Overview

Angioedema is a condition that causes sudden, temporary swelling deep under the surface of your skin or mucous membranes (like the lining of your mouth or throat). This swelling happens because tiny blood vessels leak fluid into the tissues.

It can be caused by a few different things, including allergic reactions (to foods, insect stings, or medications), certain medications themselves (especially a type of blood pressure medicine called ACE inhibitors), a genetic condition called hereditary angioedema (HAE), or sometimes, the cause remains unknown (this is called idiopathic angioedema).

Anyone can get angioedema, but it's more common if you have a history of allergies or hives, or if it runs in your family. It's important to know that angioedema itself is not contagious, so you can't catch it from someone else or pass it on through touch. Living with angioedema can be worrying, especially if the swelling is severe or happens often, as it can affect your appearance, comfort, and sometimes even your breathing. We understand this can be a difficult experience.

Symptoms

When angioedema occurs, you might notice a few different things. The symptoms can come on quite suddenly.

• Sudden, well-defined swelling: This is the hallmark sign. It often appears on the eyelids, lips, tongue, hands, feet, or genitals.
• Skin that feels tight, firm, or warm - in the swollen area.
• Pain or tenderness - in the swollen region.
• Redness or normal skin color - over the swelling. Unlike hives, the swelling is deeper.
• Swelling may or may not be itchy. If it's caused by an allergy, it's often itchy and may occur along with hives. In hereditary angioedema, itching is usually absent.
• Swelling in the throat, voice box (larynx), or tongue: This can cause hoarseness, difficulty swallowing, or difficulty breathing, which is a medical emergency.
• Abdominal cramping or pain: This can happen if the swelling affects the lining of your intestines.
• Symptoms can range - from mild, localized swelling to severe, widespread swelling. Episodes can develop rapidly, within minutes to a few hours.

Diagnosis

Figuring out if you have angioedema, and what might be causing it, usually starts with a visit to your doctor. They'll want to hear all about your symptoms – when they started, what they feel like, and how often they happen.

Your doctor will perform a physical examination, looking closely at any swollen areas. They will also ask about your medical history, any medications you're taking (including over-the-counter ones and supplements), your family's medical history (as some types of angioedema can be inherited), and any potential triggers you might have noticed.

In some cases, especially if an allergic cause is suspected, allergy testing (like skin prick tests or blood tests) might be recommended. If hereditary angioedema (HAE) is a possibility, specific blood tests will be needed to check the levels and function of certain proteins in your blood, like C1 esterase inhibitor.

Management & Treatment

Finding the right way to manage angioedema is a partnership between you and your healthcare provider. The goal is to calm the swelling, relieve discomfort, and prevent future episodes. How we approach this depends greatly on what's causing the swelling in the first place.

For many, especially if the swelling is mild, angioedema may go away on its own within a few days without any treatment. However, if you're uncomfortable or the swelling is persistent, several options are available to help.

Home Care and Over-the-Counter (OTC) Relief

If your symptoms are mild, you might find relief with these simple strategies:

• Cool Compresses: Applying a cool, wet cloth to the swollen area can help soothe the skin and reduce a puffy appearance.
• Avoid Irritants: Try to steer clear of hot showers, harsh soaps, or tight clothing, which can make the swelling feel worse.
• Antihistamines: For angioedema related to allergies, over-the-counter antihistamines can be very effective. These medications work by blocking the chemical (histamine) that your body releases during an allergic reaction.

Prescription and Advanced Treatments

When OTC options aren't enough, or if your angioedema has a non-allergic cause, your doctor has other tools to help. This is especially true for hereditary angioedema (HAE), which does not respond to antihistamines.

Prescription treatments may include:

• Corticosteroids: These strong anti-inflammatory drugs can quickly reduce swelling but are typically used for short periods.
• Specialized HAE Medications: For those with hereditary angioedema, there are specific medicines designed to treat and prevent attacks by targeting the underlying cause.
• Epinephrine Auto-Injector: If you have a history of severe reactions, your doctor may prescribe an epinephrine auto-injector (like an EpiPen) for you to carry at all times. This is life-saving medicine for severe allergic reactions.

Living with angioedema means learning what your personal triggers are and how to avoid them. Keeping a diary of your symptoms and what you ate or were exposed to can be incredibly helpful. If a medication is the cause, your doctor will help you find a safe alternative.

Improvement can be quick, often within hours for mild cases, or it may take a few days for the swelling to completely go down. If your treatment isn't providing relief, it’s important to let your doctor know. They can help investigate further and adjust your management plan.

Important Warning: Swelling of the tongue, throat, or lips can be a sign of a life-threatening emergency because it can block your airway. If you experience trouble breathing or feel your throat closing, call 911 or go to the nearest emergency room immediately.

Duration & Outlook

An episode of angioedema typically lasts from a few hours up to about three days. The swelling then usually goes away on its own without leaving any permanent marks on your skin.

Angioedema can be acute, meaning it happens just once or very rarely, perhaps due to a specific allergic reaction. Or, it can be chronic or recurrent, where episodes happen more frequently over a longer period. The outlook often depends on identifying and managing the underlying cause or triggers. For many, once triggers are known and avoided, the episodes become less frequent or stop.

It's really important to be aware of warning signs for complications. If you experience swelling of your tongue or throat, have difficulty breathing or swallowing, feel dizzy, or pass out, this is a medical emergency, and you need to seek immediate medical help. These symptoms can indicate that your airway is being affected, which can be life-threatening.

Prevention

Preventing angioedema largely depends on what's causing it for you. Once you and your doctor have an idea of the cause or your specific triggers, you can take steps to avoid them.

If your angioedema is triggered by a specific food or medication, the most important step is to avoid that substance completely. For example, if a certain pain reliever causes swelling, your doctor can help you find a safer alternative. If it's an allergy to something like peanuts or shellfish, careful reading of food labels and caution when eating out become very important.

Keeping a detailed symptom diary can be incredibly helpful. Note down what you ate, any new products you used, your stress levels, and any other potential factors around the time an episode occurs. This can help you and your doctor identify patterns and pinpoint triggers that might not be immediately obvious. For those with hereditary angioedema, specific medical plans are often in place to prevent attacks.

Causes & Triggers

Understanding what causes angioedema can sometimes feel like detective work, as there are several possibilities. The swelling happens because blood vessels deep in the skin leak fluid. This leakage can be due to the release of histamine (common in allergic reactions) or other substances called bradykinins (often involved in medication-induced or hereditary angioedema).

Common Causes:

• Allergic Reactions: This is a frequent cause. Triggers can include certain foods (like nuts, shellfish, eggs, milk), medications (especially antibiotics like penicillin), insect stings or bites, and latex.
• Medications (Non-Allergic): Some medications can cause angioedema as a side effect, even if you're not truly allergic to them. The most well-known are ACE inhibitors (medicines for high blood pressure like lisinopril or ramipril) and sometimes NSAIDs (like ibuprofen or naproxen).
• Hereditary Angioedema (HAE): This is a rare genetic condition where the body doesn't produce enough of a protein called C1 esterase inhibitor, or the protein doesn't work correctly.
• Acquired Angioedema (AAE): This is also rare and can develop later in life, sometimes in association with other medical conditions.
• Idiopathic Angioedema: Sometimes, despite thorough investigation, a specific cause cannot be found. This can be frustrating, but it means other known causes have been ruled out.

Common Triggers (these can vary depending on the type of angioedema):

• Specific foods or food additives
• Medications
• Insect bites or stings
• Stress or anxiety
• Infections (like a cold or urinary tract infection)
• Minor injury, trauma, or medical/dental procedures (especially for HAE)
• Extreme temperatures or sudden temperature changes

Who is most likely to develop it?

• People with a history of allergies or hives (urticaria).
• Individuals taking ACE inhibitor medications.
• Those with a family history of angioedema (suggesting HAE).
• People with certain autoimmune conditions.

Risk Factors:

• Having had angioedema or hives before.
• Known allergies.
• A family history of angioedema or hives.
• Taking medications known to sometimes cause angioedema (like ACE inhibitors).

When to see a doctor

It's very important to know when to seek medical help for angioedema, as some situations can be serious.

You should seek immediate emergency medical care (call emergency services or go to the nearest emergency room) if you experience any of the following signs:

• Swelling of your tongue, throat, or voice box.
• Difficulty breathing or noisy breathing (stridor).
• Trouble swallowing or a feeling like your throat is closing.
• Dizziness, lightheadedness, or fainting.
• Widespread hives along with swelling.

These can be signs of a severe reaction called anaphylaxis or that your airway is becoming blocked, both of which are life-threatening.

You should also make an appointment to see your doctor or a dermatologist if:

• You have recurrent episodes of swelling, even if they are mild.
• You suspect a medication you are taking might be causing the swelling.
• The swelling is accompanied by hives.
• You are unsure what is causing your symptoms and want an accurate diagnosis.
• The swelling is causing you significant discomfort or anxiety.

A healthcare professional can help determine the cause of your angioedema and discuss how to manage it. Please don't hesitate to reach out to them; they are there to help you.

Frequently Asked Questions (FAQs):

• Q: Can stress cause angioedema? A: Yes, for some individuals, stress can act as a trigger that can set off an episode of angioedema, particularly in certain types like hereditary angioedema or if you already have a tendency towards it. Managing stress might be a helpful part of your overall care.
• Q: Is angioedema always an allergic reaction? A: Not always. While allergic reactions are a common cause of angioedema (often accompanied by hives), it can also be caused by other factors. These include side effects from certain medications (like ACE inhibitors for blood pressure), rare genetic conditions (like hereditary angioedema), or sometimes the exact cause isn't found (idiopathic angioedema).
• Q: If I have angioedema, will I also have hives? A: Angioedema can occur with or without hives (which are itchy, raised welts on the skin). When angioedema and hives appear together, an allergic cause is often suspected. However, some types of angioedema, such as hereditary angioedema or angioedema caused by ACE inhibitor medications, typically occur without hives.
• Q: Will angioedema leave scars? A: Generally, no. The swelling from angioedema is temporary and happens in the deeper layers of the skin. Once the episode resolves, the skin usually returns to its normal appearance without any lasting marks or scars.
• Q: I had swelling once after taking a new medication. Does that mean I have angioedema? A: It's possible. If you experience swelling, especially of the face, lips, or tongue, after starting a new medication, it's crucial to contact your doctor right away. They can help determine if it was angioedema related to the medication and advise you on what to do. Never stop a prescribed medication without talking to your doctor first, but do let them know about any new symptoms.

Remember, this information is to help you understand angioedema better, but it's not a substitute for professional medical advice. Always consult with a doctor or qualified healthcare provider if you have concerns about your skin or health.

References

• Mayo Clinic. (n.d.). Hives and angioedema. Retrieved from https://www.mayoclinic.org/diseases-conditions/hives-and-angioedema/diagnosis-treatment/drc-20354914
• UPMC. (n.d.). Angiodema Evaluation & Treatment. Retrieved from https://www.upmc.com/services/south-central-pa/allergy-asthma-immunology/allergies/angioedema
• Cleveland Clinic. (2022, July 18). Angioedema: Causes, Symptoms, Types & Treatments. Retrieved from https://my.clevelandclinic.org/health/diseases/22632-angioedema
• National Center for Biotechnology Information. (2023, July 31). Angioedema. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538489/