Angioedema

Cause

Angioedema is caused by a defect in the little blood vessels deep in the skin, where there is plenty of space between the subcutaneous connective tissue. The deep blood vessels leak proteins. Those proteins attract moisture and moisture lumps are developed. This is often the result of some sort of allergic reaction to a substance in drugs, foods, candy or drink. If that is the case, angioedema usually occurs only once. It is difficult then to find the exact cause. Angioedema may recur or occur in attacks. In this case, an inherited condition causes the fluid retention. This form of angioedema can already occur at young age. Angioedema is not contagious.

Symptoms

Angioedema occurs mainly in places where connective tissue is relatively loose, such as eyelids, cheeks, lips, back of the hands, external genitals and foot ridges. Substantial fluid retention may develop there. Angioedema may occur not only in the skin, but also in the mucosa of the mouth, trachea or intestinal tract.
If an allergic reaction is the cause, the first symptoms develop two hours after ingestion of the product. These symptoms last for about twelve hours and then disappear automatically. In case of an underlying disease, the symptoms take longer, ranging from days to months. There are intermediate periods without symptoms. The swellings disappear automatically then.
The consequences of angioedema depend on the place where the swelling occurs. A swollen face doesn’t feel fine and looks very different of course. A swelling in the stomach or the intestinal tract can lead to abdominal pain, but generally without nasty consequences. Angioedema in the trachea can cause serious breathing problems. For most people that’s a frightening experience. The edema can also occur behind the eyeball. That causes an enormous pressure on the eye and the optic nerve.

Diagnosis

The doctor can easily make the diagnosis of angioedema on the basis of visible fluid retention. If the swelling has already disappeared, the condition is more difficult to identify. In that case, angioedema is often confused with allergy. By asking specific questions about the symptoms (including appearance and location of the swelling), the diagnosis can become clear. If necessary, the doctor may perform additional blood tests.

Treatment

The treatment of angioedema depends on the cause and the place where the swelling occurs.
In case of allergic angioedema, the doctor may prescribe an antihistamine (a drug that suppresses the allergic reaction) or corticosteroids (anti-inflammatories).
When there is swelling in risky places, such as the trachea, an injection of adrenaline is the best treatment. This suppresses the swelling and prevents life-threatening situations. If the patient has severe edema, it is wise to always have an epinephrine injection in the pocket.
In the hereditary form of angioedema, shortage of protein C1 esterase inhibitor should be supplemented. This is done with an injection or an infusion into the vein. Some patients need such an infusion regularly. Also in the hereditary form of angioedema, it is wise for patients to carry an epinephrine injection with them as well.

Prognosis

Angioedema can be very inconvenient, but is usually not serious. A swelling in the throat, however, can be life-threatening. Healing of angioedema depends on the cause. It can occur only once, but it may also be chronic. If it comes back, it is often in the same place(s).

Considerations

• Eat healthy, moderate, varied and balanced. Limit salt intake. Be alert for a shortage or surplus of minerals. Avoid chemical-synthetic additives (E-numbers).
• Drink enough, especially water and green tea.
• Don’t use alcohol, tobacco and drugs.
• Take care of sufficient exercise and do moderate leg muscle exercises. However, don’t stand for too long.
• In case of overweight, it is recommended to lose weight.
• Edema therapy is given by the skin therapist or edema physical therapist.
• Take care of cooling when necessary (seek shade, cold packs, cold drinks, cold bath, etc.).
• Stimulate the lymphatic vessels by exercise of targeted pressure. Bandage or use lymphatic tape. Use therapeutic, elastic stockings or bandage stockings.
• Limit stress to a minimum.
• Put edematous legs or arms high (above heart level). Slightly raise the foot of the bed.
• Apply eye compresses in case of angioedema symptoms around the eyes and eyelids.
• Avoid allergens in case of allergic angioedema.
• Wear high quality and well-fitting footwear.
• Be careful with chemical, estrogen-like substances (such as xenoestrogens).

Facts

• Angioedema was first described in 1882 by the German internist and surgeon Heinrich Quincke.
• The term ‘angioedema’ is derived from the Greek words angeion (blood vessel) and oídēma (swelling).
• The prevalence of angioedema is 7%.
• Angioedema is actually a variant of hives. It is often associated with hives, but can also occur separately.