Angioedema

Etiology

  • Bradykinin Mediated: Response to a precipitant, including: meds, in particular ACE-I; Can occur soon after initiation or months/years later
  • Histamine Mediated: Response to a precipitant, including meds, food, latex, insect bite/stings, other environmental triggers
  • Hereditary: Rare condition related to C1 inhibitor deficiency

Symptoms

  • Bradykinin Mediated: acute, focal swelling of lips, upper airway→ acute sob, sometimes intestines→ abd pain; Can occur w/first exposure to meds, or months/years after started; Typically no urticara or itching; Can be severe and life threatening due to airway issues; Can occur w/anaphylactic rxns→ low bp w/systemic sx
  • Histamine Mediated: Acute sob, edema, itching, flushing, abdominal pain; Can be severe and life threatening due to airway issues; Can occur w/anaphylactic rxns→ low bp w/systemic sx
  • Hereditary: Onset age onset; Sob, swelling, abdominal pain, no itching; Often no trigger; Can start in one area of body and spread; Sx last several days; Resolves in hours to days; Can be life threatening due to airway issues

Physical Exam Findings

  • Bradykinin Mediated: Diffuse swelling of lips/face/head/larynx/tongue if these are primary site; Stridor; Respiratory distress
  • Histamine Mediated: Redness, stridor, wheezing, hives/urticaria, swelling of face & other body parts, edema often asymmetric and non-pitting
  • Hereditary: Swelling of face, tongue; Stridor, respiratory distress; No urticaria; Non-pitting edema of face/hands/legs/genitalia/other body parts

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