Angioedemaswelling

Angioedema swelling, commonly referred to as angioedema, is the rapid swelling of the deeper layers of the skin and mucous membranes. It most often involves the face, lips, tongue, throat, hands, or abdomen. The swelling tends to persist for about 24 to 72 hours and is typically non-pitting and non-itchy. Airway involvement can occur and requires urgent medical attention.

Angioedema is categorized by mechanism and cause. The main types are hereditary angioedema (HAE) due to C1 esterase inhibitor (C1-INH) deficiency, acquired angioedema associated with C1-INH deficiency, and bradykinin-mediated angioedema such as ACE inhibitor–induced angioedema. Histamine-mediated, allergic angioedema may accompany urticaria and is often triggered by foods, drugs, or insect stings.

Diagnosis relies on history and clinical examination. Laboratory tests help distinguish types, especially low C4 levels and abnormal C1-INH antigenic level or function in suspected HAE. ACE inhibitor–associated angioedema is suggested by onset after starting the medication and lack of urticaria. Because airway swelling can be life-threatening, assessment of the airway and urgent management are essential.

Treatment depends on the underlying mechanism. Histamine-mediated angioedema responds to antihistamines, corticosteroids, and epinephrine in cases of anaphylaxis. Bradykinin-mediated angioedema requires targeted therapy such as C1-INH concentrates or a bradykinin receptor antagonist (icatibant), and avoidance or stopping of the triggering medication (e.g., ACE inhibitors). Long-term management for hereditary angioedema includes on-demand therapy, possible prophylaxis with C1-INH or other agents, and genetic counseling, with education on trigger avoidance and emergency plans.