A man takes peanut and develop stridor, neck swelling, tongue swelling and hoarseness of voice. Most probable diagnosis is
Angioneuritic edema (Ref. Harrison 17th/e p 2066 & 16riVe p 52, 1952] Angioedema is essentially an anaphylaxis limited to the skin and subcutaneous tissues and can be due to drug allergy, insect stings or bites, desensitization injections or ingestion of ceain foods (paicularly eggs, shellfish or nuts) Sometimes reactions occur explosively after ingestion of minute amounts. Others (e.g. reactions to strawberries), may occur only after overindulgence and possibly result from direct (toxic) mediator liberation. It is characterized by a diffuse and painful swelling of loose subcutaneous tissue, e.g. dorsum of hands or feet, eyelids, lips, genitalia and mucous membrane. Edema of the upper airways may produce respiratory distress and the stridor may be mistaken for asthma. Treatment Epinephrine should be the first treatment for acute pharyngeal or laryngeal angioedema. This may be supplemented, by a nebulized agonist (e.g. albuterol) and an I.V. antihistamine (diphenhydramine). This is usually sufficient to prevent airway obstruction hut intubating or performing a tracheostomy and administering 0, might be necessary. Also know Uicaria This is also an anaphylaxis reaction, but in uicarias the disease is limited to the superficial tissues. Uicaria is characterized by local wheals and erythema in the superficial dermis whereas angioedema is a deeper swelling due to edematous areas in the deep dermis and subcutaneous tissue. Generally, pruritus is the first symptom, which is followed sholy by the appearance of wheals that may remain small (1-5 mm) or enlarge. The larger ones tend to be clear in the centre and may be noticed, first as large rings (> 20 cm across) of erythema and edema. Also know If acute angioedema is recurrent progressive, painful rather than pruritic and not associated with uicaria a hereditary enzyme deficiency should be considerd. Hereditary angioneurotic edema occurs due to loss of C1 inhibitor (regulatory protein) CIF of hereditary angioneuroedema - Episodes of laryngeal edema - Prominence of recurrent gastrointestinal attacks - lack of pruritus and of uicarial lesions Laboratory diagnosis of hereditary angioneuroedema - It depends upon demonstrating the deficiency of C1 inhibitor
>Foreign body bronchus
>Parapharyngeal abscess
Foreign body larynx
Angioneurotic edema