Angioedema

Overview

Angioedema is the swelling of the area beneath the skin or mucosa. It is usually an allergic reaction, but it can also be hereditary. In some cases, this swelling is accompanied by the appearance of hives. 

Hives are itchy and raised, red welts that develop on the surface of the skin, involving only the two skin layers. Hives are also known as Urticaria.

The swelling occurs because of the accumulation of fluid. It tends to affect the areas with loose tissues, especially the face and throat, including the limbs and genitals.

Both angioedema and hives may be caused by an allergic reaction or intolerance to food, side effect or allergy to a medication, or an allergen in the surrounding environment, such as pet dander, pollen, and venom from insect bites.

Angioedema can occur with hives or alone, cause inflammation in the deeper layers of the skin. Most times, hives and angioedema are harmless, clearing up within a day and do not leave lasting marks, even without treatment. 

In very rare cases, the swelling can be a symptom of a more serious health condition, such as non-Hodgkin B-cell lymphoma. Some areas of the body, such as the eyelids, lips, and tongue are more prone to angioedema than others.

Angioedema is usually treated with antihistamines. It may be life-threatening if the swelling causes the throat or tongue to block the airway.

Angioedema can be fatal, with a big number of deaths occurring each year.

Common symptoms of angioedema

The most common symptom of angioedema is swelling with a red-colored rash under the surface of the skin. It may appear in a localized area which can be near the lips, eyes, feet, or hands.

In severe cases, the swelling may spread to other parts of the body. Angioedema may or may not be accompanied by swelling and welts on the surface of the skin.

Other symptoms of angioedema include abdominal cramping. In rare cases, people with angioedema may experience hoarseness, a swollen throat, and difficulty breathing. Angioedema may or may not itch.

If you have trouble breathing, go to the emergency room immediately or call 911 or emergency medical services. You may be needing prompt medical treatment.

Causes

There are different types of angioedema, and they all have different causes.

Allergic angioedema

Allergic angioedema is the most common type. The allergic reaction can be to foods, such as:

  • Fish
  • Shellfish
  • Peanuts
  • Eggs
  • Tree nuts
  • Milk

The allergy could also be caused by:

  • Animal dander
  • Pollen 
  • Latex
  • Insect stings

Drug-induced angioedema

Some medications may trigger angioedema, including:

  • Aspirin
  • Penicillin
  • Certain non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen
  • Some blood pressure medications called angiotensin-converting enzyme inhibitors (ACE inhibitors) may cause flare-ups that can occur quickly. Sudden reactions can still occur even if you have been taking ACE inhibitors for a long period.

Hereditary angioedema

This type of angioedema is rare. It occurs when your body does not produce enough of a blood protein called C1 esterase inhibitor. It allows fluids from your blood to move into other tissues, causing swelling.

The first bout of this type of angioedema usually occurs before a person turns 12 years old. If you have this condition, it may be passed on to your children.

Another rare type of angioedema, called acquired angioedema, has the same symptoms as hereditary angioedema. The difference is that it does not occur until a person is older, usually in the 40s. it usually occurs when a person has a weakened immune system. Unlike hereditary angioedema, acquired angioedema is not passed on to a person’s children.

Idiopathic angioedema

Idiopathic means there is no known cause for the swelling. Possible causes of this type of angioedema can include:

  • Minor infections
  • Anxiety or stress
  • Overdoing your exercises
  • High or low temperatures

Allergic and drug-induced angioedema usually occurs within the first hour of exposure to the trigger. Hereditary and acquired angioedema usually occur over several hours, but it can feel much faster if you wake up and suddenly finds swelling.

Diagnosis and Treatment

Your doctor will examine you and talk about your symptoms to find out the type of angioedema that you have. A doctor can usually form a clear diagnosis of the type of angioedema from the appearance of the symptoms, a description of the possible triggers, and by taking a family and medical history.

The doctor will also check if a person is taking any medications linked to angioedema, such as ACE inhibitors. 

When a person has been exposed to a common allergen before the angioedema occurs means that there is a likelihood of allergic angioedema. The presence of hives will also point to this type. 

A family history of angioedema may suggest that the incidence of angioedema is hereditary. 

The doctor may order some further tests to get more details about your condition. These may include:

  • A blood test to see the reaction of the immune system to a certain allergen
  • A skin prick test to confirm the link to possible allergies, in which the skin is pricked with a very tiny amount of the suspected allergen
  • A blood test to check for C1 esterase inhibitor, low levels of which suggest that the problem is hereditary

Complications of angioedema

The most dangerous complications of angioedema are swelling of the throat and airways.

The condition is usually mild, but if it progresses rapidly, or if it affects the throats, it can cause asphyxiation, leading to the following signs:

  • Fainting or dizziness
  • Sudden or rapidly escalating breathing problems
  • Collapsing

This condition is a medical emergency. Upon noticing these signs, immediately call emergency medical services or 911.

Treatment

The treatment for angioedema depends on the cause, but the most important action is to make sure that the airway is free from any obstruction. In an emergency, a breathing tube might need to be inserted for safety. 

Angioedema usually improves on its own within a few days. If you need treatment, it may include:

  • Medications to ease inflammation and swelling, such as oral corticosteroids and antihistamines
  • Drugs that slow down your immune system when corticosteroids and antihistamines do not work
  • Other medicines to ease swelling and pain, such as leukotriene antagonists, a group of non-steroid anti-inflammatory medicines
  • Blood protein controllers for hereditary angioedema

For drug-induced angioedema, your doctor usually switches you to another medicine that you will be able to better handle.

For serious attacks, you will require an epinephrine shot. Epinephrine is a type of adrenaline. For repeated serious attacks, you may have to carry an epinephrine autoinjector in an emergency.

Lifestyle and home remedies

The following tips will help you relieve your symptoms when you are experiencing angioedema:

  • Avoid triggers - The triggers can include foods, medicines, pet dander, pollen, insect stings, and latex. If you believe a medication caused your angioedema, stop using it and contact your doctor immediately.
  • Use an over-the-counter anti-itch drug - Your itching may be relieved by taking an over-the-counter oral antihistamine, such as Claritin, Zyrtec Allergy, or Benadryl Allergy. Consider taking a medicine that does not cause drowsiness. Ask your pharmacist for other options.
  • Apply cold washcloth - Covering the affected areas with a cold washcloth will help soothe the skin and prevent scratching.
  • Take a cool bath - Cool shower or bath can help relieve itching. Some people could benefit from taking a cool water bath sprinkled with baking soda or oatmeal powder, but this is not a long-term solution.
  • Avoid the sun - Relieve discomfort by avoiding the sun whenever outdoors.
  • Wear loose cotton clothing - Avoid wearing clothes that are tight, rough, and scratch, especially those made from wool.

Prevention

Allergic episodes may be avoided if you will stay away from foods, medications, or other conditions that will trigger angioedema. If you do not know the cause of your episodes, you should keep track of foods, situations, and symptoms associated with your symptoms.

Your doctor will recommend that you take antihistamines every day instead of just taking them when needed. This will help you avoid episodes, make the occurrence less often, or be less dangerous. Do not wait for the medicine to start working when you need relief from your angioedema.

Risks of Having Angioedema

Certain factors can increase your risk of developing angioedema, including:

  • A previous allergic reaction
  • A previous incidence of angioedema or hives
  • A family history of angioedema or hives
  • Sudden changes in temperature
  • Certain medical conditions such as lymphoma, lupus, hepatitis, thyroid disease, HIV, Epstein-Barr virus, cytomegalovirus, or have had a blood transfusion
  • Anxiety or stress
  • You have asthma and have taken NSAIDs
  • You have had recombinant tissue plasminogen activator (rtPA) therapy for a stroke
  • You take ACE inhibitors, especially if you are an African-American or a woman, or if you are taking angiotensin receptor blockers (ARBs).

When to Seek Medical Attention

Whether you experience angioedema for the first time or repeatedly, you need to see your doctor. In some cases, while setting up your doctor’s appointment, you may be immediately referred to a dermatologist or an allergy specialist. 

Before seeing your doctor, you should:

  • List your signs and symptoms, when they occurred, and how long they lasted
  • Bring a list of all medications you are currently taking, including supplements, vitamins, and herbal products. If possible, take the original bottles and a list of the doses and directions.
  • Make a list of questions you want to ask your doctor.

Verrill Lépicier

A seasoned and experienced Family Medicine practitioner, Dr. Lépicier closely follows medical research and updates to stay abreast of the latest developments. He believes in giving his patients the best fighting chance against diseases and infections. He prescribes modern and newly-released medicines after thoroughly studying the drug literature and gives drug companies and researchers valuable feedback on how his patients react to the medication. We're proud to have him as the team's voice of experience.

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