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Angioedema

Also listed as: Allergic reaction - angioedema


Angioedema refers to swelling that occurs in the tissue just below the surface of the skin, most often around the lips and eyes. It generally results from an allergic reaction to either a food or medication. More rarely, it may be a sign of an underlying condition such as leukemia or Hodgkin's disease. In an allergic reaction, the body produces histamine, which causes blood vessels to swell. There are two basic types of angioedema:

Angioedema can take anywhere from minutes to hours to develop. Interestingly, angioedema may affect an area on one side of the body but not on the other. In most cases, angioedema is mild. Severe angioedema can cause the throat or tongue to swell, cutting off the airway, and it can be life-threatening.


Signs and Symptoms

Common symptoms of angioedema include:


What Causes It?

Sometimes the cause is difficult to identify. An angioedema reaction (AAE in particular) may be caused by allergies to foods, dyes, or pollen, or in reaction to certain medications. Foods that commonly cause allergies include shellfish, dairy, and nuts. Drugs that often spark allergic reactions include nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), blood pressure medication, aspirin, and antibiotics. Conditions such as leukemia, Hodgkin's disease, and connective tissue disorders (such as lupus) may also trigger angioedema.


Who's Most At Risk?

These factors increase the risk for angioedema:


What to Expect at Your Provider's Office

Your health care provider will perform a physical exam and ask about your symptoms. Be sure to tell him or her about all medications (prescription and over-the-counter), herbs, and supplements you are taking. Blood and urine tests may help pinpoint the cause of the angioedema.


Treatment Options

Prevention

You should eliminate any known or suspected triggers. Allergy testing with a trained specialist may help identify inciting agents. If you are prone to angioedema, you should wear a Medic Alert bracelet that notes this condition.

Treatment Plan

The first priority is to ensure that the airway is open and that breathing is not impaired. The next steps include identifying and removing the trigger as well as relieving other symptoms. Infrequent attacks can be managed as they arise. Frequent attacks may require ongoing treatment, perhaps with an allergist, dermatologist, or other specialist to try to avoid recurrences.

Drug Therapies

Several medicines may help prevent or relieve attacks. For mild cases, you can use over-the-counter antihistamines, such as Benadryl, Alavert, or Claritin. Note that Benadryl often causes drowsiness.

You may use prescription antihistamines. For severe cases, your doctor may prescribe corticosteroids to reduce swelling and itching, or you may need a shot of epinephrine. Mild attacks tend to clear up within 4 days with or without medication.

Complementary and Alternative Therapies

In a severe attack, standard emergency medical care should be administered immediately to open airways and stabilize the condition. No new substances, including herbs or supplements, should be introduced during an acute attack.

Long-term nutritional and herbal support used in between attacks may help reduce or prevent angioedema. In addition, herbs and supplements may help alleviate mild symptoms, particularly for chronic and recurring forms. Homeopathic remedies may help alleviate mild symptoms and reduce the frequency and severity of episodes. It is important to tell your doctor about all medications, herbs, and supplements you are taking.

Nutrition and Supplements

Certain foods and food additives may trigger angioedema in people who are susceptible. You should eliminate any foods or food additives that trigger symptoms. The following are the most common food triggers:

Certain individuals may have a reaction in response to:

Health care providers can help identify food triggers by:

If you have gastrointestinal symptoms (abdominal pain, vomiting, diarrhea, or reduced appetite), this may be an indication that you absorb antigens (food triggers) more easily than others through the stomach and intestines. If so, you may benefit from a diet that eliminates common dietary antigens (as listed above) even if you do not have a specific, identifiable food allergy.

These supplements may also help treat symptoms:

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Acupuncture

Some doctors report that acupuncture may help re-establish immune balance and lessen the frequency or severity of allergic reactions such as angioedema.


Prognosis and Possible Complications

If angioedema affects the throat, the airway passage could be blocked, thereby creating a life-threatening situation. It is also possible that the angioedema may develop into anaphylaxis, which will require emergency medical care to maintain breathing, blood pressure, and heart function and to reverse the reaction.


Following Up

After an attack, it's important to identify and avoid any triggers and to treat any underlying condition.


Supporting Research

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:84-87, 160-169, 233-239.

Cicardi M, Bergamaschini L, Cugno M, et al. Pathogenic and clinical aspects of C1 inhibitor deficiency. Immunobiol. 1998;199(2):366-376.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: McGraw-Hill; 1998.

Johnston S, Martin LJ, Cai X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr . 1992;11:172-6.

Kumar SA, Martin BL. Urticaria and angioedema: diagnostic and treatment considerations. J Am Osteopath Assoc . 1999;99(3 suppl):S1-S4.

Matsuo N, Yamada K, Shoji K, et al. Effect of tea polyphenols on histamine release from rat basophilic leukemia (RBL-2H3) cells: the structure-inhibitory activity relationship. Allergy . 1997;52:58-64.

Middleton E, ed. Allergy: Principles and Practice . 5th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Paganelli R, Fagiolo U, Cancian M, Scala E. Intestinal permeability in patients with chronic urticaria-angioedema with and without arthralgia. Ann Allergy. 1991;66(2):181-184.

Pizzorno JE Jr, Murray MT. Textbook of Natural Medicine . Vol. 1. 2nd ed. New York, NY: Churchill Livingstone; 1999:619-623, 746-749, 751-759.

Shah UK, Jacobs IN. Pediatric angioedema: ten years' experience. Arch Otolaryngol Head Neck Surg . 1999;125(7):791-795.

Waytes AT, Rosen FS, Frank MM. Treatment of hereditary angioedema with a vapor-heated C1 inhibitor concentrate. N Engl J Med . 1996;334(25):1630-1634.

Zuraw BL. Urticaria, angioedema, and autoimmunity. Clin Lab Med . 1997;17(3):559-569.


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