From the Guidelines
Quincke's edema of the uvula, also known as uvular angioedema, is a self-limiting condition that typically resolves spontaneously within 24-48 hours without specific treatment. The condition presents as sudden swelling of the uvula due to fluid accumulation in the tissues, often following an allergic reaction, trauma, or infection. Initial management focuses on identifying and removing the trigger if possible. For mild cases, observation and reassurance are sufficient as the condition is self-limiting.
Key Considerations
- For moderate symptoms, cold liquids, ice chips, or anti-inflammatory medications like ibuprofen (400-600mg every 6-8 hours) may provide relief 1.
- In more severe cases with respiratory distress, immediate medical attention is necessary, potentially requiring antihistamines such as diphenhydramine (25-50mg orally or IV), corticosteroids like methylprednisolone (125mg IV), or epinephrine (0.3-0.5mg IM) for significant airway compromise 1.
- The natural course involves gradual reduction of swelling as the inflammatory response subsides.
- Recurrence is possible if the patient is re-exposed to the triggering factor, so identification of the cause is important for prevention.
- The pathophysiology involves increased vascular permeability leading to fluid extravasation into the uvular tissue, creating the characteristic swelling.
Management Approach
- Upper airway edema should be treated as a medical emergency, with consideration for early intubation or tracheotomy in severe cases 1.
- Patients experiencing oropharyngeal or laryngeal attacks should be observed in a medical facility that can perform intubation or tracheostomy if necessary 1.
- The use of specific medications such as C1-INH, icatibant, or ecallantide may be effective in treating acute attacks of angioedema 1.
From the Research
Clinical Manifestations
- Quincke's edema, also known as angioedema of the uvula, is characterized by a nonerythematous swollen uvula, fullness in the throat, and signs of airway obstruction 2
- Symptoms may include throat tightness, altered voice, and tachypnea 3, 4
- The condition can be life-threatening due to the risk of respiratory compromise 2, 5
Causes and Triggers
- Quincke's edema can be induced by several factors, including foods, drugs, and inhalants 2
- Allergic reactions, such as food allergy, can also trigger the condition 6
- Other causes of laryngeal edema with upper airway obstruction include radiotherapy in cancer and the intake of ACE-Inhibitors 5
Treatment and Management
- Treatment typically involves corticosteroids, antihistamines, and β2-agonist nebulization 3
- Sympathomimetic drugs, both by injection and by inhalation, can also be effective in resolving the swelling and symptoms 4
- In cases of hereditary angioedema (HAE), replacement therapy with purified C1 inhibitor concentrate (C1-INH) has proven to be effective 5