Angioedema

Angioedema
Other names	Angiooedema, Quincke's edema, angioneurotic edema
Allergic angioedema: this child is unable to open his eyes due to the swelling.
Specialty	Allergy and immunology, emergency medicine
Symptoms	Area of swelling[1]
Usual onset	Minutes to hours[1]
Types	Histamine mediated, bradykinin mediated[1]
Risk factors	Family history[2]
Diagnostic method	Based on symptoms[2]
Differential diagnosis	Anaphylaxis, abscess, contact dermatitis[2]
Treatment	Intubation, cricothyroidotomy[1]
Medication	Histamine: antihistamines, corticosteroids, epinephrine[1] Bradykinin: C1 esterase inhibitor, ecallantide, icatibant, fresh frozen plasma[1]
Frequency	~100,000 per year (US)[1]

Angioedema is an area of swelling (edema) of the lower layer of skin and tissue just under the skin or mucous membranes.^[1][3] The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs.^[1] Often it is associated with hives, which are swelling within the upper skin.^[1][3] Onset is typically over minutes to hours.^[1]

The underlying mechanism typically involves histamine or bradykinin.^[1] The version related to histamine is due to an allergic reaction to agents such as insect bites, foods, or medications.^[1] The version related to bradykinin may occur due to an inherited problem known as C1 esterase inhibitor deficiency, medications known as angiotensin-converting enzyme inhibitors, or a lymphoproliferative disorder.^[1]

Treatment to protect the airway may include intubation or cricothyroidotomy.^[1] Histamine-related angioedema can be treated with antihistamines, corticosteroids, and epinephrine.^[1] In those with bradykinin-related disease a C1 esterase inhibitor, ecallantide, or icatibant may be used.^[1] Fresh frozen plasma may be used instead.^[1] In the United States the disease affects about 100,000 people a year.^[1]