Parasitic infestations as a cause of episodic angioedema

Angioedema (AO) is a localized transient acute, recurrent edema of the skin or mucous membranes. Vasoactive substances play a key role in the development of AO: histamine, tryptase, prostaglandin, bradykinin, which lead to a reversible increase in endothelial permeability. Usually, the manifestations persist from 2 hours to several days and in most cases disappear without a trace, without additional therapy. ICD-10 CODE: T 78.3 - angioedema, D 84.1 - defect in the complement system. The purpose of the study. The purpose of the study is to study the features of episodic angioedema as a manifestation of parasitic invasion Materials and methods. The clinical case of a 10-year-old boy who was hospitalized in the pediatric department as planned with complaints of recurrent swelling of the eyelids, perianal area, itchy skin, hemorrhagic rashes, abdominal pain was analyzed. These symptoms are noted periodically for 2.5 years. The child’s anamnestic data, allergoanamnesis, gender characteristics, and the structure of the main diagnoses were analyzed. The results of laboratory and instrumental research methods were evaluated (including the level of C1 inhibitor for differential diagnosis with hereditary angioedema). Results. The results of the study. For 2.5 years, the child was periodically hospitalized in various hospitals with symptoms of periorbital edema and abdominal pain. These symptoms persisted from 2 weeks to 2 months. And they were registered with a frequency of 2 months. Blood tests showed an increase in IgE by 10 times, IgG to helminths by 6 times. At normal values of the C1 inhibitor. During the EGDS, a large number of roundworms were discovered. The normal level of the C1 inhibitor, as well as the absence of similar signs of the disease in the child’s closest relatives (autosomal dominant type of inheritance) made it possible to exclude hereditary angioedema with a high degree of probability. Conclusion. The data obtained during the analysis allowed us to conclude that parasitic invasion may be the cause of angioedema in children. Blood eosinophilia, as one of the important indicators of parasitic invasion, may be absent during the long course of infection. The presence of elevated total immunoglobulin E and positive minimum levels of antibodies to helminths in the blood should alert doctors in terms of further search for parasitic invasion.

angioedema, helminths, children

1. Federal Clinical guidelines for the diagnosis and treatment of patients with angioedema. Moscow. 2013. (in Russ.)@@ Федеральные «Клинические рекомендации по диагностике и лечению больных с ангионевротическим отеком» Москва. 2013 г.

2. Khaitov R.M. «Clinical allergology», 2002 7. V.F. Zhernosek «Allergic diseases in children», Minsk. 2003. (in Russ.)@@ Хаитов Р.М. «Клиническая аллергология», 2002 7. В.Ф. Жерносек «Аллергические заболевания у детей», Минск 2003 г.

3. Sologova S.S., Tarasov V.V. Modern aspects of the use of antihistamines in children.Russian Medical Journal. 2015;(14):852-856. (in Russ.)@@ Сологова С.С. Современные аспекты применения антигистаминных препаратов у детей. Русский медицинский журнал. 2015;(14):852-856.

4. Revyakina V.A., Shakhtmeister I.Ya., «Local glucocorticoid therapy of allergic skin diseases in children» Guide for practitioners. Moscow, 1998. (in Russ.)

5. Pavlov O.B., Bychkovsky D.E., Prostratskaya A.A., Suschaya E.M. Quincke’s edema. Military medicine. 2015;(34):143-146. (in Russ.)

6. Ilyina N.I. Drug allergy. Methodological recommendations for doctors. (Part 1).Russian allergol. journal. 2013;(5):27-40. (in Russ.)