Angioedema (of the face) – QUICK HITS

22 Apr

Self limited swelling of the lips/mouth/uvula/face (Another type of angioedema, bowel wall angioedema, will not be covered here.)

-can occur with or without other signs/symptoms of allergic reaction.   

-Causes can include Hereditary angioedema, Mast cell mediated angioedema (allergic ractions), or in bradykinin induced angioedema

 

Mast Cell Mediated Angioedema

-Symptoms begin with minutes of exposure and resolve in 24-48 hours

-Associated with other symptoms/signs of allergic reaction including

  • urticaria,
  • pruritis,
  • bronchospasm,
  • hypotension,
  • throat tightness

 

Bradykinin Induced Angioedema

Generally isolated to swelling with no other symptoms (no urticaria or other signs of systemic involvement)

-Usually develops slower, over 24-36 hours, and can last two to four days

-No clear association with when this may occur- for ACE inhibitor angioedema, can occur at onset of medication use, after a recent medication dose change, or after years of use

Immunosuppressed patients are more likely to experience this type of reaction even from medications they have been on for a long time

-Unilateral angioedema is more commonly related to ACE inhibitor induced angioedema

 

Hereditary Angioedema

-Caused from C1 inhibitor deficiency

-About 25% of patients have with Hereditary angioedema have a new mutation, so no family history does not rule out hereditary angioedema as a cause

 

Idiopathic Angioedema

-Recurrent episodes of angioedema without any systemic symptoms who have no drug exposure or complement pathway deficiency

 

Treatment

-Without a clear cause general treatment is the same for all three groups:

            –AIRWAY: Intubate if patient exhibits impending airway loss

            -If laryngeal or other respiratory involvement consider Epinephrine IM or SC and/or albuterol

 

            –Glucocorticoids

            –H1 and H2 antihistamines

-Note:  if Bradykinin induced angioedema, the main treatment is cessation of the medication causing the reaction           

 

Common Medication Causes for All Types of Angioedema

-ACE inhibitor or ARB

NSAID

-Calcium channel blockers

-Estrogens

-Antibiotics

 

Submitted by J. Grover. 

 

Sources:  Chan YF and Kalira D.  “Angiotensin-Converting Enzyme Inhibitors as a Cause of Unilateral Tongue Angioedema in a 68 Year old Woman.”  American Journal of Emergency Medicine 2005: 9:249-250.; Kuhlen JL and Forcucci J.  “Angiotensin-Converting Enzyme Inhibitor-induced Unilateral Tongue Angioedema.”  American Journal of the Medical Sciences 2012: 344:5;416-417.; Uptodate.  An Overview of Angioedema:  Clinical Features, Diagnosis, and Management; picture

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