Key takeaways
• Angioedema involves swelling deep within the skin, often around the eyes, lips, or tongue, and can be triggered by allergic reactions, medications, or, in some cases, have no identifiable cause.
• Symptoms range from mild swelling and itchiness to severe breathing difficulties, with the latter requiring immediate medical attention due to the risk of airway blockage.
• Management includes avoiding known allergens, using antihistamines or corticosteroids to reduce swelling, and, in cases of hereditary angioedema, specific medications or surgical intervention may be necessary.
Angioedema is a temporary, recurring subcutaneous (under the skin) or submucosal (thin layer of tissue under mucous membrane) swelling. It typically affects the:
skin on the forehead, around the eyes, and on the lips
tongue
hands
feet
genitals
gastrointestinal tract
upper airways
The direct cause of the swelling is leaking blood vessels in the surrounding tissues or skin, but there are several potential underlying causes of the condition.
In some cases, swelling occurs along with the appearance of hives. This is why angioedema is sometimes referred to as “giant hives.”
Hives are itchy and raised welts that develop on the skin’s surface, involving the top two skin layers.
Causes of either angioedema or hives include:
allergic reaction or intolerance to food
side effect or allergy to a medication
allergens in the surrounding environment, such as: pollen
pet dander
venom from insect bites
In other cases, a doctor may not know the underlying cause.
When angioedema is passed from a parent to a child through genetic transmission, the condition is known as hereditary angioedema.
has different causes than acquired angioedema, but the symptoms and treatment approaches are similar.
The
symptom of angioedema is swelling. It often occurs around the eyes, lips, and tongue, but it may also occur in the feet, hands, or genitals.
Angioedema may be accompanied by swelling and welts on the skin’s surface known as urticaria (
). Allergic angioedema can cause itchiness.
Other angioedema symptoms may include:
fainting
abdominal cramping
dizziness
shortness of breath
Medical emergencyIn more severe cases, people with angioedema may experience swelling of the airways, making it difficult to breathe, and an unsafe drop in blood pressure.
Call 911 or go to an emergency room right away if you’re having trouble breathing. This may be a sign of a medical condition that requires prompt treatment.
There are several types and causes of angioedema.
Allergic angioedema
Allergic angioedema is the
form of angioedema. It may occur due to reactions to food, medication, or other allergies.
Some potential causes include:
latex
peanuts
insect stings
antibiotics
shellfish
insect bites
Nonallergic drug-induced angioedema
Drug-induced angioedema
when a person has a nonallergic reaction to medication. You can distinguish it from allergic reactions due to the lack of hives or itchiness.
A common cause includes angiotensin converting enzyme inhibitors, a common class of blood pressure medications. This includes:
rampril
Hereditary angioedema (HAE)
Hereditary angioedema (HAE) is
than either allergic or drug-induced angioedema. It occurs when you inherit a deficiency or defect in an enzyme in the complement pathway, which makes up part of the immune system.
Idiopathic angioedema
Idiopathic angioedema occurs when a doctor cannot find a cause for the angioedema. Idiopathic cases of angioedema may occur in up to
of cases. Experts do not know much about how idiopathic angioedema starts or its nature.
Acquired angioedema
Acquired angioedema may develop after an infection or illness, such as lupus (SLE). In
, it may be the result of leukemia or lymphoma. Autoimmune diseases can also cause this type of angioedema.
Certain factors may increase your risk of developing angioedema. Risk factors can vary based on the severity or cause. According to
from 2014, potential risk factors associated with recurrent and severe angioedema include:
older age
being of Hispanic descent
having ACEi-induced angioedema
having coexistent cardiopulmonary disease
smoking
from 2020 noted that people who take ACE inhibitors might have a higher chance of developing angioedema due to:
being born female
being of African American descent
taking NSAIDs
living in the upper Midwest
If you have allergies, try to avoid known triggers because these may cause angioedema. Other risk factors may include:
previous occurrence of angioedema or hives
previous allergic reaction
family history of angioedema or hives
sudden temperature changes
stress or anxiety
certain medical conditions
A doctor will perform a physical exam and ask you about your symptoms and medical history. During the exam, they will examine your swelling and welts, if any are present. They may also listen to your breathing to see if your throat has been affected.
Be sure to tell your doctor if you’ve recently been exposed to substances that have triggered an allergic reaction. This information may help them determine the specific cause of your reaction.
Your doctor will perform blood tests if hereditary or acquired angioedema is suspected. These
:
checking levels of complement components, including C2 and C4
These tests measure the levels or function of certain proteins in the blood. Abnormal results can be associated with a health problem related to an underlying autoimmune disease. They can also help determine the best course of treatment.
People with mild symptoms of angioedema
treatment. But those with moderate or severe symptoms may require medications to relieve intense swelling. Medications
:
in the case of an acute allergic reaction
antihistamines like loratadine (Claritin, Alavert) and cetirizine (Benadryl Allergy, Piriteze Allergy, Zirtek Allergy, more) in the case of an allergic reaction or angioedema when the cause is unknown
glucocorticosteroids like
or Solu-Medrol in the case of an acute allergic reaction
Hereditary angioedema may require surgical intervention or
. They may also treat a person with:
C1 inhibitor concentrate
ecallantide (Kallikrein inhibitor)
icatibant (bradykinin-receptor antagonist)
If possible, avoid contact with substances that may cause swelling. In less severe cases of angioedema, applying cool, wet compresses to soothe the skin and prevent scratching and wearing loose cotton clothing to avoid further skin irritation may help.
If a medication is causing the angioedema, your doctor may have you switch to a different one.
If you’re pregnant, you should speak with your doctor before starting any medication or before treatment.
Long-term treatment for recurrent angioedema
using C1 inhibitors.
In many cases, angioedema is a harmless condition that will disappear within
.
However, angioedema can be dangerous when severe swelling occurs near the throat. A swollen throat or tongue can block your airway and make breathing difficult.
Severe angioedema may be due to
, a sudden life threatening reaction. In such severe cases, you should get emergency medical help immediately.
The best way to prevent allergic angioedema is to avoid known and suspected allergens or those that have caused the condition to occur previously.
Taking these preventive measures can help lower your risk of having another episode.
Angioedema symptoms can range from mild to life threatening, so you may need emergency medical care, especially if you have trouble breathing.
When treatment is needed, doctors will often recommend antihistamines or other medications to help the swelling go down. Mild cases may not need treatment and can clear within a few days.