Urticaria affecting deeper layers of the skin is referred to as angioedema. Angioedema usually involves the skin around the eyes, cheeks or lips. However, it can also involve the hands, feet, genitals and the mucosa of the throat and bowel in severe cases. Angioedema and urticaria can occur disjointedly or at the same time.
The symptoms of angioedema include:
- Swelling of the skin
- Pain and local rise of temperature of the affected region
- Discrete welts
- In severe cases, patients may experience difficulty in breathing or swallowing due to swelling of the inner lining of the throat and air tubes
- Patients may also experience distortion of vision secondary to swelling of the conjunctiva
Types of angioedema
The four major types of angioedema include:
- Allergic angioedema- caused due to allergic reactions, such as reaction to ingestion of peanuts
- Idiopathic angioedema- the underlying cause is not known; certain factors such as stress or infection may be involved
- Drug-induced angioedema- caused secondary to a reaction to some medications
- Hereditary angioedema- caused due to faulty genes inherited from their parents. This form of angioedema is not associated with urticaria.
Angioedema may be caused due to the allergic reaction resulting in the release of histamine and other chemicals into the bloodstream. In a majority of the cases the cause of angioedema is not known. The following are the common causes of angioedema:
- Allergies to food, medication, cosmetic, soaps, detergents and pet dander
- Insect stings and bites
- Emotional and physical stress
- Exposure to physical agents such as sunlight, heat, cold and pressure
- Infections and certain diseases such as lupus, lymphoma and leukemia
The diagnosis of angioedema involves the physical examination of the skin. The doctor will inquire about exposure to any irritating substance. In a few cases, blood tests may also be conducted. Physical examination may also reveal abnormal breath sounds such as stridor.
Mild angioedema may not require any treatment. In moderate to severe cases medications may be required to relieve the symptoms. Cold compresses can help relieve pain. The other approaches used for the management of angioedema are listed below:
- In case of allergic angioedema eliminate the exposure to the allergen which can include food, medication, contact allergen etc.
- For drug induced angioedema, the offending medication can be substituted by an alternative medication.
- Antihistamines provide symptomatic relief
- A prophylactic approach is recommended in hereditary angioedema as it does not respond well to the commonly used medications.
- Adrenaline and steroid shot may be used in severe cases
- In the case of severe breathing difficulty, the patient may be intubated.
In cases of severe angioedema that does not respond to treatment contact your physician immediately.