ANGIOEDEMA

Angioedema is almost identical to the common skin condition of urticaria or hives. In hives, raised, red, itchy, irregular bumps appear on your skin, whereas in angioedema the same thing is happening but deeper in the skin. You cannot see the raised, red bumps, but you can feel a firm swelling pushing up your normal skin. Instead of angioedema being itchy, it may be tender or painful.

Angioedema can occur anywhere on the body, but it more commonly involves the eyelids, lips, tongue, and external genitalia. It can also occur inside the body. In the intestines it can cause abdominal pain, and in the airways it can cause difficulty in breathing, which can be fatal. Fortunately the most common occurrence of angioedema is on the outside of our body, and, although uncomfortable, it is not dangerous.

Anyone can get angioedema. About 15% to 20% of all individuals will have at least one episode of hives or angioedema in their lifetime.

The swelling of angioedema is usually present for only a day or two at any one spot. However, it often will move from one location to another and last for several days. Sometimes it can become chronic.

Angioedema is an allergic reaction that somehow has come into your body. It is not an infection, although infections can cause an attack of angioedema. It is not contagious, although certain types are hereditary, and you should check to see whether other family members have had a similar problem. The usual causes of angioedema are a new drug, a new food, a new perfume, etc. You may even have taken that drug or food in the past without problem, but now you have developed an allergy to it.

Although no cure exists for angioedema, it can be treated and the symptoms controlled. The main treatment is to prevent recurrences.

The diagnosis of angioedema is made by the typical appearance of the swollen skin and its tendency to come and go. There are some blood tests that can be done, but they are not always helpful and do not affect treatment. A family history of angioedema is very important; therefore family members should be asked about any episodes of angioedema they have had, and you should tell your doctor about these.

The typical rash of angioedema is puffy or swollen skin that is firm and may be painful. The rash can occur anywhere but usually involves the eyelids, lips, genitalia, tongue, hands, and/or feet. The swelling can occur inside the body as well. You must contact your doctor immediately if you are having any trouble breathing or are wheezing, or are having abdominal pain. Angioedema often resolves in a day or two to a week, but in some cases it can persist and may require long-term treatment. Chronic angioedema, although uncomfortable and irritating, usually will not progress to a more serious disease.

The primary treatment for angioedema is removal of whatever is causing the allergy. Unfortunately the exact cause of the angioedema is often not known, and even if it is (e.g., pollen), it may be impossible to remove it. Therefore the main treatment of active angioedema is to control the symptoms.

Application of cold compresses may provide local comfort. Lotions and creams are usually not helpful because they don't penetrate deep enough under the skin to reach the angioedema.

Oral antihistamines work well but must be taken in adequate amounts on a regular basis. Failure to take antihistamines regularly may result in the angioedema coming back. Antihistamines are well known for their tendency to make individuals drowsy, as well as causing other side effects such as dry mouth. Newer antihistamines have fewer side effects. If antihistamines are not controlling your symptoms, see your doctor. Your doctor can prescribe stronger medications such as steroids.

The best treatment is always prevention. You should carefully examine potential causes for your angioedema. Try to remember if you ate a new food, wore new clothes, took a new drug, wore a new perfume, were exposed to a new smell, or have a new job. Anything that you can think of which might have caused your angioedema is helpful. Sometimes your doctor may need to perform tests to find out what the allergic problem is. If you know what triggers your angioedema, the best treatment is to avoid that trigger.

• Do seek medical aid immediately if you are having trouble breathing or are having chest pain.
• Do use cold compresses on the swollen areas.
• Do take antihistamines in proper doses for the swelling.
• Do immediately note any possible causes for your angioedema (new food, drug, soap, perfume, etc.).
• Do remove or stop any possible cause of the swelling, such as new food, new soap, or new perfume. Ask your doctor about any drugs you are taking.

• Don't use heat on the swelling.
• Don't use creams, ointments, or lotions.

• If you are having trouble breathing, having chest pain, or having abdominal pain, contact you doctor immediately.
• If your angioedema is not responding to antihistamine therapy after 2 or 3 days of continuous treatment.
• If you are having recurrent attacks of angioedema.

American Academy of Dermatology
930 N. Meachum Road
Schaumburg, IL 60173
847-330-0230




Angioedema of the upper lip, with severe swelling of deeper tissues. (Courtesy of Beverly Sanders, M.D. From Goldstein BG, Goldstein AO: Practical dermatology, ed 1, St Louis, 1992, Mosby. Used by permission.)

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