Angioedema refers to swelling that occurs in the tissue just below the
surface of the skin. It generally results from an allergic reaction to either a
food or medication; it may be a sign, though, of an underlying condition such as
leukemia or Hodgkin's disease. There are two basic types of angioedema:
Hereditary angioedema (HAE), which is genetic and tends to recur
Acquired angioedema (AAE)
The onset of angioedema varies widely, taking anywhere from minutes to hours
to develop. Interestingly, angioedema may affect an area on one side of the body
but not on the other.
Signs and Symptoms
Common symptoms of angioedema include:
Burning, painful, swollen areas; usually not itchy; often affects
eyelids, lips, tongue, throat, palms, soles, or genitalia
Hoarseness, tight or swollen throat, breathing trouble
Discolored patches or rash on the hands, feet, face, or
Vomiting, abdominal pain, diarrhea, and reduced appetite
Swelling in or around the eyes
In a form called angioedema-eosinophilia syndrome, hives, itching,
fever, muscle pain, decreased urine, weight gain, and high white blood cell
What Causes It?
Sometimes the cause is difficult to identify. An angioedema reaction (AAE in
particular) may be caused by allergies to foods, dyes, or pollen, or in reaction
to certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs,
such as ibuprofen) and angiotensin-converting enzyme (ACE) inhibitors (such as
captopril, lisinopril, enalapril). Conditions such as leukemia, Hodgkin's
disease, and connective tissue disorders (such as systemic lupus erythematosus)
may also trigger angioedema.
Who's Most At Risk?
These factors increase the risk for angioedema:
Experiencing injury, sudden temperature change, stress, or anxiety
Undergoing a dental procedure
Going through puberty or menstruating
Having had a body-wide allergic reaction in the past
Having ovarian cysts
Taking ACE inhibitors (such as captopril, lisinopril,
What to Expect at Your Provider's Office
Your healthcare provider will perform a physical exam and ask about your
symptoms. Blood and urine tests may help pinpoint the cause of the angioedema.
You should eliminate any known or suspected triggers. Allergy testing with a
trained specialist may help identify inciting agents. If you are prone to
angioedema, you should wear a Medic Alert bracelet that notes this condition.
The first priority is to ensure that the airway is open and that breathing is
not impaired. The next steps include identifying and removing the trigger as
well as relieving other symptoms. Infrequent attacks can be managed as they
arise. Frequent attacks may require ongoing treatment, perhaps with an
allergist, dermatologist, or other specialist to try to avoid
Several medicines may help prevent or relieve attacks. These include
epinephrine, antihistamines, and corticosteroids. Children respond better to
treatment with these medications than adults do. Acute attacks tend to clear up
within four days with or without medication.
Complementary and Alternative Therapies
In a severe attack, standard emergency medical care should be administered
immediately to open airways and stabilize the condition; no new substances,
including herbs or supplements, should be introduced during an acute attack.
Long-term nutritional and herbal support used in between attacks may help
reduce or prevent angioedema. In addition, herbs and supplements may help
alleviate mild symptoms, particularly for chronic and recurring forms.
Homeopathic remedies may help alleviate mild symptoms and reduce the frequency
and severity of episodes.
Certain foods and food additives may trigger angioedema in people who are
susceptible. You should eliminate any foods or food additives that trigger
symptoms. The following are the most common food triggers:
Certain individuals may have a reaction in response to:
Sulfites—used as an antioxidant or freshening
agent (preservative) in many foods and beverages
Yellow dye No. 5 (also called
tartrazine)—those who react to aspirin or other NSAIDs
are more susceptible to having an allergy to yellow dye No. 5
Healthcare providers can help identify food triggers by:
Collecting detailed information about your diet
Performing skin tests for sensitivity to certain substances
Cautiously testing suspected triggers
Monitoring symptoms as foods are eliminated from your diet then slowly
re-introduced one at a time
If you have gastrointestinal symptoms (abdominal pain, vomiting, diarrhea, or
reduced appetite), this may be an indication that you absorb antigens (food
triggers) more easily than others through the stomach and intestines; in that
case, you may benefit from a diet that eliminates common dietary antigens (as
listed above) even if you do not have a specific, identifiable food
Quercetin (a naturally occurring flavonoid) may reduce the likelihood
of an allergic reaction. The recommended amount is generally 200 to 400 mg three
times a day before meals. If you are sensitive to citrus or take calcium-channel
blockers to treat high blood pressure, you should avoid citrus-based forms of
Bromelain (Ananas comosus, an enzyme derived from
pineapple)—used by some clinicians to help reduce
inflammation; some recommend its use with turmeric (Curcuma longa), which
may enhance the effects of bromelain.
Devil's claw root (Harpagophytum
procumbens)—may be recommended by an herbal
specialist to reduce inflammation and skin lesions
Ginkgo biloba extract—used as an
anti-allergenic agent and anti-inflammatory, although in very rare instances,
ginkgo has been reported to cause an allergic reaction of the skin.
Goldenseal (Hydrastis canadensis)—has
been used for gastrointestinal symptoms such as stomach pain, diarrhea, and
reduced appetite that may accompany a severe allergic reaction; some clinicians
also recommend goldenseal for those with food allergies to prevent or lessen
Licorice root (Glycyrrhiza glabra)—has
been used traditionally to diminish inflammation in the case of an allergic
reaction; may also normalize immune
Apis is traditionally used for hives and angioedema and may be
useful to prevent or treat chronic, recurrent cases. An experienced homeopath
considers each individual case and may recommend treatments to address both the
underlying condition and any current
Although not confirmed by scientific literature, some clinicians report that
acupuncture may help reestablish immune balance and lessen the frequency or
severity of allergic responses such as angioedema.
If angioedma affects the throat, the airway passage could be blocked, thereby
creating a life-threatening situation. It is also possible that the angioedema
may develop into anaphylaxis, which will require emergency medical care to
maintain breathing, blood pressure, and heart function and to reverse the
After an attack, it's important to identify and avoid any triggers and to
treat any underlying condition.
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Review Date: October 2000
Reviewed By: Participants in the review process include: Amy Atar, MD, Infectious Disease
Specialist and HIV Consultant, Cambridge City Hospital, Cambridge, MA; Constance
Grauds, RPh, President, Association of Natural Medicine Pharmacists, San Rafael,
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