Allergic reaction - angioedema
Angioedema is swelling that happens just below the surface of the skin, most often around the lips and eyes. When you have an allergic reaction, your body produces histamine, which causes blood vessels to swell. Angioedema is like hives, but with hives there are itchy red welts on the surface of your skin. Angioedema is a deeper swelling.
Both hives and angioedema are usually caused by an allergic reaction to either a food or medication. Things like pollen or insect stings can also cause angioedema. In rare cases, it may be a sign of an underlying condition, such as leukemia or Hodgkin's disease. There are two basic types of angioedema:
- Hereditary angioedema (HAE), a rare genetic condition
- Acquired angioedema (AAE)
Angioedema can take anywhere from minutes to hours to develop. It may affect just one side of the body. In most cases, angioedema is mild. Severe angioedema can cause the throat or tongue to swell, cutting off the airway, and it can be life threatening.
Signs and Symptoms
Common symptoms of angioedema include:
- Red welts that suddenly appear, especially near the eyes and lips, but also on the hands, feet, and the inside of the throat.
- Burning, painful, swollen, sometimes itchy areas.
- Discolored patches or rash on the hands, feet, face, or genitals.
- More rarely, hoarseness, a tight or swollen throat, or trouble breathing.
- In a form called angioedema-eosinophilia syndrome, hives, itching, fever, muscle pain, decreased urine, weight gain, and high white blood cell count occur.
What Causes It?
Sometimes the cause is unknown. Angioedema may be caused by allergies to foods, dyes, or pollen, or certain medications. Foods that often cause allergies include:
Medications that often spark allergic reactions include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or Advil
- Blood pressure medications
Other conditions that may trigger angioedema include:
- Hodgkin's disease
- Connective tissue disorders such as lupus
- Insect bites and stings
Who Is Most At Risk?
Factors that increase the risk for angioedema include:
- Having hives or angioedema before
- Having a body-wide allergic reaction in the past
- Experiencing injury
- Sudden temperature changes
- Stress or anxiety
- Undergoing a dental procedure
- Having ovarian cysts
Also, women are affected by angioedema more often than men.
What to Expect at Your Doctor's Office
Your doctor will do a physical exam and ask about your symptoms. Be sure to tell your doctor about all medications (prescription and over-the-counter), as well as herbs and supplements you are taking. Blood and urine tests may help pinpoint the cause of the angioedema.
You should get rid of any known or suspected triggers for allergies. Allergy testing with a trained specialist may help identify what you're allergic to. If you often have angioedema, you should wear a Medic Alert bracelet.
If you have mild angioedema, you may be able to treat it with over-the-counter antihistamines or alternative therapies. With severe angioedema, the first priority is to ensure that the person's airway is open and they can breathe. The next steps include finding and removing the allergen, as well as relieving other symptoms. You can manage infrequent attacks as they happen. Frequent attacks may require ongoing treatment, perhaps with an allergist, dermatologist, or other specialist.
Several medicines may help prevent or relieve attacks. For mild cases, you can use over-the-counter antihistamines, such as Benadryl, Zyrtec, Allegra, or Claritin. Note that Benadryl often causes drowsiness.
Your doctor may prescribe antihistamines. Mild attacks tend to clear up within 4 days with or without medication. For severe cases, your doctor may prescribe corticosteroids to reduce swelling and itching, or you may need a shot of epinephrine (EpiPen).
Complementary and Alternative Therapies
In a severe attack, you should seek emergency help right away. DO NOT take any new drugs, herbs, or supplements during an attack.
Following a good nutritional plan and using herbs in between attacks may help reduce or prevent angioedema. Herbs and supplements may help reduce mild symptoms, especially if you often have angioedema. Find a health care practitioner who is experienced at prescribing herbs and supplements so you can find the right ones for you. It is important to tell your doctor about all medications, herbs, and supplements you are taking.Nutrition and Supplements
Some foods may trigger angioedema in people who are allergic. You should eliminate any foods or food additives that trigger symptoms. The following are the most common food triggers:
Some people may have a reaction in response to:
- Citrus fruits.
- Sulfites. Used as an antioxidant or preservative in many foods and beverages.
- Yellow dye No. 5 (also called tartrazine). Those who are allergic to aspirin or other NSAIDs are more likely to have an allergy to yellow dye No. 5.
Your doctor can help identify food triggers by:
- Getting detailed information about your diet.
- Doing skin tests for allergies.
- Testing suspected triggers.
- Watching symptoms as foods are eliminated from your diet, then slowly re-introduced one at a time.
If you have stomach symptoms, such as abdominal pain, vomiting, diarrhea, or reduced appetite, you may want to try a diet that eliminates common food triggers even if you don't have a specific food allergy.
These supplements may also help treat symptoms:
- Vitamin C. May help lower histamine levels, although there isn't a lot of evidence. Reduce dose if diarrhea develops. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
- Vitamin B12 (by injection). May help reduce the frequency of ongoing attacks, although there isn't a lot of evidence. Doctors don't know whether taking oral B12 would work the same way.
- Quercetin (a plant-based flavonoid). May reduce the likelihood of an allergic reaction, although there isn't a lot of evidence. If you are sensitive to citrus or take calcium-channel blockers to treat high blood pressure, you should avoid quercetin. Quercetin may interact with medications, including blood thinners, so ask your doctor before taking it. Very high doses have been associated with kidney damage, so don't take quercetin for more than 2 months without taking a break. Quercetin is best absorbed in its water-soluble form, often referred to as hesperidin methyl chalcone (HMC). It can be harder to find.
- Bromelain. Is sometimes used to help reduce inflammation. It is often combined with turmeric (Curcuma longa) because it makes the effects of bromelain stronger. People who are allergic to pineapple should not take bromelain. Both bromelain and turmeric may increase the risk of bleeding, especially if you take blood-thinning medication such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider.
- Goldenseal (Hydrastis canadensis). Has been used for gastrointestinal symptoms such as stomach pain, diarrhea, and reduced appetite that may go along with a severe allergic reaction. Some providers may recommend goldenseal for people with food allergies to prevent or reduce allergic reactions. Goldenseal interacts with a number of medications, including blood thinners and cyclosporine. It may also lower blood sugar. Ask your doctor before taking goldenseal if you take any other medication, or if you have diabetes.
- Licorice root (Glycyrrhiza glabra). Has been used traditionally to reduce inflammation in the case of an allergic reaction. It may also help support immune system health. DO NOT take licorice if you have high blood pressure, erectile dysfunction, edema, or heart failure; hormone-sensitive cancers, such as breast, prostate, ovarian, or uterine cancer; diabetes; kidney disease; liver disease; low potassium, or if you are taking corticosteroids prescribed by your doctor. Licorice interacts with a number of medications, so to be safe, ask your doctor before taking licorice if you take any other medications.
- Chamomile (Matricaria recutita). Has been used traditionally to treat hives, although there is no scientific evidence that it works. Chamomile can make the effects of other sedatives stronger. It also interacts with many other medications, including potentially estrogen and birth control medications. People who are allergic to ragweed should not take chamomile. Use caution if you have a history of hormone-sensitive cancers or conditions.
Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Apis mellifica. A homeopathic remedy with decongestant properties. It is traditionally used for hives and angioedema and may be useful to prevent or treat chronic, recurrent cases.Acupuncture
Some doctors report that acupuncture may help reduce the frequency or severity of allergic reactions such as angioedema.
Prognosis and Possible Complications
If angioedema affects the throat, it can block the airway, which could be life-threatening. In rare cases, angioedema may develop into anaphylaxis, which requires emergency medical care to maintain breathing, blood pressure, and heart function, and to reverse the reaction.
After an attack, it's important to identify and avoid any triggers and to treat any underlying condition.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:84-87, 160-169, 233-239.
Chan NJ, Soliman AM. Angiotensin converting enzyme inhibitor-related angiodema: onset, presentation, and management. Ann Otol Rhino Laryngol. 2015;124(2):89-96. PMID: 25059449 www.ncbi.nlm.nih.gov/pubmed/25059449.
Chinen J, Shearer WT. Advances in basic and clinical immunology in 2006. J Allergy Clin Immunol. 2007;120(2):263-270. PMID: 17590425 www.ncbi.nlm.nih.gov/pubmed/17590425.
Cicardi M, Bergamaschini L, Cugno M, et al. Pathogenic and clinical aspects of C1 inhibitor deficiency. Immunobiol. 1998;199(2):366-376.
Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017.
Inomata N. Recent advances in drug-induced angioedema. Allergol Int. 2012;61(4):545-557. PMID: 23183389 www.ncbi.nlm.nih.gov/pubmed/23183389.
Johnston S, Martin LJ, Cai X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr. 1992;11(2):172-176. PMID: 1578094 www.ncbi.nlm.nih.gov/pubmed/1578094.
Kelly M, Donnelly JP, McAnnally JR, Wang HE. National estimated of emergency department visits for angioedema and allergic reatcions in the United States. Allergy Asthma Proc. 2013;34(2):150-154. PMID: 23484890 www.ncbi.nlm.nih.gov/pubmed/23484890.
Kumar SA, Martin BL. Urticaria and angioedema: diagnostic and treatment considerations. J Am Osteopath Assoc. 1999;99(3 suppl):S1-S4. PMID: 10217914 www.ncbi.nlm.nih.gov/pubmed/10217914.
Lin RY, Levine RJ, Lin H. Adverse drug effects and angioedema hospitalizations in the United States from 2000 - 2009. Allergy Asthma Proc. 2013;34(1):65-71. PMID: 23406938 www.ncbi.nlm.nih.gov/pubmed/23406938.
Madsen F, Attermann J, Linneberg A. Epidemiology of non-hereditary angioedema. Acta Derm Venereol. 2012;92(5):475-479. PMID: 22791189 www.ncbi.nlm.nih.gov/pubmed/22791189.
Matsuo N, Yamada K, Shoji K, Mori M, Sugano M. Effect of tea polyphenols on histamine release from rat basophilic leukemia (RBL-2H3) cells: the structure-inhibitory activity relationship. Allergy. 1997;52(1):58-64. PMID: 9062630 www.ncbi.nlm.nih.gov/pubmed/9062630.
Paganelli R, Fagiolo U, Cancian M, Scala E. Intestinal permeability in patients with chronic urticaria-angioedema with and without arthralgia. Ann Allergy. 1991;66(2):181-184. PMID: 1994789 www.ncbi.nlm.nih.gov/pubmed/1994789.
Rye Rasmussen EH, Binslev-Jensen C, Bygum A. Angioedema-assessment and treatment. Tidsskr Nor Laegeforen. 2012;132(21):2391-2395. PMID: 23160589 www.ncbi.nlm.nih.gov/pubmed/23160589.
Shah UK, Jacobs IN. Pediatric angioedema: ten years' experience. Arch Otolaryngol Head Neck Surg. 1999;125(7):791-795. PMID: 10406319 www.ncbi.nlm.nih.gov/pubmed/10406319.
Waytes AT, Rosen FS, Frank MM. Treatment of hereditary angioedema with a vapor-heated C1 inhibitor concentrate. N Engl J Med. 1996;334(25):1630-1634. PMID: 8628358 www.ncbi.nlm.nih.gov/pubmed/8628358.
Zuraw BL. Novel therapies for hereditary angioedema. Immunol Allergy Clin North Am. 2006;26(4):691-708. PMID: 17085285 www.ncbi.nlm.nih.gov/pubmed/17085285.
Zuraw BL. Urticaria, angioedema, and autoimmunity. Clin Lab Med. 1997;17(3):559-569. PMID: 9316773 www.ncbi.nlm.nih.gov/pubmed/9316773.
Review Date: 11/19/2016
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M Editorial team.