Angioedema

Angioedema is a reaction that causes swelling in the tissue below your skin. It most often affects your lips and eyelids. But it can affect any body part. It usually comes on quickly and lasts a few hours to a couple of days.

Swelling from angioedema can happen when your body reacts to something like food, medicine or even vibrations. Sometimes, it happens for no clear reason. It may be due to a health problem you were born with or another issue that makes the swelling come and go without warning. Your provider might consider other causes if the swelling lasts longer than two or three days.

Angioedema can be serious, even fatal, if your airways swell or your blood pressure drops too low. Call 911 (or your local emergency number) or get to an emergency room if you’re having trouble breathing or feeling weak or dizzy.

Symptoms of angioedema

Angioedema causes swelling, most commonly in your:

• Face
• Eyelids
• Lips
• Tongue
• Throat and airways
• Hands
• Feet
• Genitals

Other symptoms include:

• Abdominal pain
• Diarrhea
• Nausea and vomiting
• Dizziness
• Fainting

Hives often happen at the same time as angioedema. But you can have angioedema without hives.

Is it life-threatening?

It can be. Angioedema can sometimes cause severe airway swelling or a sudden drop in blood pressure. Call 911 (or your local emergency number) or get to an emergency room if you’re having trouble breathing or feeling weak or dizzy.

Angioedema causes

Angioedema happens when liquid from small blood vessels escapes and fills up tissues, causing swelling. It often happens in response to allergies, drug side effects or vibrations. Inherited gene changes, cancer, autoimmune diseases and infections can also cause it without a predictable trigger. Sometimes, it happens for no known reason (idiopathic angioedema).

Specific causes of angioedema include:

• Allergies: Triggers for allergic angioedema include food allergies, drug allergies, latex allergies, insect stings and spider bites. Swelling usually happens within minutes to a couple of hours after exposure. It often causes hives, too.
• Non-allergic drug reactions: Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of non-allergic drug reactions. The reaction doesn’t happen right away. Swelling can happen within a few weeks or months of starting the medication.
• Vibrations: Vibratory angioedema can happen while you’re riding a motorcycle, running, jogging, using powered gardening tools or during other activities that cause vibrations.
• Gene variations: You can inherit hereditary angioedema (HAE) from one or both biological parents. It can cause frequent, unpredictable swelling.
• Low levels of C1-inhibitor: C1-inhibitor is an immune system protein. Acquired C1-inhibitor deficiency causes episodes of swelling that don’t seem to have a specific trigger. Cancers, autoimmune disorders and infections can cause C1-inhibitor deficiency.

Can stress cause it?

Sometimes. If you have idiopathic or hereditary angioedema, stress might make swelling more likely.

Risk factors

You’re at higher risk for angioedema if you:

• Have allergies to food, latex or medications
• Have a health condition that affects your B cells (like certain types of cancer)
• Have an inherited gene variation that causes angioedema

How doctors diagnose angioedema

Your healthcare provider will begin with a physical examination. They’ll ask you questions about:

• When the swelling started
• What you may have eaten or touched that could have caused the reaction
• What medications and supplements you’re taking
• Whether or not you’ve had this type of reaction before
• If you have family members who experience similar swelling

Allergy skin tests and allergy blood tests can help determine if the swelling is an allergic reaction. If there’s no known trigger, genetic testing and other blood tests can help determine if another health condition is causing the swelling.

How is angioedema treated?

If you have allergic angioedema, you should avoid food, medications and other substances that cause swelling. Check with your provider before stopping prescription medications. If the swelling is a medication side effect, your provider will help you find a medication to replace the one that’s causing you to swell. They might also recommend applying ice or taking cool showers to reduce swelling.

Medications

Medications your provider might recommend to prevent or treat angioedema depend on the cause. They include:

• Antihistamines, steroids or epinephrine to treat swelling in allergic angioedema
• Omalizumab (Xolair®) to reduce the risk of an allergic reaction if you’re accidentally exposed to a food you’re allergic to, or to treat chronic idiopathic angioedema
• Medications that reduce your risk of swelling for HAE (like Cinryze®, Haegarda® Orladeyo® or Takhzyro®)
• Medications that treat HAE swelling when it happens (like Berinert®, Firazyr®, Kalbitor® or Ruconest®)
• An epinephrine autoinjector (Epipen®, Auvi-Q®) for severe swelling

When should I see my healthcare provider?

Talk to a healthcare provider if you have repeated episodes of swelling, especially if you don’t know the cause. Call 911 (or your local emergency services number) or go to the ER if you or someone you’re with experiences:

• Swelling of your face, lips, tongue or throat
• Sudden weakness or fainting
• Severe vomiting or diarrhea

What can I expect if I have angioedema?

Most of the time, angioedema is manageable by avoiding things that cause it or taking medications that help prevent it. But don’t stop taking medication prescribed by your doctor unless they say it’s OK. Your provider might also recommend keeping an epinephrine autoinjector or other emergency medications with you in case of unexpected swelling.

Can I prevent angioedema?

There are medications that can reduce your risk of swelling if you have HAE, acquired C1-inhibitor deficiency or chronic idiopathic angioedema. If you have allergy-related angioedema, you can prevent swelling by avoiding the food, medication or other triggers that cause allergic reactions. If you have non-allergic angioedema as a drug side effect, you’ll need to work with your healthcare provider to find another medication.