Understanding Quincke’s Oedema: Causes, Symptoms, Diagnosis, and Treatment

Have you ever felt a feeling of fullness or swelling at the back of your throat, or a sudden voice change? If you take a look at the inside of your mouth, you may notice visible swelling or an enlarged uvula hanging unusually. This could be a sign of Quincke’s oedema. In this blog, we will cover what Quincke’s oedema is, its common causes and triggers, symptoms, diagnosis, and existing treatment options.

What is Quincke’s Oedema?

Angioneurotic oedema, or angioedema, is a condition where the lower layers of skin and tissue beneath the skin or mucous membranes swell due to the accumulation of fluids. If the swelling is present in the uvular region, it is called angioneurotic uvular oedema, isolated uvular angioedema, or Quincke’s oedema.

The uvular region is a flashy extension at the back of the tongue and hangs above the throat. The main function of the uvula is to produce saliva to keep the throat and mouth moist, as well as to aid in eating and drinking.

Is Quincke’s Oedema only seen in the uvular region?

Quincke’s oedema mostly refers to swelling in the uvular region only. While angioedema can occur in other areas such as the face, gastrointestinal tract, hands, feet, and, rarely, the genital region.

What are the most common causes of Quincke’s Oedema?

The basic pathophysiology behind Quincke’s oedema is the manifestation of allergic reactions, particularly type 1 hypersensitivity reactions. The release of histamine and other chemical molecules induces inflammation in response to allergens by producing IgE antibodies produced by plasma cells.

In addition to exposure to allergens such as certain foods (e.g., peanuts, fish, tree nuts) or triggers like pollen, other causes or risk factors for Quincke’s oedema include trauma, inhalation of substances like marijuana, adverse reactions to medications such as angiotensin-converting enzyme inhibitors, general anaesthesia during medical procedures, obesity, and smoking.

Can Quincke’s Oedema occur genetically?

Quincke’s oedema can be hereditary and non-hereditary. The C1 esterase inhibitor acts like a gatekeeper by regulating the production of certain immune system pathways, like the complement system and kinin pathway. In hereditary cases, the deficiency or dysfunction of the C1-esterase inhibitor can lead to uncontrolled activation of the pathway, producing too much bradykinin and other inflammatory responses, which leads to significant swelling.

What are the symptoms of Quincke’s Oedema?

Symptoms of Quincke’s oedema usually include the presence of foreign bodies in the throat, which can cause obstruction and a sensation of throat fullness. Additional symptoms may include swelling of the uvular region, changes in voice or trouble speaking, difficulty in breathing or swallowing, and coughing. A serious medical emergency is considered when the respiratory system is compromised due to the condition.

How is Quincke’s Oedema diagnosed?

Diagnosis for Quincke’s oedema usually includes direct visualisation of the uvular region and also noticing if there are any signs of tongue swelling. In most cases, laryngoscopy may be performed to check if there is any involvement in the laryngeal or vocal cord. There are chances of misdiagnosis, with symptoms of Quincke’s oedema often identified as uvulitis, an infectious condition. Neck X-rays may be done to rule out this condition and confirm Quincke’s oedema.

How is Quincke’s Oedema currently treated?

Whether hereditary or nonhereditary reasons cause the symptoms, more laboratory testing is necessary to establish the course of treatment. For acute cases of Quincke’s oedema, treatment usually includes the administration of epinephrine, antihistamines, steroids, and airway management. This is usually done based on the airway status and the disease’s severity. In emergency cases, doctors may perform intubation or cricothyroidotomy to relieve airway obstruction.

Quincke’s oedema caused by hereditary circumstances is usually prescribed with fresh frozen plasma or plasminogen inhibitors. Additionally, in cases where there are continuous episodes of Quincke’s oedema despite medications, surgeries like partial uvulectomy, i.e., removal of the part of the uvula, may be appropriate.

What is the recovery for patients with Quincke’s Oedema?

In most cases, recovery can last between 1-2 days. If the case is unknown, doctors will monitor for recurrence. Quincke’s oedema has a typically favourable prognosis with a low recurrence rate. However, in rare circumstances, recurrent swelling—even after a uvulectomy—could signal the presence of a tumour.