Introduction
It may be drug-induced, hereditary or acquired, and some forms require urgent treatment because of the risk to the airways.
Symptoms
- Deep, firm swelling, often not itchy
- Usually no hives
- Lips, eyelids and tongue often affected
- Possible abdominal pain (hereditary forms)
- Sometimes slower onset
- Prolonged duration (48 to 72 hours, sometimes longer)
Causes
- Drug-induced
- ACE inhibitors, more rarely sartans (angiotensin II receptor blockers)
- Hereditary
- C1 inhibitor deficiency or dysfunction
- Acquired
- associated with certain systemic diseases
- Possible triggers
- stress, injury, infections, dental procedures
Diagnosis
- Targeted history (medicines, family history)
- Clinical examination
- Ruling out an allergic mechanism
- Specific blood tests if bradykinin-mediated angio-oedema is suspected
- Referral to hospital in case of doubt or severity
Treatments
- Permanent discontinuation of the responsible medicine (ACE inhibitor)
- Specific treatments for bradykinin-mediated forms
- Close medical monitoring
- Hospital admission if breathing is affected
- Patient education on warning signs
- ineffective
Management
Distinguish allergic from non-allergic angio-oedema
Identify the exact cause
Prevent recurrences
Refer for specialist follow-up if needed
Make future prescriptions safe