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Angioedema: An emergency that should not be ignored
What is angioedema?
Angioedema (ANN), or angioedema, is a sudden, profound swelling of the skin, subcutaneous tissue, mucous membranes, or larynx, usually caused by an allergic or pseudoallergic reaction. This condition is considered an emergency because it can cause life-threatening airway obstruction.
Developmental mechanisms: how and why edema occurs
Angioedema occurs due to increased vascular wall permeability caused by inflammatory mediators. The main pathogenetic mechanisms are:
Histamine pathway — a reaction to allergens (foods, medications, insect bites), as a rule, is accompanied by hives.
Bradykinin pathway — characteristic of hereditary or acquired forms of ANN, associated with C1-esterase inhibitor deficiency.
Idiopathic mechanism — when the cause is not precisely established.
Main symptoms of angioedema
Fast growing localized swelling (face, lips, eyelids, tongue, larynx, genitals)
Presence of pain or burning sensation, but usually no itching
Dyspnea, difficulty swallowing or voice changes (with laryngeal edema)
In hereditary form - repeated episodes, that occur without an obvious allergen
The importance of laboratory diagnostics
Correct diagnosis is critical, as the treatment of histamine and bradykinin ANN is radically different.
Table of tests for different types of angioedema
| Type of ANN | C1 inhibitor | C4 | IgE | Frequency |
|---|---|---|---|---|
| Allergic | Norm | Norm | Increased | Frequent |
| Hereditary | Reduced | Reduced | Norm | Rare |
| Medicated | Norm | Can be reduced | Norm | Occurs |
| Idiopathic | Norm | Norm | Norm | Not installed |
Emergency care for acute edema
Antihistamines (loratadine, cetirizine)
Glucocorticosteroids (prednisolone, dexamethasone)
Adrenaline (epinephrine) — at risk of anaphylaxis
Bradykinin inhibitors (icatibant) or plasma — in the case of hereditary ANN
Research and clinical recommendations
In the report World Allergy Organization (WAO) (2022) noted that up to 30% cases of ANN are non-allergic in nature. It was also emphasized that hereditary forms are often not diagnosed in time, which creates a risk of fatal airway obstruction. That is why in many countries it is recommended to carry an emergency first aid kit.
Angioedema is not just a cosmetic problem. In some cases, it is a life-threatening condition. Early diagnosis, access to emergency treatment, and understanding the different mechanisms of development can save lives.
