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Allergies

Angioedema

With Angioedema patients’ get swelling of the deeper part of the skin (called dermis), of the subcutaneous tissue, mucosa or submucosal tissues. Swellings may appear anywhere over the body, but more often of the face (lips, eyelids, tongue). With severe attacks patient can get swelling of the throat (windpipe) which is a medical emergency (see anaphylaxis). Angioedema can frequently be due to an underlying allergy (food, drug, insect venom) but can also be due to many non-allergic causes.

Allergic angioedema

Allergic angioedema is often triggered by a food or a drug, symptoms starting within seconds-minutes to within an hour of exposure to the offending allergen. Patients may suffer from just the swellings or may have associated rash as well.

ACE inhibitor induced angioedema

In some patients a class of blood pressure tablets, ACE inhibitors, can cause sporadic angioedema, predominantly affecting the face (mouth, lips, eyelids, tongue or throat), often waking the patient in the middle of the night. This condition can often be missed because the drug does not cause the swelling each time you take the medication. The patients are advised to stop the medication in consultation with their GPs. However even after stopping the medication, the patients may continue to get the symptoms for up to 2 months after stopping.

Hereditary Angioedema

In some patients history of angioedema (swellings) can run in families. This is known to occur due to inheritance of decreased ability to produce a protein called C1 esterase inhibitor. Deficiency of this protein can cause the build up of another protein called bradykinin in the body which can cause angioedema (swelling). Patient’s start getting symptoms in childhood, more often during their teens but can get their first episode during their early adulthood. Patients can get swelling of the abdomen with pain, vomiting or diarrhoea, or may get swelling in their peripheries. Severe attacks may result in swelling of the mouth or windpipe which is a medical emergency. Trauma like contact sports, dental work, infections, periods, and stress both emotional and physical can often precipitate the episodes. Drugs like oestrogen containing contra-ceptive pills or some blood pressure tablets (ACE inhibitors) can precipitate the attacks. The diagnosis can be confirmed by measuring the levels of C1 esterase inhibitor in the blood. Unlike allergic angioedema, hereditary angioedema is treated by intravenous infusion of C1 esterase inhibitor concentrate or by subcutaneous injection of a bradykinin receptor blocker.

Acquired angioedema

In very rare patients C1 esterase inhibitor deficiency can be acquired, whereby it may be associated with some underlying haematological or autoimmune conditions.

Idiopathic angioedema

In some patients no underlying cause can be found for the recurrent episodes of angioedema, when it is called idiopathic angioedema.

 

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