Aust J Dermatol 51; Sign up to the newsletter. Full name. Email address. Subcutaneous and submucosal surfaces beneath the dermis. Epidermis outer layer of skin and dermis inner layer of skin. Skin and mucosa , particularly the eyelids and lips. Acute allergic angioedema almost always occurs with urticaria within hours of exposure to the allergen. Food allergy , especially nuts, shellfish, milk, eggs Drug-induced urticaria , eg, to penicillin, nonsteroidal anti- inflammatory drugs NSAIDs , sulfa drugs , vaccines Radiocontrast media Insect venoms Natural rubber latex , eg, medicinal gloves, catheters , balloons, contraceptive devices.
Angiotensin-converting enzyme ACE inhibitors Cascade of effects via kinin production, arachidonic acid metabolism and nitric oxide generation. Idiopathic angioedema frequently chronic and relapsing and usually occurs with urticaria. Hereditary angioedema very rare autosomal dominant inherited disease. Type 1 results in low levels and function of circulating C1 inhibitor; Type II has normal levels of C1 inhibitor protein but a reduction in function Occurs in 1 in 50, males and females; Type III more severe in women.
Decreased C1 inhibitor activity leads to excessive kallikrein, which in turn produces bradykinin , a potent vasodilator. Acquired during life rather than inherited May be due to B-cell lymphoma or antibodies against C1 inhibitor. Join our mailing list:. Read more The content provided is for education, communication and information purposes only and is not intended to replace or constitute medical advice or treatments.
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Contact Us Locate a Specialist Sitemap. Autoimmunity Drug allergy Food allergy Food other adverse reactions Immune system Immunodeficiencies Insect allergy bites and stings Other allergies. Home Patients Allergy and the skin Angioedema. How common is angioedema? There are three major patterns of angioedema: Angioedema plus hives urticaria : the hives itch and the angioedema is itchy, hot or painful.
Angioedema alone: itchy, hot and red swellings, often large and uncomfortable. Angioedema alone: skin-coloured swellings, not itchy or burning, often unresponsive to antihistamines. Where does angioedema occur? Is angioedema dangerous? When to suspect an allergic cause Allergic causes for isolated angioedema are rare but should be suspected with short-lived episodes of swelling that occur under similar situations, such as after taking certain foods or medicinations.
Main causes of angioedema ACE angiotensin converting enzyme inhibitor medications Around 1 in people who take these heart and blood pressure medications develop swellings. Hereditary angioedema HAE This is a rare condition occurring in approximately 1 in 50, people who have low levels deficiency or reduced effectiveness of a C1-inhibitor enzyme.
Acquired C1-inhibitor deficiency In even rarer cases, low levels of C1 inhibitor occur in association with some cases of lymphoma, malignancies and in autoimmune diseases such as Systemic Lupus Erythematosus SLE. Infection A viral infection is usually the most common cause of hives urticaria and angioedema in children, especially if they last for more than 24 hours. Food or drug allergy Swellings due to allergic reactions to foods or drugs are sometimes severe and dramatic, but usually resolve within 24 hours.
Other causes Thyroid gland disease and some types of inflammatory arthritis are more common in people with hives urticaria and angioedema. Swellings that can look like angioedema Contact allergy from animals or plants is usually localised to the site of direct contact. It is often itchy, short-lived, does not cause internal swelling and causes blistering rashes that weep and peel after a few days. Insect stings from bees, wasps and some ants can cause severe local and temporary swelling.
Palindromic rheumatoid arthritis is a rare form of arthritis that causes swellings that last a few days at a time, mainly over joints and affecting the limbs. Swellings are usually painful and hot rather than itchy. Some people with this condition will eventually go on to develop rheumatoid arthritis. Less common mimics of angioedema include the following causes of swelling that tend to persist: Dermatomyositis muscle weakness, facial redness and swelling.
Blockage of the superior vena cava a major vein in the chest which can result in fixed fluid accumulation in the neck and face and arms. Underactive thyroid gland which can cause puffiness of the face and lips known as myxoedema.
Facial rosacea causing non-specific puffiness of the face, redness, flushing and pimples. Orofacial granulomatosis fixed facial and lip swelling sometimes associated with inflammation of the bowel. Subcutaneous emphysema leakage of air into the soft tissues, often occurring after trauma or surgery.
Cluster headache severe one-sided headache associated with puffiness around the eye on the same side. How long does angioedema last? Allergy injections allergen immunotherapy Allergen immunotherapy desensitization Allergic reactions hypersensitivity reactions are inappropriate responses of the immune system to a normally harmless substance.
Angioedema without hives is sometimes caused by ACE inhibitors, which are used to treat high blood pressure and heart failure. When ACE inhibitors are the cause, the face and upper airways are most commonly affected, but the intestine may be affected. Eating even a tiny amount of some foods can suddenly result in angioedema. But with other foods such as strawberries , these reactions occur only after a large amount is eaten. Also, angioedema sometimes occurs after a substance that can be seen on x-rays radiopaque contrast agent Radiopaque Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail.
Contrast agents include Radiopaque contrast agents Angioedema can be chronic, recurring over weeks or months. The cause is usually unknown, but it may be repeated, unintentional intake of a substance, such as penicillin in milk or a preservative or dye in foods. However, usually when angioedema recurs with or without hives , no specific cause is identified—called idiopathic angioedema. In angioedema, swelling may not be equal on both sides of the body, and it can be mildly painful.
It can affect the back of the hands or feet, eyelids, tongue, face, lips, or genitals. Sometimes the membranes lining the mouth, throat, and airways swell, making swallowing or breathing difficult.
Occasionally, the digestive tract is involved, resulting in nausea, vomiting, crampy abdominal pain, or diarrhea. Many people also have hives Hives Hives are red, itchy, slightly elevated swellings. Hives usually begin with itching. Typically, crops of hives then come and go. One spot may remain for several hours, then disappear, and later, another may appear elsewhere. After the hive disappears, the skin usually looks completely normal.
People may have an anaphylactic reaction Anaphylactic Reactions Anaphylactic reactions are sudden, widespread, potentially severe and life-threatening allergic reactions. Anaphylactic reactions often begin with a feeling of uneasiness, followed by tingling Blood pressure may become dangerously low shock. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Hives on white skin Open pop-up dialog box Close. Hives on white skin Hives may be accompanied by angioedema, which can cause swollen welts that appear reddish on white skin. Hives on brown skin Open pop-up dialog box Close.
Hives on brown skin Hives, also known as urticaria, causes itchy welts that may be triggered by exposure to certain foods, medications or other substances. Angioedema Open pop-up dialog box Close. Angioedema Angioedema may cause large welts below the surface of the skin, particularly around the eyes and lips.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references AskMayoExpert. Mayo Clinic; Kang S, et al. Urticaria and angioedema. In: Fitzpatrick's Dermatology.
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