Concern first. “Some parts of my face and head swell: I’m sorry, but I have to stop.” Then the reassurance. “A little rest and cortisone will be enough.” Since Tuesday the fans of Ermal Meta have been wondering what the health problem that hit the Albanian musician could be. The singer has not leaked any hypothesis. Based on the symptoms described, however, everything suggests angioedema. A condition that can have different causes and evolutions.
Quincke’s edema: what is it?
Also known as Quincke’s edema, from the name of the German internist who first framed it, angioedema consists of a rapid skin swelling: edema, in fact. The swelling can reach the mucous membrane and its tissues. The disorder – which has some particular characteristics: the long duration (24-72 hours), the lack of itching and skin lesions – mainly affects the face and upper respiratory tract. Not only that, though. Even the hands, feet, genitals and mucous membranes can be affected by these swellings: they almost never cause pain and itching. This is a problem triggered by an alteration in the permeability of blood vessels, which tend to dilate following the release of various mediators (bradykinin, histamine).
The possible causes
The most frequent forms of Quincke’s edema are allergic in origin. But its appearance can also be the side effect of some drugs (especially the antihypertensives belonging to the class of ACE inhibitors and, secondly, of the sartans) and occur after the intake of some foods. The list includes those that represent the main cause of allergic reactions at the table: peanuts, nuts, fish and shellfish. While the intake of cinnamon and alcoholic beverages can increase the likelihood of the problem occurring in predisposed patients.
A genetic origin
In fact, angioedema can also have a genetic origin. This is the case of the hereditary form, due to the deficiency of the blood protein C1 esterase-inhibitor: whose main function is to inhibit complement, a component of the immune system involved in the defense mechanisms against infectious agents.
The risk of respiratory tract involvement
Angioedema is a rare condition. And with an almost always positive evolution. The greatest risks occur when the problem concerns the mucous membrane of the respiratory tract. In these cases Quincke’s edema mainly affects the tongue, soft palate, nasal passages, sinuses and larynx. Their obstruction can, in the most serious cases, even lead to the death of the patient. For this reason, immediate admission to a hospital is essential, where patients can receive immediate assistance (by administering adrenaline) and the airways can be constantly monitored. The swelling may improve on its own within a few days. But to find the most effective treatment, we need to know the causes of angioedema.
How to treat angioedema?
If the problem is of allergic origin, the treatment is based on the use of antihistamines and cortisone (referred to by the same Meta). In the event that the involvement of some drugs is suspected, they are firstly replaced and checked for the gradual disappearance or otherwise of symptoms. However, the path to take is different if the angioedema is of hereditary origin: a remote hypothesis, however, for Meta, since the disease tends to manifest itself from the first years of life, in the presence of a genetic basis. In this case – laboratory confirmation is required for the diagnosis: with values of some complement proteins lower than those expected – the response to antihistamines and cortisone drugs is almost always insufficient. However, there are drugs that can prevent swelling or treat it as soon as it occurs. Generally, some drugs containing androgens (which can regulate the level of protein in the blood) and some derived from the plasma of a healthy human donor are used to relieve symptoms.