FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ANGIONEUROTIC EDEMA –- AN ALLERGY, BUT ALLERGY SHOTS DON'T HELP

Question: I have chronic angioneurotic edema. What causes it, and what can be done to treat it?

Answer: It will help both you and my other readers if I first explain the difference between angioneurotic edema and a related disorder called urticaria.

Both of these conditions produce swelling of skin and mucous membranes. Urticaria is often referred to as "hives," a red, raised, itchy swelling of the skin -- a "wheal" that usually lasts for a few hours. Angioneurotic edema produces swelling of the skin, but the swelling is in deeper skin layers and usually lasts for several days instead of hours. Angioneurotic edema usually produces a diffuse, painful swelling in the hands, feet and face, especially around the lips and eyes. The swelling may occur in mucous membranes -- the skin-like tissue that lines the mouth, throat, bronchial tubes and digestive tract, as well.

Both angioneurotic edema and urticaria are the result of a disturbance to the circulation in the affected area of the body. The very small blood vessels in that area are dilated and leak clear fluid into the skin in response to histamine release. Leakage into the deeper layers of the skin causes generalized swelling, like a "fat lip," without the appearance of hive.

Angioneurotic edema can be the result of an inherited enzyme deficiency, but it and urticaria are most often produced by an allergic reaction. Medications, foods, inhaled allergens, insect bites and stings, and substances that contact the skin are the most common offenders. In other words, almost any substance that can get in you or on you has the potential to produce this type of reaction.

Acute angioneurotic edema, where the tissue in air passages becomes swollen and causes difficulty breathing, is a medical emergency, and you should get to the nearest ER quickly. With chronic angioneurotic edema, “watchful waiting” may be the best approach. Without treatment, about one half of those suffering from urticaria alone and about one fourth of those who have both urticaria and angioneurotic edema will be symptom-free within one year. There are, on the other hand, many for whom there is no effective treatment. Despite our best efforts, about 20 percent of those who have urticaria and/or angioneurotic edema will have repeated episodes for 20 years or more.

The doctor will ask about the victim's family history. If no blood relative has chronic problems with hives or angioneurotic edema, it's unlikely that the hereditary form is involved. This is important because there is very specific treatment for this form of the disorder.

Since the most common cause of urticaria and angioneurotic edema is an allergic reaction, it's important to try to identify the culprit. It this can be done, avoidance of future exposure is the best way to prevent new attacks. Examples of common offenders include penicillin, aspirin, ibuprofen (Motrin, Advil, etc.) and "ACE inhibitor" blood pressure medications. Common food or food additive agents include artificial food coloring, seafood, chocolate, nuts, strawberries, tomatoes and eggs.

There are several medications that work effectively to decrease the severity and frequency of attacks. However, for reasons not yet clearly understood, we can't use allergy shots to treat the underlying allergic origin of angioneurotic edema as we can with most other allergies. Your doctor will prescribe medication to help treat your chronic angioneurotic edema. Unfortunately, treatment is the best we can offer since we don't yet have any medications that can "cure" you of this illness.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.