Introduction:

Angioedema refers to swelling that occurs in the tissue just below the surface of the skin, most often around the lips and eyes. It is similar to hives, but hives involve itchy red welts on the surface of your skin, whereas angioedema is a deeper swelling. Both hives and angioedema are usually caused by an allergic reaction, to either a food or medication. In rare cases, 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:

• Hereditary angioedema (HAE), a rare condition that is genetic
• Acquired angioedema (AAE)

Angioedema can take anywhere from minutes to hours to develop. It 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:

• Sudden appearance of red welts, especially near the eyes and lips, but also on the hands, feet, and the inside of the throat
• Burning, painful, swollen areas; sometimes itchy
• Discolored patches or rash on the hands, feet, face, or genitals
• More rarely, hoarseness, tight or swollen throat, breathing trouble
• In a form called angioedema-eosinophilia syndrome, hives, itching, fever, muscle pain, decreased urine, weight gain, and high white blood cell count occur.

What Causes It?:

Sometimes the cause is unknown. An angioedema reaction (AAE in particular) may be caused by allergies to foods, dyes, or pollen, or 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 medications, 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:

• Having hives or angioedema before
• Having had a body-wide allergic reaction in the past
• Experiencing injury, sudden temperature change, stress, or anxiety
• Undergoing a dental procedure
• Having ovarian cysts

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 your health care provider 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 for allergies. Allergy testing with a trained specialist may help identify allergens. If you are prone to angioedema, you should wear a Medic Alert bracelet that notes this condition.

Treatment Plan

If you have mild angioedema, you may be able to treat it with over-the-counter drugs or alternative therapies. With severe angioedema, 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 allergen as well as relieving other symptoms.You can manage infrequent attacks as they happen. Frequent attacks may require ongoing treatment, perhaps with an allergist, dermatologist, or other specialist.

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. Common antihistamines include fexofenadine (Allegra), cetirizine (Zyrtec), and desloratadine (Clarinex).

Corticosteroids also may be used. In severe cases of allergic reactions, they are usually given intravenously (IV) at first. In milder cases, your doctor may prescribe oral (pill) forms.

Leukotrine receptor antagonists are a newer class of drugs which block leukotrines, chemicals involved in your body’s allergic response. Your doctor may prescribe them to treat allergy symptoms; they do not cause drowsiness. These drugs include montelukast (Singulair) and zafirlukast (Accolate).

Complementary and Alternative Therapies

In a severe attack, you should seek emergency care immediately. Do not take any new drugs, herbs, or supplements 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 reduce 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 allergic. You should eliminate any foods or food additives that trigger symptoms. The following are the most common food triggers:

• Seafood
• Nuts
• Legumes
• Eggs
• Chocolate
• Milk
• Berries

Some people may have a reaction in response to:

• Citrus fruits
• Sulfites -- used as an antioxidant or freshening agent (preservative) in many foods and beverages
• Yellow dye No. 5 (also called tartrazine) -- those who are allergic to aspirin or other NSAIDs are more susceptible to having an allergy to yellow dye No. 5

Health care providers can help identify food triggers by:

• Collecting detailed information about your diet
• Performing skin tests for sensitivity to certain substances
• Cautiously testing suspected triggers
• Monitoring symptoms as foods are eliminated from your diet, then slowly re-introduced one at a time

If you have gastrointestinal symptoms (abdominal pain, vomiting, diarrhea, or reduced appetite), you may benefit from a diet that eliminates common dietary triggers (as listed above) even if you do not have a specific, identifiable food allergy.

These supplements may also help treat symptoms:

• Vitamin C (2 - 4 g per day) may help lower histamine levels. Reduce dose if diarrhea develops.
• Vitamin B12 (1,000 mcg per week by injection) may help reduce the frequency of chronic attacks. It is not known whether taking oral B12 would have the same effect.
• Quercetin (a plant-based flavonoid) may reduce the likelihood of an allergic reaction. The recommended amount is generally 200 - 400 mg three times a day before meals. If you are sensitive to citrus or take calcium-channel blockers to treat high blood pressure, you should avoid citrus-based forms of flavonoids. Quercetin is best absorbed in its water-soluble form, often referred to as hesperidin methyl chalcone (HMC). Few manufacturers make this form, so it can be harder to find. Talk to your doctor about which form of quercetin is best for you.
• Bromelain is sometimes used to help reduce inflammation;. You can take it with curcumin (Curcuma longa), the yellow pigment of turmeric, which may make its effects stronger. Avoid bromelain if you are allergic to citrus.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider.

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.

• Green tea may have antihistamine properties. Drink three cups per day. If caffeine is a problem for you, drink decaffeinated coffee.
• Devil's claw (Harpagophytum procumbens, 2 - 2.5 g per day) may reduce inflammation and skin lesions. Do not take devil's claw if you take blood pressure medication or blood-thinning medication, or if you have diabetes.
• Goldenseal (Hydrastis canadensis, 250 - 500 mg three times per day) has been used for gastrointestinal symptoms such as stomach pain, diarrhea, and reduced appetite that may accompany a severe allergic reaction. Some health care providers also recommend goldenseal for those with food allergies to prevent or lessen reactions.
• Licorice root (Glycyrrhiza glabra, 200 - 400 mg 3 times per day) has been used traditionally to lessen inflammation in the case of an allergic reaction. It may also normalize immune function. Do not take licorice if you have heart disease, high blood pressure, or edema.
• Chamomile (Matricaria recutita) has been used traditionally to treat hives, although there is no scientific evidence that it works. To make a tea, steep 2 – 4 g of fresh flower heads in a cup of boiling water for 10 minutes. Strain and cool. Drink 3 times per day.

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.

• Apis is traditionally used for hives and angioedema and may be useful to prevent or treat chronic, recurrent cases.

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 person’s airway could be blocked, which could be life-threatening. In rare cases, angioedema may develop into anaphylaxis, which requires 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.

Alternative Names:

Allergic reaction - angioedema