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 )
- Memon RJ, Tiwari V. Angioedema. [Updated 2021 Dec 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538489/
- Nedelea, I., Deleanu, D.”Isolated angioedema: An overview of clinical features and etiology (Review)”. Experimental and Therapeutic Medicine 17.2 (2019): 1068-1072.
- Andersen MF, Longhurst HJ, Rasmussen ER, Bygum A. How Not to Be Misled by Disorders Mimicking Angioedema: A Review of Pseudoangioedema. Int Arch Allergy Immunol. 2016;169(3):163-70. doi: 10.1159/000445835. Epub 2016 Apr 22. PMID: 27100932.
- Loverde, Daniel & Files, Daniel & Krishnaswamy, Guha. (2017). Angioedema. Critical Care Medicine. 45. 725-735. 10.1097/CCM.0000000000002281.
- Angioedema in the emergency department: a practical guide to differential diagnosis and managementBernstein et al. International Journal of Emergency Medicine (2017) 10:15