Angioedema
Brief description of the condition
Angioedema is a sudden swelling and affects areas of skin and mucous membranes, typically the lips or tongue. It can be caused by an allergic-like response. For the majority of sufferers, the condition is a nuisance, but for some it can be life-threatening if the swelling affects the mouth, throat or tongue with possible airway obstruction. There are four main types of angioedema - allergic, idiopathic, drug-induced and hereditary.
Key signs and symptoms
- Sudden onset (within minutes) obvious swelling, with or without itch
- Swelling usually round the eyes and lips but can affect the tongue, throat, hands, feet and genitals
- In some cases, associated symptoms including chest tightness, wheezing, itching and hypotension (patient is flushed or faint), could indicate a severe allergic reaction or anaphylaxis
Initial management
Determine if the airway is compromised. Symptoms include: difficulty breathing; high pitched breathing sound (stridor); difficulty swallowing (dysphagia); hoarse or muffled sounding voice (dysphonia).
If the airway is compromised, send the patient immediately to emergency medical care at the nearest emergency department or call 999.
If the airway is not compromised:
- If the swelling is severe, advise the patient to seek urgent medical care which might include oral or intravenous steroids and antihistamine.
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- Note that if the patient has an adrenaline auto-injector, it would be appropriate for them to use it.
- If the swelling is mild and static or diminishing, this is generally self-limiting and resolves spontaneously and therefore treatment might not be required.52 Advise the patient to seek non-urgent medical care to review medication and discuss prophylaxis.
Subsequent care (medical)
Provide follow-up medical care to identify the cause of angioedema and to establish if there is any relevant underlying medical condition (e.g. urticaria) that requires ongoing medical care.