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Angio-what?! Making Sense of Angioedema

If you are living with urticaria, there’s a chance you’ve experienced angioedema. Learn more about it here. 

Many people are familiar with the hives associated with urticaria. For some, however, the itchy, red wheals are accompanied by another frustrating and sometimes very painful symptom:  Angioedema. Have you ever heard the silly phrase “get your swell on” when people lift weights at the gym and want to look bigger? Well, angioedema is something like that – minus it being something to brag about. It’s painful, may be serious and people won’t envy your swelling. People with angioedema definitely “get their swell on”, just in the worst way possible. 

What the heck is angioedema?

It’s basically a fancy name for rapid swelling (or edema); only instead of affecting the outer layer of skin (the epidermis) as hives do, it’s the deeper skin tissues (the dermis, subcutaneous tissue, mucosa and submucosal tissues) that rapidly react.1 Like hives, angioedema appears to be triggered by the production of histamine from the mast cells within these tissues.2 The condition generally occurs in the hands and feet, but can also affect the head, neck, face and even genitals in men.3 Not ideal, to say the least.

Who gets angioedema?

Quite a few of us actually. In fact, up to 20% of people may experience angioedema at some stage in their life.4 If you have urticaria, you may well be one of them – 40% of people with urticaria may also be  affected by angioedema.5 The condition may occur for other reasons, too, whether an allergic reaction to a substance (such as a drug, food, latex or animals), or through a genetic condition known as hereditary angioedema.6 In rare instances, angioedema can also be caused by certain cancers, or autoimmune diseases such as lupus.7

Can it be serious?

Yes, but it’s rare, so don’t completely freak out when you notice swelling. It is only serious if it affects the tissues of the respiratory tract and constricts the airways. This typically happens when it is hereditary angioedema, which should be monitored closely and treated by a specialist. But again, don’t worry, angioedema of this kind is very unusual with urticaria.8  Angioedema swelling tends to have a slower onset and persist for several days.9 Mostly, the condition may be painful and very inconvenient; facial swelling can impair vision, while puffy feet can make it impossible to get your shoes on.10 You can imagine how this may impact your shopping agenda when you have to buy more than one shoe size…

What are common misconceptions about it?

Angioedema can look pretty alarming and is often mistaken for an allergy.11 You may think, ‘Swelling? Hives? it must be an allergic reaction. Boom, I’m cured!’ Although angioedema does happen in some cases of an allergic reaction, it does not mean you can simply write it off as one.12 It is also commonly thought to be painless – wrong again. As we mentioned above, the swelling can be very painful. In fact, in some cases angioedema can also affect the digestive system, leading to abdominal pain and bowel issues.13

How does it play into your life?

Angioedema can cause a great deal of mental distress14,15 – some may feel self-conscious about their appearance, while diagnosis can be a long, drawn-out process that adds to anxiety.16 In one study, 39% of people with angioedema showed signs of depression.17

So, what’s the next step?

If you have questions regarding angioedema, your next step should be right into your doctor’s office to discuss what may help to ease the swelling and reduce pain.18 And, to help you in this quest, here are a few tips on talking to your doctor. So, if you would like your ‘swell’ only to be gym related, now is the right time to see your doctor.

  1. Wikipedia. Angioedema https://en.wikipedia.org/wiki/Angioedema
  2. MSD Manual. Angioedema By Peter J. Delves http://www.msdmanuals.com/en-gb/professional/immunology-allergic-disorders/allergic,-autoimmune,-and-other-hypersensitivity-disorders/angioedema
  3. Medical News Today. What is angioedema? Christian Nordqvist http://www.medicalnewstoday.com/articles/216095.php 
  4. Medical News Today. What is angioedema? Christian Nordqvist http://www.medicalnewstoday.com/articles/216095.php
  5. Chronic Urticaria and Angioedema. Allen P. Kaplan. N Engl J Med 2002; 346:175-179. http://www.nejm.org/doi/full/10.1056/NEJMcp011186 
  6. Angioedema, Allen P Kaplan. World Allergy Organ J. 2008 Jun; 1(6): 103–113. Published online 2008 Jun 15. doi: 10.1097/WOX.0b013e31817aecbe https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651192/   
  7. Hereditary and Acquired Angioedema. Merck Manual http://www.merckmanuals.com/en-ca/home/immune-disorders/allergic-reactions-and-other-hypersensitivity-disorders/hereditary-and-acquired-angioedema
  8. Understanding Urticaria and Angioedema Jim Christensen, M.D. Allergy & Asthma Associates http://www.pulmonarylasvegas.com/public/Understanding-Urticaria-And-Angioedema.pdf
  9. Urticaria and angioedema: Diagnosis and evaluation. Kevin D. Cooper. Journal of the American Academy of Dermatology. Volume 25, Issue 1, Part 2, July 1991, Pages 166–176. http://www.sciencedirect.com/science/article/pii/0190962291701844 
  10. Medical News Today. What is angioedema? Christian Nordqvist http://www.medicalnewstoday.com/articles/216095.php
  11. Urticaria and angioedema. Spickett G1. J R Coll Physicians Edinb. 2014;44(1):50-4 https://www.ncbi.nlm.nih.gov/pubmed/24995449
  12. Urticaria and angioedema. Spickett G1. J R Coll Physicians Edinb. 2014;44(1):50-4 https://www.ncbi.nlm.nih.gov/pubmed/24995449
  13. HealthyType. Angioedema. http://www.healthhype.com/intestinal-angioedema-causes-symptoms-diagnosis-treatment.html
  14. Depression and anxiety in patients with hereditary angioedema. Fouche AS1, Saunders EF2, Craig T3. Ann Allergy Asthma Immunol. 2014 Apr;112(4):371-5. https://www.ncbi.nlm.nih.gov/pubmed/24428960
  15.  Psychological Correlates in Subjects with Hereditary Angioedema (HAE). Salemi M, Bella FD, Miragliotta A, Perricone R, Domenica M, et al. (2014)  J Psychol Psychother 4:134. 
  16. Urticaria and angioedema: a practical approach. Am Fam Physician. 2004 Mar 1;69(5):1123-8. Muller BA. http://www.aafp.org/afp/2004/0301/p1123.html
  17. Depression and anxiety in patients with hereditary angioedema. Fouche AS1, Saunders EF2, Craig T3. Ann Allergy Asthma Immunol. 2014 Apr;112(4):371-5. https://www.ncbi.nlm.nih.gov/pubmed/24428960
  18. Angioedema Treatment & Management. Huamin Henry Li, MD, PhD, CPI. Medscape. http://emedicine.medscape.com/article/135208-treatment#d9 

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