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Angioedema -Quick revision card

First described by Quincke in 1882 , AKA angioneurotic edema , Quincke’s edema transient , typically non-pruritic , non-pitting swelling just below the skin ( subcutanous and/ or submucosal ) mostly affects the face , lips , neck , extremities , oral cavity ( serious -life threatening if it affects larynx ) ie affects areas with loose connective tissue distinct to oedema ( fluid accumulates in the interstitium -persistent pitting with pressure ) angiodema is due to ↑↑ ed vascular permeability can occur in isolation or or accompanied by urticaria ( 50 % cases ) or as a feature of anaphylaxis mediated by histamine , bradykinin or other mechanisms.

Axquired  allergic ( associated with anaphylaxis ) non-allergic drug induced complement mediated idiopathic ( further divided into histaminergic & non histaminergic )

Hereditary Autosomal dominant condition due to mutation in the gene encoding for C1-esterase inhibitor HAE type 1 ( low plasma conc of C1 ) HAE type 2 ( normal conc of functionally impaired C1 )

 

Histamine mediated -responds to antihistamines
○ similar to anaphylaxis
○ 50 % with urticaria
○ occurs quickly
○ typically self limiting over 24 hrs
○ h/o atopy ?
○ foods , medications , stinging insect venoma , radio contrast ,NSAID hypersensitivity reaction
 Bradykinin mediated 
Family h/o hereditary angiodema ? Patient on ACEI ? Previous problems

 

acute contact dermatitis cellulitis / erysipelas drug rash with eosinophilia and systemic symptoms dermatomyositis SVC syndrome Hypothyroidism Subcutaneous emphysema Orofacial granulomatosis Hypocomplementemic urticarial vasculitic syndrome Idiopathic edema.

ACE / sartan related

bulk of A&E presentations ( bradykinin mediated ) more common in blacks / females seen in 0.1 -0.7 of patients on ACE-usually affects face, lips , tongue and larynx majority ( 50 % ) develop within 1st weeks of treatment , but may happen intermittently or happen years after starting ACEi / sartan therapy typical erythema without itching Consider stopping for 3/12 ( can also happen with ARB’s but with lower frequency )

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