Malady Wise

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Angioedema

Overview

  • Self-limited, localised swelling, where fluid extravasates into interstitial tissue

Clinical features

  • Onset minutes to hours

  • Spontaneous resolution in hours to days

  • Asymmetric

  • Usually not gravity dependent

  • Face, lips, larynx and bowels

Types

  • Mast cell-mediated

    • Allergic reactions to food or insect stings

    • Histamine is prominent

    • Urticaria, pruritus, bronchospasm, throat tightness, hypotension

  • Bradykinin mediated

    • Usually over 24 t o36 hours

    • No urticaria, bronchospasm or allergic reactions

    • Resolves 2 to 4 days

Sites

  • Larynx

  • Lips, tongue, uvula

  • Skin and mucous membranes

  • Bowel wall

    • ACEI related

    • Acquired C1 inhibitor deficiency

    • HAE

Evaluation

  • Just angioedema

    • CRP, ESR, C4

    • If C4 low then further testing for HAE or acquired C1-INH deficiency

  • Angioedema + urticaria

    • Different work up for urticaria

  • Angioedema + anaphylaxis

    • Serum tryptase might help

    • Often mast cell mediated

  • Angioedema due to allergen

    • IgE testing

    • Variable sensitivity and specificity

Treatment

  • Allergic reactions

    • H1 antihistamines

    • Gucocorticords

  • ACEI induced

    • Discontinue

  • C1-inhibitor

    • Replace

  • Recurrent idiopathic

    • Non sedating antihistamines

    • Montelukast