Angioedema also spelled as ‘angiooedema’ and is referred to as Quincke’s edema. It is a condition characterized by rapid swelling of the dermis, mucosa, submucosal tissues and subcutaneous tissues. The condition is often mistaken with urticaria; however, urticaria is commonly referred to as hives and is associated with upper dermis. It was believed that there is a connection with the nervous system; hence the condition is also called as angioneurotic oedema. Nevertheless this possibility is ruled out.
The condition can be a medical emergency especially in cases wherein angioedema progresses rapidly. This is because the condition may lead to airway obstruction causing suffocation. In case, the condition occurs due to allergic reaction then Epinephrine hormone therapy may prove to be highly beneficial and life saving. However, the same therapy has no significant effect in treating hereditary angioedema.
Causes of Angioedema
Angioedema can be resulted due to allergic reactions. Such reaction causes histamine as well as other chemicals to be released in the blood. Body usually releases histamine on detecting any foreign substance such as allergen, through its immune system. However, in majority of cases the cause of the condition is never determined. However hypothesis points towards several factors that may cause angioedema which includes:
- Animal dander
- Certain kind of exposure to cold, heat, water or sunlight
- Certain foods like shellfish, berries, milk or eggs, etc
- Bites from insects
- Medicines like antibiotics, NSAIDs, ACE inhibitors, etc
Angioedema, like hives, can also occur after infection or due to other illnesses. In some cases the condition run in families and may have certain triggers causing a similar complications etc.
Symptoms of angioedema
Angioedema is often accompanied with symptoms which may help in determining the affliction of the condition. The swelling caused due to the condition can affect the genital area, hands, feet, bowel, eye and lining of the feet. The signs of this condition usually develop suddenly, except in case of hereditary angiooedema. These signs may last for around three days. In case if the patient is suffering from urticaria then the swelling may also be itchy.
Swollen region, in some cases, may feel warmer and painful. Person may suffer from breathing difficulties if the throat lining as well as airway is affected. Some affected individuals have also reported of vision issues. People affected with inherited angioedema suffer from stomach pain, diarrhea, queasiness and vomiting. In less common cases people complain about difficulties while urinating.
There are several ways in which angioedema is diagnosed. Primarily the doctor may analyze the condition and try to determine the cause of the condition. Dermatologic test is often suggested for people suffering from the condition. In most cases of the condition laboratory testing may not be needed. There are certain tests such as C4 level test, C1 esterase inhibitor test, C1q test, CBC with differential, D-dimer level test, Urinalysis, complete metabolic profile, antinuclear antibody test, CH50 level test, etc, that can help in determining the condition.
ESR or Erythrocyte and CRP C-Reactive Protein level test are also suggested to the patient suffering from the issue. In people with history of thyroid disease or other autoimmune conditions, thyroid examinations are suggested. Stool analyses are also recommended for some patients to check for ova or parasites. There are also some imaging techniques that may help in determining the cause of the condition. These techniques would include:
- Plain abdominal x-ray film: This would provide a thumbprint appearance of the intestine
- Ultrasonography of abdomen: This helps in analyzing the ascites
- Computer Tomography or CT scan of Abdomen: This would indicate any serious edema of wall of the bowel
- Radiography of Chest: This would indicate pleural effusion
- Radiography of soft tissues: This would help in determining swelling of soft tissues
In case of allergic angioedema, further attacks can be prevented by avoiding triggers through allergens and antihistamine use. Cetirizine is an antihistamine which is commonly prescribed for the condition. In some cases patients have reported relief through a combination of low dose of cetirizine which reduce the frequency as well as intensity of attacks. However, a higher dose may be needed in case if attack is experienced. In severe cases of allergic angiooedema desensitization to supposed allergens may be needed. Chronic cases of the condition can be handled with steroid therapy which has good response. Epinephrine may prove to be a life saver in cases airway obstruction is recorded.
In case of hereditary angioedema certain stimuli that have led to attack in previously must be avoided. This condition type does not respond to corticosteroids, epinephrine or antihistamine. General treatment is based on use of C1-INH from donor blood which is given to the patient intravenously. In emergency cases fresh frozen blood plasma that contains C1-INH can be given to the patient. In most European nations this protease inhibitor is only available for patients who are enrolled with special programs. Future attacks of such genetic angioedema can be prevented or its frequency can be reduced by using androgens such as danazol, methyltestosterone or oxandrolone.
In case of acquired angioedema, also abbreviated as AAE, is segregated in three types Type- I, Type- II, and non-histaminergic angioedema. In such cases anti-fibrinolytic like ε-aminocaproic acid or tranexamic acid may prove to be helpful. Cinnarizine can be used in patients who suffer from liver issues, as it can block C4 activations.
It is essential to treat the condition timely and effectively as it may lead to fatal consequences. Consult a doctor if you experience any of the aforementioned side-effects. An appropriate treatment through professional medical guidance can help in avoiding complications of angioedema.