Angioedema

Angioedema refers to increased vascular permeability below the dermis leading to edema. This process is similar to urticaria and is the result of vasoactive mediators such as histamine, serotonin, and bradykinin. Angioedema has many causes, including: food, drugs/medication, hymenoptra exposure, complement-mediated, hereditary, malignancy, and idiopathic.

Angioedema is often first noticed on the head/face. However, it can occur anywhere on the body. The patient will have painless (sometimes painful) edema that is nonpitting and without pruritis. Abdominal pain may be present, which is likely the result of edema within the GI tract.

The most concerning issue related to angioedema is airway management. The edema can occur very rapidly and airway compromise may occur. Fiberoptic intubation is preferred. However, a surgical airway may be required if the edema has occluded the airway.

Medications typically used for allergic reactions may or may not be helpful in the treatment of angioedema. If the etiology is an IgE mediated process, then medications such as diphenhydramine, ranitidine, epinephrine, and steroids will likely improve the edema. However, these treatments often do not work in ACE inhibitor angioedema or hereditary angioedema. The treatment in these cases is supportive along with airway management.

The patient in photo (A) recently started an ACE inhibitor. The patient in photo (B) has leukemia related angioedema.

Resources:

Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill; 2004.

Reid M, Euerle B, Bollinger ME. Angioedema. Oct 20, 2008. http://emedicine.medscape.com/article/135208-overview