Angioedema is a medical condition characterized by swelling deep within the skin's layers or mucous membranes. It commonly affects areas such as the lips, eyes, hands, feet, genitals, or the lining of the digestive tract.

This condition is often triggered by allergic reactions, certain medications, or underlying genetic factors. While it can occur in individuals of any age, its specific cause determines the necessary course of treatment.

Management of angioedema is typically overseen by a primary care physician, allergist, or immunologist. Effective recovery involves using specific medications to reduce swelling and strictly avoiding known triggers or allergens.

Main symptoms

The most common symptoms associated with angioedema include:

Visible swelling of the skin in various areas of the body;
Redness, itching, or a warm sensation on the affected skin;
Pain or tenderness at the site of the swelling;
Swelling of the tongue;
Abdominal pain, cramping, diarrhea, nausea, and vomiting.

If you notice these symptoms, you should consult a healthcare professional, such as an allergist or immunologist, to receive an accurate diagnosis and start a treatment plan.

In some instances, angioedema can progress to a severe allergic reaction known as anaphylactic shock. Watch for warning signs like shortness of breath, difficulty breathing, excessive sweating, confusion, rapid heartbeat, or feeling as though you might faint.

If any of these severe symptoms occur, seek emergency medical care immediately, as untreated anaphylaxis can be life-threatening.

How long does an angioedema flare-up last?

The duration of an episode depends on the underlying cause. When triggered by an allergy or a specific medication, the swelling typically lasts between 24 and 48 hours.

In cases of hereditary angioedema, the symptoms often persist longer, usually lasting between 2 to 3 days.

Confirming a diagnosis

A diagnosis is usually reached by an allergist, immunologist, or primary care doctor. They will perform a physical exam and review your medical history, including any medications you are currently taking.

During an acute episode, especially if anaphylaxis is suspected, medical staff will also monitor your vital signs, oxygen levels, and state of consciousness.

To determine if the condition is hereditary, doctors may order specific blood tests to measure C1 inhibitor and C4 levels. In other cases, skin or blood tests for allergies may be recommended to identify specific environmental or food triggers.

Possible causes

Several factors can lead to the development of angioedema, including:

Genetic or hereditary factors;
Allergies to peanuts, dust, insect stings, or certain medications;
Reaction to drugs like ibuprofen or ACE inhibitors (e.g., captopril);
High levels of stress;
Hormonal fluctuations.

Common infections, such as a cold or the flu, can also trigger an episode in some individuals.

Types of angioedema

There are several distinct types of angioedema, classified by their triggers:

1. Hereditary angioedema

This form is caused by genetic mutations passed through families. It results in a deficiency of the C1 inhibitor protein, leading to an overproduction of bradykinin. This chemical causes fluid to leak into tissues, resulting in severe swelling of the face, mouth, airways, or extremities.

2. Allergic angioedema

This is the most common type and is triggered by an immune response to foods, beverages, latex, insect stings, or medications. Symptoms usually appear rapidly, often within minutes or a few hours of exposure.

3. Medication-induced angioedema

This type is often linked to angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, lisinopril, or ramipril. Certain non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can also be the cause. Unlike allergic reactions, these symptoms may develop more gradually.

4. Idiopathic angioedema

Angioedema is classified as idiopathic when a specific cause cannot be identified despite testing. Swelling can occur anywhere on the body, including the face, torso, or limbs.

5. Lip angioedema

Specifically affecting the mouth area, this type is often caused by an allergic reaction. It is important to monitor this closely, as swelling can spread to the tongue or throat, potentially obstructing the airway.

6. Emotional angioedema

While not a primary cause on its own, extreme stress or anxiety can trigger or worsen episodes, particularly in individuals who already have the hereditary form of the condition.

7. Periorbital angioedema (eyes)

This occurs when the swelling is localized around the face and eyelids. In severe cases, the swelling can be so pronounced that it becomes difficult or impossible to open the eyes.

Treatment options

Treatment plans are tailored to the type of angioedema and the severity of the reaction. Guidance from a medical professional is essential for safe management.

1. Emergency treatment

If the swelling affects the mouth, tongue, or throat and interferes with breathing, hospital care is required immediately. Doctors will typically administer an injection of epinephrine (adrenaline) to quickly open the airways.

Other intravenous treatments may include corticosteroids like methylprednisolone or antihistamines like diphenhydramine. In extreme cases, a breathing tube (endotracheal intubation) may be necessary to keep the airway open.

2. Routine medications

Medications are used both to manage active symptoms and to prevent future flare-ups. Common prescriptions include:

Antihistamines: Cetirizine or fexofenadine;
Corticosteroids: Prednisone;
Androgenic steroids: Danazol (used primarily for prevention in hereditary cases);
Antifibrinolytics: Tranexamic acid;
Bradykinin B2 receptor antagonists: Icatibant.

3. Fresh frozen plasma

For severe hereditary angioedema or reactions caused by ACE inhibitors, a transfusion of fresh frozen plasma may be used. Alternatively, a concentrated C1 inhibitor transfusion may be administered to help regulate bradykinin levels.

4. Prevention and avoidance

The most effective way to manage allergic angioedema is to identify and avoid the specific allergen. If a medication is the culprit, your doctor will help you transition to a different class of drug that does not carry the same risk.

Angioedema: Symptoms, Causes, Types & Treatment