the area of edema does not redden and does not itch — typical of angioedema.
• The edema has affected the tongue or throat, hoarseness has appeared — this is already about breathing.

Why Quincke's edema occurs: allergic and non-allergic nature

In the allergic variant, the immune system reacts to an allergen — food, medication, pollen, animal dander, an insect bite — and releases histamine into the blood. In the non-allergic variant, histamine is released in response to a medication (most often from the ACE inhibitor group), insect venom, or a food or olfactory irritant. Five types are distinguished: acute allergic, non-allergic, idiopathic (cause unknown), hereditary and acquired — the latter occurs with lymphoma or connective tissue diseases, such as lupus. The hereditary form is associated with C1-inhibitor deficiency, is more common in men, and is triggered by minor injuries and stress. In most cases the cause of the edema is never found.

Why edema is dangerous and which signs indicate a threat to breathing

Edema of the face and lips is unpleasant in itself, but usually harmless and resolves within a few days. The danger lies in the spread of edema to the larynx: the trachea is compressed and breathing is impaired. Warning signals: hoarseness of the voice, barking cough, noisy breathing, first difficult exhalation, then inhalation, the face reddens, then sharply pales. On examination the doctor may hear stridor — noisy breathing on inhalation. If the edema has affected the tongue or throat, this is a medical emergency.

In itself it is not a reason to call an ambulance; 103 or 112 — if the lips, mouth, throat or tongue have suddenly swollen, you are breathing very fast or with difficulty, feel that you are suffocating, your throat is tight, it is difficult to swallow, the skin, tongue or lips have turned blue, gray or pale, confusion, drowsiness or dizziness have suddenly appeared, or the person has lost consciousness.

How it is diagnosed and when to see a doctor

The doctor examines the skin and asks about contact with irritants. Blood tests and allergy tests may be ordered, although often the cause of the edema or urticaria cannot be found. You should see a doctor if the edema does not resolve, is severe, or has appeared for the first time in your life. If the edema has affected only the hands, feet or genitalia, this is a reason for an urgent consultation, but not for panic. Remember: this material is for reference and does not replace a doctor's consultation — if in doubt, it is better to see a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer