Have you ever noticed that your lips suddenly swell up, or that your eyes feel puffy? Sometimes your entire face, even your hands and feet, swell up. It's normal to feel a little scared when something like this happens. Most of the time, this is caused by a condition called angioedema . Let's talk about this in detail, very simply, okay?
What is Angioedema? Let's understand it simply!
Simply put, Angioedema is a swelling of the tissues beneath our skin, especially the dermis, the inner layer of the skin, or the layers beneath a mucous membrane. This occurs as a reaction to something. You may have heard of a condition called urticaria , or hives . Angioedema and hives often occur together, and the causes are very similar. In both cases, fluid leaks from our small blood vessels into the tissues, causing the areas to swell.
Angioedema usually starts suddenly and subsides within a day or two. It mostly affects the lips and around the eyes . But, imagine, if this swelling affects our airways , it can be very dangerous, even life-threatening . So we need to be careful about that too.
What are the main types of angioedema?
There are several types of angioedema. Different health organizations may classify them differently, but in general, we can identify several main types.
1. Acute allergic angioedema
This is probably the type you've heard of and experienced the most. It occurs when you're exposed to something you 're allergic to . This could be something you've eaten (a food, a drink), taken a medicine, or touched (for example, something made of natural rubber latex). It can also occur after being bitten by an insect or spider.
Acute allergic angioedema occurs very quickly , usually within a few minutes to an hour or two, after exposure to the allergen. This swelling is often accompanied by hives.
2. Angioedema due to a non-allergic drug reaction
This type of angioedema does not occur immediately after you take a medicine. The main class of drugs that cause this non-allergic reaction are angiotensin-converting enzyme inhibitors , or ACE inhibitors , or ACEIs for short. These drugs are commonly used to dilate blood vessels, treat heart conditions, and lower high blood pressure. Nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen and naproxen, can also cause this type of angioedema.
3. Angioedema of unknown cause (Idiopathic angioedema)
The word " idiopathic" means "of unknown cause." So it's hard to find a specific cause for this type of angioedema. The swelling usually occurs in the face, arms, trunk, and legs. Some people may also have immune system problems and stress.
4. Hereditary angioedema (HAE)
This is hereditary angioedema , also known as HAE for short. This is something you get from your parents through your genes. Children can inherit it even if only one parent has the gene, or even if they have the disease. Some people can also develop this type of angioedema due to spontaneous genetic mutations. It is estimated that about 1 in 50,000 people may have this type of hereditary angioedema (HAE). There are three main types of this, each of which is related in some way to the levels of C1 protein and/or C1 esterase inhibitor in our blood.
5. Acquired C1 inhibitor deficiency angioedema
This also causes angioedema, but it is not hereditary. Acquired means that you were not born with the deficiency, but you develop it later in life. Like other types, this type of angioedema can affect your larynx, or windpipe, and can cause asphyxiation. If you have a condition like B-cell lymphoma, this condition is called Acquired C1 inhibitor deficiency.
6. Angioedema caused by vibration (Vibratory angioedema)
In this condition, the swelling is caused by continuous vibrations. For example, this can happen when you ride a motorcycle, run, jog, get a strong massage, or do other similar activities. Vibratory angioedema is another form of a rare condition called chronic inducible urticaria . In it, hives appear in response to external stimuli such as cold, heat, water, pressure, or vibration. The itchy welts are continuous and last for about six weeks.
Who is more likely to develop angioedema?
In fact, anyone can develop angioedema. It is estimated that between 20% and 25% of the American population will experience angioedema and/or urticaria at least once in their lifetime. So this condition is common in Sri Lanka as well.
What are the symptoms of angioedema? How do you recognize them?
The main symptoms of angioedema are:
- Facial swelling or puffiness , especially around the eyes and mouth, including the lips and tongue. Imagine waking up in the morning and suddenly your lips are so swollen that it feels like it's hard to speak.
- If your intestines become inflamed, you may experience digestive problems . This includes stomach pain, diarrhea, nausea, and vomiting.
- Swelling of the hands, feet, or genital areas.
- Changes in blood pressure can cause things like dizziness or fainting .
- Swelling of the mouth, throat, or airways can make it difficult to breathe and speak. This is the most dangerous thing. If something like this happens, it is a medical emergency. You need to go to the hospital right away!
Most importantly: If your throat swells and you feel like you're having trouble breathing, it's not a joke. Seek medical advice immediately.
Why does angioedema occur? What are the causes?
The causes of angioedema vary depending on the type of angioedema you have. However, the most common cause is allergies . There are many types of allergies that can cause it:
- Food allergies: Mainly milk, eggs, nuts like cashews, and seafood like shellfish are responsible for this.
- Medication allergies: Antibiotics such as penicillin and sulfa drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), and contrast media used in some imaging tests can cause this. These types of allergies can cause hives.
- Venom: The poison secreted by insect bites, and rarely by animals such as the brown recluse spider.
- Natural rubber latex: Latex is a material used to make things like gloves, balloons, condoms, and medical catheters. Your doctor may have asked you if you are allergic to latex.
Other causes include hereditary and later problems with the C1 inhibitor protein, drug reactions that occur without itching or rash (these are not typical allergies), and vibrational movements.
Is Angioedema contagious?
No, not at all. You cannot catch angioedema from someone else, nor can you catch it from someone else. It is not a contagious disease.
How do you diagnose angioedema? What do doctors look for?
It can be difficult to tell exactly what type of angioedema you have. Your doctor will first examine you physically, but most of the time the swelling is easily visible. Then they will ask you a few questions:
- When did the swelling start?
- Did you eat, drink, take, or touch anything that you think may have caused the reaction?
- What medications and supplements are you currently taking?
- Has there ever been a reaction like this before?
- Has anyone else in your family had swelling like this?
In addition to asking these questions, your doctor may order blood tests or skin tests to check for allergies , or blood tests to check for angioedema related to the C1 inhibitor protein.
What are the treatments for Angioedema?
The treatment for angioedema varies depending on the type you have.
- For severe allergic reactions , your doctor may give you an injectable epinephrine injection that you can keep with you at all times. You should give yourself this injection when you call 911 (1990 in Sri Lanka) in an emergency.
- For allergic angioedema , your doctor may prescribe antihistamines or steroids . These can be taken as pills, as a liquid (oral), or given intravenously.
- If you have a non-allergic drug reaction , your doctor will find a suitable alternative to the medication that is causing the swelling. Never stop taking your medication without your doctor's advice.
Home remedies include applying ice to reduce swelling, taking a cool bath, and applying a cool, wet cloth to the swollen area. These can work well for localized swelling, swelling all over the lips, or for puffy eyes.
If you have hereditary, idiopathic, or acquired C1 inhibitor deficiency angioedema , you will likely be referred to a specialist. Some of the medications used to treat or prevent hereditary angioedema (HAE) include:
- C1 esterase inhibitor (recombinant) (Ruconest®)
- C1 inhibitor (human) (Berinert®, Cinryze®, Haegarda®)
- Ecallantide (Kalbitor®)
- Icatibant (Firazyr®)
- Lanadelumab (Takhzyro®)
- Berotralstat (Orladeyo®)
Are there ways to prevent angioedema?
Yes, there are some ways.
- If you have allergy-related angioedema , you can prevent it by avoiding foods, medications, or other things (triggers) that cause an allergic reaction.
- If you develop non-allergic angioedema while taking ACEI medications (ACE inhibitors) , you should talk to your doctor about switching to another medication.
What can someone with angioedema expect?
Most cases of angioedema do not last long . They usually resolve on their own. However, in severe cases, treatment is required to keep the airway open.
Can Angioedema be fatal? Is this dangerous?
For some people, allergic angioedema can lead to a condition called anaphylaxis - severe swelling of the airways and lungs. This can be life-threatening . Doctors advise people with this condition to carry injectable epinephrine (EpiPen®, Auvi-Q®, Adrenaclick® and other brands) to treat severe allergic reactions.
Whatever the cause, angioedema affecting the airway is always a medical emergency. Therefore, immediate treatment is required. Sometimes, a surgical procedure called a tracheostomy (creating an opening in the windpipe) may be necessary to help with breathing.
If I have angioedema, how can I take care of myself?
If you have angioedema, you should avoid allergy triggers . If your doctor prescribes medications to prevent further episodes, take them exactly as directed. If you have been told to carry injectable epinephrine , make sure you always have it with you. Teach your family and friends how to use it.
When should I see a doctor?
If you have a severe allergic reaction and swelling affects your airways, call 1990 (emergency ambulance service) immediately.
In less severe cases, if you have persistent angioedema, see your doctor. They can discuss prevention options. Other treatment options include oral antihistamines and steroids. Some doctors have used a monoclonal antibody called Omalizumab (Xolair®) for idiopathic angioedema, which is difficult to treat.
Finally, the most important things to remember
If your eyes, lips, or hands feel swollen, it could be a skin reaction called angioedema. This is more likely to happen if you suffer from allergies. Keep a record of when and at what times this happens, and learn to avoid the things you are allergic to. If you know that other people in your family have had these reactions, tell your doctor. He or she may suggest tests to see if the condition runs in your family. If you have angioedema due to an allergy, it is very important to keep an injectable epinephrine nearby, as swelling in your airways can cause you to stop breathing. Don't panic, but it is wise to be aware of this and take the necessary measures.
` Angioedema, swelling, allergies, skin diseases, emergency care, epinephrine, urticaria
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