Allergic Angioedema, Hypersensitivity Angioedema, Giant Hives
What is Angioneurotic edema?
Angioneurotic edema may be a hypersensitivity reaction and is characterized by fluid collection in the deeper layers of the skin and mucous membranes (subcutaneous and submucosal layers).
The preferred nomenclature is hypersensitivity angioedema (as opposed to acquired or hereditary angioedema). The cause of this disease is unknown, though it has the characteristics of an allergic or hypersensitive reaction.
Drugs, particularly penicillin and other antibiotics, are common causes of the acute form of the disorder. Other medications that can trigger the disorder are aspirin, the nonsteroidal anti-inflammatory drugs, sulfonamides, and many other drugs. It can be a reaction to food notably fresh fruit, tomatoes, and shellfish, chocolate and nuts. Occupational exposure to vibrations can cause vibratory angioedema. A recent concern in the health care and law enforcement fields is the development of hypersensitivity to latex gloves causing urticaria and angioedema.
How is it diagnosed?
History: The individual may complain of swelling, with or without itching, hoarseness, a difficulty breathing and, rarely, abdominal pain. These individuals often have a personal or family history of allergies, asthma, and eczema.
Physical exam is characterized by areas of firm, non-demarcated, asymmetric swelling, most often in areas of loose skin such as the eyelids, lips, and genitals. In some individuals, the mouth and tongue may be swollen.
Tests: There are no laboratory abnormalities associated with this disorder. Skin tests are not recommended.
How is Angioneurotic edema treated?
If a cause can be detected, it should be avoided and underlying illnesses treated. Antihistamines can give symptomatic relief.
What might complicate it?
Swelling of the larynx with airway obstruction is a rare complication.
Angioneurotic edema can be an acute, chronic (longer than six weeks) or recurrent disorder.
Angioneurotic edema can precede systemic anaphylaxis, although through the history and physical, there is little doubt as to the diagnosis.
Emergency medicine specialist, allergist, and dermatologist.
Last updated 27 May 2012