Angioedema - Symptoms, causes and treatment

Angioedema is swelling that occurs under the skin. This condition is generally harmless. However, angioedema can occur in the throat and make it difficult to breathe. This condition is dangerous and must be treated immediately.

Angioedema is generally an allergic reaction, but some cases of angioedema are caused by inherited disorders. Sometimes, it is not known what causes this condition.

Angioedema causes generalized swelling in certain parts of the body. Some parts of the body that are more susceptible to angioedema are the eyelids, lips, and tongue.

Causes of Angioedema

The causes of angioedema are very diverse and can be grouped into four types, namely:

1. Allergic angioedema

This type of angioedema occurs due to allergic reactions, including:

  • Food allergies, especially fish, nuts, shellfish, milk and eggs
  • Drug allergies, such as certain types of antibiotics, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Allergy due to insect bites
  • Allergy due to pollen
  • Allergy to latex, a type of rubber used in rubber gloves, balloons, or condoms

2. Drug-induced angioedema

A person can develop angioedema due to the use of certain drugs even though they do not have an allergy to these drugs. Swelling can occur shortly after taking the drug, but it can also appear months or years afterward.

Some types of drugs that can trigger angioedema are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen
  • Hypertension class ACE inhibitor, for example ramipril, perindopril, and lisinopril
  • ARB class hypertension drugs, including valsartan, losartan, and irbesartan

3. Hereditary angioedema

This type of angioedema runs in families. This condition is caused by a deficiency of the C1-esterase inhibitory protein in the blood. Lack of protein can trigger dilation of blood vessels and tissue swelling.

The appearance of symptoms hereditary angioedema sometimes the trigger is unknown. However, in some people, the condition can be triggered by:

  • Stress
  • Surgical procedures or dental treatment
  • Use of birth control pills
  • Pregnancy
  • Injury or infection

4. Idiopathic angioedema

Idiopathic angioedema is angioedema of unknown cause. Experts suspect this condition is related to disorders of the immune system.

Swelling of idiopathic angioedema can be triggered by the following conditions:

  • Stress or anxiety
  • Minor infection
  • Sports that are too strenuous
  • Weather that is too hot or too cold
  • Medical conditions, such as lupus or lymphoma (very rare)

Angioedema risk factors

Angioedema can happen to anyone. However, there are a number of factors that can increase a person's risk of developing this condition, including:

  • Feeling stressed or restless
  • Experiencing sudden changes in temperature
  • Have you had angioedema before?
  • Have a family history of angioedema
  • Have allergies, for example to food or medicine
  • Have asthma, hepatitis, lymphoma, lupus, HIV, thyroid disease, or Epstein-Barr virus infection
  • Taking ACE inhibitors or ARBs
  • Have you ever received a blood transfusion?

Symptoms of Angioedema

The main symptom of angioedema is swelling beneath the skin's surface due to fluid buildup in the deep layers of the skin. Generally, this condition occurs in the hands, feet, the area around the eyes, lips, tongue, and genitals. In severe cases, swelling occurs in the throat and intestines.

The swollen part of angioedema will enlarge, and feel thick and solid. Angioedema can also cause redness, pain, and a burning sensation in the skin. Usually, angioedema also occurs with urticaria or hives.

A number of other symptoms may also result from swelling. These symptoms include:

  • Stomach ache
  • Diarrhea
  • Throw up
  • Hard to breathe
  • Dizziness and feeling like fainting

When to go to the doctor

Check with your doctor if you experience swelling of the skin or tongue for no apparent reason. If the swelling you experience is accompanied by symptoms of shortness of breath, dizziness, and you want to pass out, seek medical attention immediately to the ER. This condition can be an anaphylactic reaction that can be life-threatening.

Angioedema diagnosis

The doctor will ask you about the symptoms you are experiencing and what things might trigger the symptoms. The doctor will also ask about other diseases (including allergies) that the patient has and the medications he is currently taking. In addition, the doctor will also ask if any of the patient's family has experienced similar symptoms.

After that, the doctor will perform a physical examination, especially on the part of the body that is experiencing swelling. The doctor will also listen to the patient's breath sounds to detect if there is swelling in the throat.

Based on questions and answers, the doctor can suspect the cause of angioedema. From there, the doctor will perform additional tests to determine the cause.

If angioedema is suspected to be caused by allergies, the doctor will run allergy tests. Allergy testing can be done in two ways, namely:

  • Skin prick test (skin prick)

    The skin prick test is done by pricking the patient's skin using a tool that has been given a small amount of allergen (allergy triggering substance), to see a mild allergic reaction on the patient's skin.

  • blood test

    A sample of the patient's blood will be examined to see how the patient's immune system reacts to certain allergens.

If an allergy is not suspected, or if an allergy test is not positive, your doctor may be able to test your C1 esterase inhibitor protein level to determine if you have an allergy. hereditary angioedema.

Angioedema Treatment

Angioedema usually goes away on its own within a few days. However, there are several independent treatments that can be done to help relieve symptoms, namely:

  • Cold compress the swollen area
  • Wearing loose clothing to prevent skin irritation
  • Don't scratch the swollen area
  • Shower with cold water
  • Avoid foods that can trigger allergies
  • Consult a doctor before using drugs, especially drugs class ACE inhibitor

If the self-medication above is not enough to relieve symptoms, people with angioedema are advised to consult a doctor. In general, swelling due to angioedema can be treated with antihistamine tablets or corticosteroid tablets.

However, in patients whose swelling is severe, doctors can give corticosteroid injections. Meanwhile, in anaphylactic reactions, injections epinephrine should also be performed to treat shock.

Please note that the above treatments may not be effective in patients hereditary angioedema. In this condition, medications that can help relieve symptoms include:

  • Ecallantide
  • Icatibant
  • C1 esterase . inhibitors

Complications of Angioedema

In some cases, angioedema can lead to serious complications, such as:

  • Dehydration due to vomiting and diarrhea
  • Total airway obstruction
  • Asphyxia (lack of oxygen)
  • Death

Angioedema Prevention

Angioedema can be prevented by avoiding triggering factors, for example by avoiding foods, drugs, or other factors that can trigger this reaction, and managing stress well.

To help remember, you can note down anything that can trigger symptoms of angioedema. In addition, it is advisable to consult with a doctor before taking medication, especially if you or your family have a history of this disease.

In patients hereditary angioedema, doctors may prescribe oxandrolone or danazol to reduce the risk of recurrence of swelling. Another option is the administration of tranexamic acid, especially in female patients and children.