Angioedema is a condition that comes about due to an allergic reaction. It is characterised by widespread swelling of the skin and mucosal membranes. It frequently affected the eyelids, the face, lips and the genitalia but could affect any other area. Predisposing risk factors include temperature changes, anxiety states, stress and occurrence of ovarian cysts. In rare circumstances it may follow invasive dental procedures. At the moment, no exact treatment for angioedema has been formulated.
The disease starts when risk factors trigger a substance known as histamine to be released. Histamine mediates most of the allergic reactions known. Its production follows ingestion of antigens in form of some drugs and foods. The reduction of this component, therefore, is the first step in providing relief to patients suffering from angioedema. Later after these symptoms have abated, investigations can be carried out to establish the exact causative factor and to give specific treatment.
Triggering factors should be removed or avoided. Drugs known to predispose to the condition include those known as angiotensin converting enzyme inhibitors (captopril and enalapril, for example). These drugs are potent antihypertensive agents. If angioedema is noted during therapy, they should be stopped immediately and replaced with the appropriate alternatives. Beta blockers, calcium channel blocking drugs and angiotensin receptor blockers are suitable alternatives. Other triggering agents that may need to be avoided include nuts, milk legumes, chocolates, and berries among others.
Several anti-inflammatory drugs can be used to reduce the oedema. Oedema is the extravasation of fluid into various tissues and causes the characteristic swelling seen in this condition. Drugs known as antihistamines work by antagonising the effects of histamine and therefore reduce swelling. If the disease has been in existence for a long period of time, glucocorticoids can be used. Epinephrine provides relief for blocked airways.
In a special form of the condition known as hereditary angioedema, a substance referred to as bradykinin has been found to play a major role. This substance is a potent dilator of blood vessels. It is formed in large quantities in persons that have a deficiency of the C1 inhibitor (C1INH). The deficiency results in unregulated immune reactions. The treatment in this case is administration of C1 inhibitor concentrate of blood from a donor given intravenously.
Priority during an emergency is given to maintaining an open airway, breathing and the circulation. Swelling within the oral and nasal mucosa as well as in the lower airways is a cause of airway obstruction. Due to a compromise in breathing, an endotracheal tube is inserted to help with oxygen provision.
A number of nutritional supplements are believed to help. Intravenous administration of vitamin B12 helps in the relief of chronic symptoms. Vitamin C is also given to lower the raised levels of histamine. Quarcetin is a plant based flavonoid that will raise the threshold of going into an allergic reaction. Green tea and liquorice are herbs that are used as anti-inflammatory agents in these patients. Any form of herb must be used under supervision due to the high risk of adverse reactions.
In summary, the treatment for angioedema aims at eliminating the trigger factors for allergy and to stop the inflammation. In severe disease, emergency measure are undertaken to secure the airway open and to maintain breathing. Apart from looking at the strength of a drug during treatment, it is also important to consider the possible adverse drug reactions.
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