Angioedema

Overview

Angioedema is swelling that happens in the deeper layers of your skin. It most often appears around the eyes, lips, throat, hands, feet, or genitals. Unlike a hive, which is on the surface, this swelling makes the skin puff up from below. It usually forms quickly and can feel warm, painful, or look red.

Allergic angioedema is fairly common. Many people experience it at some point in their lives. The inherited form is much rarer.

Anyone can develop angioedema. Allergic triggers are more common in younger people, while medicine-related swelling is more common in older adults. The inherited form often starts in childhood.

Symptoms

Common symptoms

• Puffiness under the skin, often around the eyes, lips, mouth, hands, feet, or genitals
• Swelling that appears suddenly and may come and go
• A warm, red, or slightly painful feeling in the swollen area
• The area may be itchy, or it may feel tight and stretched

Symptoms in children

• Swelling around the eyes and mouth, which can spread to the hands or feet
• Unusual irritability, especially if the swelling is in the mouth
• A change in cry or voice — this can be a sign of throat swelling
• Trouble swallowing or drooling more than usual

Symptoms in older adults

• Swelling that may come from blood pressure medicines, especially the group called ACE inhibitors
• Less clear triggers, because the cause is often not allergy
• Swelling that takes longer to go away, especially if the person has other health conditions
• Other conditions, such as heart failure, can make the swelling worse

Causes

Main causes

• Allergic reactions to foods, such as nuts, eggs, fish, or milk
• Insect stings or bites
• Blood pressure medicines (especially the group called ACE inhibitors)
• Some pain relievers and other medicines
• Infections, like colds and flu
• Stress, heat, cold, or physical pressure on the skin
• A rare inherited condition that runs in families

Risk factors

• A past reaction of any type to a food, medicine, or insect sting
• Family history of angioedema or the inherited form
• Taking an ACE inhibitor for blood pressure
• An autoimmune condition, where the immune system attacks your own body
• Frequent severe allergies or a history of anaphylaxis

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have swelling that does not improve in a few hours, spreads, or is accompanied by fever or pain.
• If you recently started a new medicine and develop swelling, seek medical advice quickly.

Book a routine appointment if:

• If you have had several episodes of unexplained swelling, or if swelling keeps coming back and affects your daily life, book an appointment with your GP.

Diagnosis

Your doctor will ask you questions and examine the swelling. They will want to know when it started, what you ate, which medicines you take, and whether you have had it before. They will also look for swelling in your mouth and throat.

Tests that may be done

• Blood tests to check for allergy antibodies or, if inherited angioedema is suspected, levels of certain proteins
• Allergy skin-prick testing, usually in an allergy clinic
• A trial of stopping a medicine that could be the cause, but only with your doctor's advice
• Occasionally, urine or stool tests to rule out other conditions

What to expect at your appointment

The doctor will explain what might be going on and what to watch for. If a clear trigger is found, you will get advice on how to avoid it. If the cause is uncertain, you may be referred to an allergy specialist. You should always feel able to ask questions.

Treatment

Treatment depends on the cause and how severe your symptoms are. Avoiding known triggers is the first step. For a mild attack, symptoms often settle on their own. For more troublesome swelling, a doctor can prescribe treatments that reduce the allergic response.

Self-care at home

• Keep a cool, damp cloth on the swollen area for 10–15 minutes at a time
• Loosen tight clothing around the swelling
• Avoid the trigger if you know what it is, such as certain foods or drinks
• Keep a diary of episodes to share with your doctor
• Do not massage or scratch the swollen area

Medical treatments

Your doctor may prescribe an allergy medicine to block the body's chemical response. For moderate swelling, a short course of steroid tablets can help calm the immune system. If you have had a severe reaction, you may be given an emergency injectable device and taught how to use it. For the inherited form, specialists use specific treatments tailored to each person.

Living with this condition

Living with angioedema is about recognising your early warning signs and keeping away from your triggers. If you know you have a food or medicine trigger, avoiding it is the most effective protection. Many people find their symptoms settle without treatment, but keeping a written action plan from your doctor gives you confidence.

Lifestyle tips

• Learn to read food labels carefully if you have food-related swelling
• Tell your dentist and other healthcare professionals about your condition before any procedure
• Wear a medical ID bracelet or carry a card if you are at risk of serious reactions
• Talk to your pharmacist before taking any new medicine, including over-the-counter remedies

Diet and exercise

There is no special diet or exercise plan that stops angioedema. If a food allergy causes your symptoms, you need to avoid that food completely. Otherwise, follow a balanced diet and take part in normal activity. If exercise seems to trigger your swelling, talk to your doctor before changing your routine.

Mental health and emotional wellbeing

Angioedema can be worrying, especially if you have had a severe episode. Anxiety about a sudden attack is normal. If it is affecting your sleep, mood, or confidence, speak to your GP. They can suggest talking therapies that help you cope.

Prevention

You can often prevent angioedema by avoiding the exact trigger that causes it. For medicine-related swelling, stopping the offending medicine — under medical supervision — usually prevents future attacks. If no trigger is found, the focus is on treating episodes quickly.

Complications

If left untreated

• Breathing problems if swelling blocks the throat
• Severe allergic reaction (anaphylaxis) that can be life-threatening
• Pain and discomfort leading to difficulty with eating, speaking, or daily activities
• In the inherited form, bowel-wall swelling can cause severe abdominal pain and sometimes dehydration

Long-term outlook

With the right management, most people with angioedema stay safe and healthy. Even a severe episode can be treated effectively if help is sought right away. Many people discover their triggers and are able to avoid them completely. Remember that doctors see this condition often and can support you through it.

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