All you need to know about angioedema

Adeyemi Maxwell

ANGIOEDEMA is a condition characterised by swelling beneath your skin. It can happen at many points on your body, including your face, throat, larynx (your voice box), uvula (the little piece of skin that hangs from the back of your throat), arms, hands, legs or feet. It can also happen around your genitals and in your intestines. It is common to get hives at the same time.

The swelling feels like large, thick, firm welts and can cause redness, pain, or warmth in the swollen areas. Swellings can occur around the lips and tongue and can be associated with urticaria, wheals and itching in other parts of the body. If it occurs in the lower intestine, it can bring stomach pain.

Angioedema can be dangerous if swelling is in your throat or tongue. That can make it hard to breathe. If this happens, you should get medical help right away as this can rapidly constitute a medical emergency.

Types and causes

There are four types of angioedema, and they all have different causes. Allergic angioedema: This is the most common kind. Your allergic reaction can be to foods, like: shellfish, fish, peanuts, tree nuts, eggs, or milk. It could also be to: pollen, animal dander, latex and insect stings.

Drug-induced angioedema: Some medicines can trigger angioedema. They include penicillin, aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Certain blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors like enalapril, lisinopril, perindopril, captopril can also cause flare-ups that can happen quickly. Even if you’ve been taking ACE inhibitors for a long time, sudden reactions can still happen.
Hereditary angioedema (HAE): Though this is uncommon, it happens when your body doesn’t make enough of a blood protein called C1 esterase inhibitor. This anomaly lets fluid from your blood move into other tissues, which brings swelling.

Usually, most patient have the first bout of this illness before they turn 12 years old. Sufferers may also pass the condition on to their children.

There’s another very rare type called acquired angioedema that has the same symptoms as hereditary angioedema. It is different because it does not happen until one is older than 40 years. It usually happens when you have a weakened immune system. Unlike hereditary angioedema, this variant cannot be passed on to one’s children.

Idiopathic angioedema: Idiopathic means there is not a known cause for the swelling. Possible culprits can include:

* Anxiety or stress

* Minor infections

* High or low temperatures

* Overdoing it when you exercise

Allergic and drug-induced angioedema usually happen within an hour of exposure to your trigger.

Hereditary and acquired types usually happen over many hours, but it can feel much faster if you wake up and suddenly discover swelling.

Risk factors that increase the chance of angioedema:

* Incident of hives, allergic reactions, or angioedema previously.

* People with history of lupus, lymphoma, thyroid disease, hepatitis, HIV, cytomegalovirus, Epstein-Barr virus, or who have had a blood transfusion.

* People with a family history of hives or angioedema.

* Patients who have asthma and taking non-steroidal anti-inflammatory pain killers (NSAIDs).

* Patients who take angiotensin-converting enzyme (ACE) inhibitors such as enalapril, lisinopril or captopril. This is especially true if you’re a woman or African American, or if you take angiotensin receptor blockers (ARBs) such as losartan, candesartan, valsartan or irbesartan, although to a lesser degree.

Of significance is the occurrence of this condition in patients who take angiotensin-converting enzyme (ACE) inhibitors for high blood pressure. This may occur within a few weeks of treatment but it can also occur after years of taking the medications without problems. Most people suddenly develop swollen lips and the oropharyngeal structures, and often necessitate immediate attention and prompt treatment.

* People having recombinant tissue plasminogen activator therapy for a stroke.

Treatment

Angioedema usually gets better on its own within a few days, especially if mild. In moderate to severe cases where treatment is needed, such treatment options can include:

* Medicines to ease swelling and inflammation, like antihistamines and oral corticosteroids

* Drugs to slow down your immune system if antihistamines and corticosteroids do not work.

* Medicines that ease pain and swelling, like leukotriene antagonists – a group of non-steroidal anti-inflammatory medicines.

* Blood protein controllers can also be used if you have hereditary angioedema.

If your angioedema is drug-induced, your doctor will usually discontinue such drug and switch you to another medicine that you can handle better.

In cases of a serious or severe attack, you may need a shot of epinephrine (adrenaline) as a treatment option. For repeated strong attacks, you may need to carry a pen-like device so you can inject yourself with epinephrine in an emergency.

Prevention

One can avoid allergic episodes if one stays away from foods, medications or other conditions that trigger angioedema. If you don’t know what’s causing your episodes, try to keep a diary to track foods, symptoms and situations that you are exposed to before the presentation of your symptoms.

The doctor might suggest that you take antihistamines every day instead of just when you need them. This can help get rid of severe episodes, make them happen less often, or be less dangerous.

If you develop symptoms of angioedema, it is wise to seek early medical intervention to have the condition treated.

Contact Dr Maxwell on 3631807 or 7575411