Angioedema is swelling that occurs beneath the skin, often around the eyes, lips, throat, and even the genitals. It can occur with or without hives, which are itchy raised welts on the skin. Hives and angioedema can be uncomfortable, sometimes life-threatening, and are closely tied to immunology, allergies, and different types of triggers. Understanding the symptoms and causes is essential for early diagnosis and proper management.
What is Angioedema?
Angioedema is swelling of the deeper layers of the skin, often caused by an allergic reaction, autoimmune condition, or sometimes medications like ace inhibitors. Unlike a hive, which is itchy and visible on the skin surface, angioedema may occur without hives and cause more severe internal swelling. Angioedema is often sudden and can affect the face and lips, throat, airway, and digestive tract. Because angioedema can be life-threatening in severe cases, prompt diagnosis and management are critical.
Episodes of angioedema are usually treated with antihistamines or emergency treatment if airway swelling occurs. Angioedema is usually diagnosed through a combination of medical history, blood tests, and allergy testing. Since angioedema is a reaction that causes deeper swelling, identifying the exact cause helps guide long-term treatment.
What are the Symptoms of Angioedema?
The signs and symptoms of angioedema depend on the type of angioedema and the trigger involved. Symptoms may include:
- Sudden swelling of the face and lips
- Throat swelling that may cause trouble breathing
- Swelling that affects your lips, eyelids, and genitals
- Episodes of swelling in the respiratory tract or digestive tract
- Itchy skin, though sometimes swelling occurs without hives
Symptoms usually appear quickly and may last hours or days. Mild symptoms may not need treatment, but severe angioedema with airway involvement is a medical emergency. Symptoms usually worsen if the angioedema is hereditary or caused by an enzyme imbalance involving the C1-inhibitor.
What are the Causes of Angioedema?
There are several known causes of angioedema:
- Allergic angioedema caused by an allergic reaction to foods, insect stings, or allergens
- Medication-induced angioedema, often linked to ACE inhibitors (angiotensin-converting enzyme inhibitors) or NSAIDs:
- ACE inhibitors (used to treat high blood pressure and heart failure)
- Generics: lisinopril, enalapril, captopril, ramipril, benazepril
- Trade names: Zestril (lisinopril), Vasotec (enalapril), Capoten (captopril), Altace (ramipril), Lotensin (benazepril)
- NSAIDs (nonsteroidal anti-inflammatory drugs, often used for pain or inflammation)
- Generics: ibuprofen, naproxen, diclofenac, indomethacin
- Trade names: Advil/Motrin (ibuprofen), Aleve (naproxen), Voltaren (diclofenac), Indocin (indomethacin)
- ACE inhibitors (used to treat high blood pressure and heart failure)
- Autoimmune disorders that sometimes cause swelling
- Hereditary angioedema, which is related to a C1-inhibitor deficiency
- Idiopathic angioedema, where the exact cause is unknown
Angioedema may also be caused by an angiotensin-converting enzyme inhibitor used to treat high blood pressure. This reaction that causes swelling can occur weeks or months after starting the medication.
Treatment for Angioedema
The treatment of angioedema depends on the type and severity. Acute treatment may involve:
- Antihistamine medications – examples such as cetirizine, fexofenadine, loratadine, diphenhydramine or hydroxyzine are often used
- Corticosteroids to reduce swelling
- Emergency treatment for airway swelling or severe allergic reaction such as epinephrine.
For hereditary angioedema, medications that restore or replace the missing C1-inhibitor enzyme are used to treat long-term symptoms and acute symptoms. People with angioedema may also undergo blood tests or allergy testing to determine the cause.
Treatment is needed urgently if swelling affects the airway or respiratory tract. Without treatment, severe angioedema can be life-threatening.
What is Hereditary Angioedema?
Hereditary angioedema is a rare form of angioedema caused by a deficiency of the C1-inhibitor enzyme. This inherited condition leads to episodes of swelling that affect the face, throat, digestive tract, and genitals. Unlike allergic angioedema, this form of angioedema does not respond well to typical antihistamines or epinephrine Hereditary angioedema is often diagnosed through blood tests that check for C1-inhibitor activity. Because swelling usually happens suddenly, patients with hereditary angioedema must have a plan for emergency treatment.
What is Idiopathic Angioedema?
Idiopathic angioedema occurs when the exact cause of swelling cannot be determined. This form of angioedema is often chronic and may recur for years after treatment. While some cases may respond to antihistamines, others may not need treatment unless severe symptoms develop.
Idiopathic angioedema is suspected when no allergy, ACE inhibitor use, or hereditary factor can be identified. Diagnosis and treatment focus on managing symptoms and preventing complications.
How are Hives and Angioedema Related?
Hives and angioedema often appear together, a condition known as urticaria and angioedema. While hives are itchy and visible, angioedema causes deeper swelling. In some cases, hives do not develop, and patients experience angioedema without hives.
Hives and angioedema may both be caused by an allergic reaction, autoimmune disorders, or medications. Both conditions fall under the field of immunology, which studies how the immune system responds to allergens and triggers.
When to Seek Medical Help for Angioedema
Because angioedema can be life-threatening, it is important to seek medical help if:
- You experience sudden swelling of the throat or airway
- You have trouble breathing or throat swelling
- Episodes of angioedema become frequent or severe
Angioedema is often managed with diagnosis and treatment at a specialist allergy center. If angioedema is suspected, blood tests or allergy testing may be ordered to determine the cause.
If you are experiencing recurrent swelling from angioedema, schedule an appointment with NY Allergy & Sinus Centers for diagnosis and management. Call us today at 212-686-6321.
