Angioedema is also known as quincke’s edema which defined as the deep and rapid swelling of the dermis, subcutaneous tissues, mucosa and sub mucosal tissues of the body due to an allergic reaction.Swelling in case of angioedema is similar to hives (urticaria) but the swelling is deep under the skin than on the surface.
Angioedema is usually a non pitting and nonpruritic type of edema. In acute attacks of angioedema the common sites of body involved are skin, larynx, buccal mucosa and mucosa of gastrointestinal tract. If larynx is involved in angioedema then swelling of larynx is a life threatening condition. The disease is usually associated with urticaria.Most of the times angioedema and urticaria occur together.
When angioedema attack the area of the swelling which is peripheral or facial parts then pain may be absent or mild but it will be severe in gastrointestinal angioedema.
Angioedma otherwise come along with urticaria most of the times as it involves deeper layer of skin but in urticaria more superficial layer of the skin is involved. Involvement of mucosa is seen in angioedema but not in urticaria.
Bradykinin plays a very important role in the pathophysiology of angioedema. Bradykinin is a peptide which acts as a vasodilator leads to increase the permeability of the vessel and hence causing rapid accumulation of fluid in the interstitium. This process usually occurs in face as it is the most common site for development of edema as its skin has very little supporting connective tissue. Bradykinin is developed by different cell types in response to different stimuli.
The mechanisms that interfere in production or degradation of bradykinin can leads to angioedema.
Angioedema can also occur due to antibody formation against C1INH. This is an autoimmune disorder.
Is There Any Type Of Angioedema?
Angioedema is classified into two types:
Acquired angioedema: This can be of many types such as immunologic, idiopathic or non-immunologic. This type of angioedema is caused by allergy and comes along with other allergic symptoms and urticaria.
Hereditary angioedema (HAE): It exist in three forms-
• Type Ι- Occur when there are decreased levels of C1INH.
• Type ΙΙ- Occurs when there are normal levels, but functions are decreased of C1INH.
• Type ΙΙΙ- When there is no detectable abnormality in C1INH, occurs in an X-Linked dominant fashion and therefore this type mainly affects women.
Hereditary angioedema affects more commonly the females.
Hereditary angioedema type ΙΙΙ is found predominantly in women.
Chronic idiopoathic angioedema is more common in females than in males.
Angioedema can affect patient at all ages.
Allergic reactions to food are more common in children.
In cases of HAE the onset of attacks usually occurs around puberty.
Africans and Americans are more prone to develop angioedema.
The major cause of angioedema is allergic reaction. After the reaction there is release of histamine and other chemicals in bloodstream.
When the immune system detects a foreign substance it releases histamine.
Following are the causes of angioedema:
• Animal dander.
• Foods such as berries, shellfish, nuts, fish, nuts, milk and eggs.
• Insect bites.
• Medicines such as antibiotics, non steroidal anti-inflammatory drugs and blood pressure medicines.
• Exposure to water, sunlight, cold or heat.
Angioedema may also occur along with other infections such as lupus, leukemia and lymphoma.
Herediatary angioedema is caused due some defect in genes.
• The major symptom of angioedema is sudden swelling below the surface of the skin.
• The major sites for appearance of swelling are around the eyes and lips. Other parts are hands, feet and throat.
• The swelling can occur in the form of line or maybe in spread out form.
• The swelling parts are painful and itching may also be an associated symptom.
• Abdominal cramping is also seen.
• Difficulty in breathing.
• Swollen eyes and mouth.
• Chemosis occur.
• Complete blood count.
• Serum electrolytes.
• Renal function test.
• Liver enzymes.
• Allergy tests.
• Angioedema is a life threatening trouble if swelling occurs in larynx as it leads to obstruct the airway passage.
• As there is swelling in the airway passage this can make intubation difficult and can cause vocal cord damage during intubation.
• Severe abdominal pain.
• Bowel obstruction.
• Acute pancreatitis.
• Skin rupture can occur.
• When angioedema occur lower extremities than it can lead to difficulty in walking and daily activities are impaired.
In cases where angioedema is induced by any drug reaction as soon as it is detected than further triggers can be avoided any medications help to treat.
Hereditary angioedema requires continuous lifelong treatment.
Allergy related differential diagnosis of angioedema is as follows:
• Natural rubber latex.
• Foods such as milk, egg, shellfish, tree nuts, soy, wheat, seafood.
• Bites and stings.
Drug related differential diagnoses are as follows:
• Beta-lactam antibodies.
• ACE inhibitors.
Viral infection to be considered for differential diagnosis is as follows:
• Hepatitis B
• Hepatitis C
• Herpes simplex.
• Coxsackieviruses A and B.
Bacterial infections to be considered for differential diagnosis of angioedema are as follows:
• Dental caries/abscesses.
• Otitis oedema.
• Upper respiratory infection.
• Urinary tract infection.
Parasitic infection included for differential diagnosis is as follows:
• Echinococcus species.
• Filarial species.
• Toxocara species.
• Schistosoma species.
• Strongyloides species.
• Fasciola species.
Other conditions considered for differential diagnosis are as follows:
• Contact edema.
• Localized edema.
• Morbilliform drug eruptions.
• Ludwig angina.
• Bullous pemphigoid.
• Erythema multiformis.
• Peritonsillar abscess.
• Retropharyngeal abscess.
• Urticaria pigmentosa.
Medications given to treat angioedema are as follows:
• Anti-inflammatory medicines.
People with angioedema should take care of following measures:
• Patient is advised to avoid any known allergen.
• Avoid any medicines, herbs, or supplements that are not prescribed by a health care provider.
Cold compresses or soaks help in relieving pain.
• Sudden swelling with redness especially of face, nose, extremities and genitals.
• There is sensation of burning and itching in the affected parts.
• This medicine is indicated when attack come especially after the person is exposed to cold weather.
• The condition get worse after consumption of alcohol, in the morning time and when exposed to sun.
• This medicine is indicated to patients who have tendency to develop oedematous swelling.
• The lesions appear as multiple pale swellings without redness and itching.
• This medicine is indicated when angioedema is concomitant with following conditions angioedema with severe debility, angioneurotic oedema after scar;atina.
• Indicated in condition when angioedema occur with fever, pain diarrhea and suppressed urine.
• This medicine is indicated when dropsy and anasarca develops due to disturbed functions of thyroid gland.
• There is extreme dryness of skin.
• The skin is cold to touch.
• The angioneurotic oedema tends to become worse at night.
• This medicine is indicated when scarlet red rash with oedema appear o the skin.
• Indicated for angioedema that affects mainly face, arms and legs.
• There is presence of excessive itching in affected parts.
• The symptoms come suddenly and vanish suddenly.
• This medicine is indicated when the angioneurotic oedema comes whenever a person is exposed to sun.
• Indicated for paersons who develop angioedema in person with cardiac illness.
• It typically affects the skin around the eyes and the face.
• Right side is more affected than the left.
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