Angioedema is a condition that causes sudden swelling beneath the skin or mucous membranes. This swelling often appears around the eyes, lips, throat, hands, or feet. While it can be frightening especially when it affects breathing most cases are not life-threatening if treated quickly.

What is Angioedema?

Angioedema happens when fluid leaks from blood vessels into the deeper layers of the skin or mucous membranes. It is similar to hives (also called urticaria), but while hives appear on the surface of the skin, angioedema affects deeper tissues (Kaplan, 2017).

There are four main types of angioedema:

  1. Allergic angioedema
  2. Hereditary angioedema (HAE)
  3. Acquired angioedema
  4. Drug-induced angioedema, especially from medications like ACE inhibitors.

Causes and Triggers

The most common cause is an allergic reaction, often to foods like nuts, shellfish, or eggs. In these cases, angioedema may occur alongside other allergy symptoms such as itching, hives, or even anaphylaxis—a severe allergic reaction that requires emergency care (Zuberbier et al., 2018).

Hereditary angioedema is a genetic condition passed down in families. It is rare but serious, caused by a deficiency or malfunction in a protein called C1 inhibitor. This type of angioedema doesn’t respond to typical allergy medications like antihistamines (Bork et al., 2021).

Drug-induced angioedema, particularly from ACE inhibitors used to treat high blood pressure, is also a known risk. It may appear weeks or even years after starting the medication (Bas et al., 2017).

Symptoms to Watch For

The symptom of angioedema is rapid swelling in one or more areas of the body. Commonly affected areas include:

  • Eyelids and lips
  • Tongue and throat (which can block airways)
  • Hands, feet, and genitals

The swelling may be painful or feel tight but is usually not itchy. In hereditary angioedema, swelling may also occur in the abdomen, causing nausea, vomiting, and cramping (Zuraw & Christiansen, 2020).

In some cases, angioedema is accompanied by hives, especially in allergic reactions. However, hereditary and drug-induced forms often occur without a rash.

Diagnosing Angioedema

Diagnosis typically starts with a physical exam and a detailed history of symptoms and possible triggers. Doctors may ask about recent foods, new medications, family history, and whether hives are present.

For hereditary angioedema, blood tests are used to measure levels of C1 inhibitor and complement proteins. This helps confirm the diagnosis and rule out other causes (Bork et al., 2021).

Treatment Options

Treatment depends on the type and cause of angioedema:

1. Allergic Angioedema

  • This form is often treated with:
  • Antihistamines (e.g., diphenhydramine)
  • Corticosteroids to reduce inflammation
  • Epinephrine (adrenaline) in severe cases, especially when breathing is affected

2. Hereditary Angioedema

This form does not respond to antihistamines or steroids. Treatment may involve:

  • C1 inhibitor replacement therapy
  • Bradykinin receptor antagonists (e.g., icatibant)
  • Plasma kallikrein inhibitors to prevent attacks (Zuraw & Christiansen, 2020)

Patients with HAE may also need medications to prevent future episodes, especially before surgery or dental work.

3. Drug-Induced Angioedema

The most important step is stopping the offending medication. Swelling often goes down within a few days. If the airway is involved, emergency care is critical.

When to Seek Emergency Help

Any angioedema involving the tongue, throat, or breathing difficulties should be treated as a medical emergency. Immediate treatment with epinephrine and hospital observation may be necessary.

Living with Angioedema

For people with recurring angioedema, managing the condition involves:

  • Avoiding known triggers
  • Carrying emergency medication like epinephrine auto-injectors
  • Regular follow-ups with specialists, especially for hereditary forms

Patients with HAE often benefit from genetic counseling and support groups to better understand and cope with their condition.

 

While angioedema can be a frightening experience, especially when it affects the face or throat, it is treatable in most cases. Early recognition of symptoms, understanding the cause, and following the right treatment plan can help manage the condition effectively. Whether it’s allergy-related, hereditary, or drug-induced, working with a healthcare provider is key to staying safe and healthy.

References

  1. Bas, M., Greve, J., Stelter, K., Jappe, U., & Hoffmann, T. K. (2017). Therapeutic strategies for angioedema induced by angiotensin-converting enzyme inhibitors. Allergy, 72(2), 249–261. https://doi.org/10.1111/all.13041
  2. Bork, K., Hardt, J., Witzke, G., & Staubach, P. (2021). Hereditary angioedema: New findings concerning symptoms, affected organs, and course. American Journal of Medicine, 134(6), 749–758. https://doi.org/10.1016/j.amjmed.2020.09.037
  3. Kaplan, A. P. (2017). Chronic urticaria and angioedema. New England Journal of Medicine, 376(7), 656–665. https://doi.org/10.1056/NEJMra1505336
  4. Zuberbier, T., Aberer, W., Asero, R., Bindslev-Jensen, C., Brzoza, Z., Canonica, G. W., … & Maurer, M. (2018). The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy, 73(7), 1393–1414. https://doi.org/10.1111/all.13397

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