Angioedema is the medical term for swelling underneath the skin, which frequently occurs as part of an allergic reaction.

In some cases, angioedema may be caused by certain medications and is called non-allergic drug reaction angioedema.

Deficiencies or dysfunction in certain blood proteins also can lead to angioedema. This type of angioedema is either hereditary or may be acquired later in life due to an inappropriate immune system response.

Treatments for angioedema vary depending on the cause, duration, and severity of the condition.

Treatment of allergic angioedema

The majority of cases of angioedema are caused by an acute allergic reaction and will resolve by themselves. Lifestyle changes to help avoid specific substances (such as certain foods, insects, or latex) that trigger allergic reactions can help prevent this type of angioedema.

Symptoms may be uncomfortable, so a variety of medications may be used depending on the severity of the angioedema and related allergic symptoms. For milder cases, antihistamines, which dampen the allergic response, may be effective.

If angioedema is more severe, doctors may choose to treat it with oral corticosteroids, a type of anti-inflammatory medication. If both antihistamines and oral corticosteroids prove ineffective, immunosuppressant medications may be prescribed.

Severe acute angioedema in the throat or tongue can lead to difficulty breathing and even become life-threatening. Patients who have a history of angioedema in these areas may be prescribed an EpiPen (self-injected, intramuscular injection of epinephrine) to be used in an emergency.

If allergic angioedema is long-lasting or chronic, other medications may be better suited. For example,  anti-inflammatory medications called leukotriene antagonists, such as montelukast or zafirlukast, may be prescribed. Another option is omalizumab, a monoclonal antibody that reduces sensitivity to allergens.

Treatment of non-allergic angioedema

Non-allergic drug reaction angioedema can be caused by certain medications, especially angiotensin-converting enzyme (ACE) inhibitors, which frequently are used to treat high blood pressure or congestive heart failure. These angioedema cases usually are resolved by switching to a different medication that does not cause angioedema.

Hereditary angioedema is caused by the insufficient production and/or dysfunction of one of two blood proteins: C1 inhibitor protein, involved in the immune system, or coagulation factor 12, involved in blood clotting.

In acquired angioedema, the levels of C1 inhibitor also are too low, but this is caused by the immune system mistakenly attacking and eliminating it after it is naturally produced.

These forms of angioedema do not respond to antihistamines or corticosteroids. They usually are treated with medications that help boost the amount of C1 inhibitor protein. These include danazol, stanozolol, and tranexamic acid.

Another option is Haegarda, which is a plasma-derived concentrate of C1-esterase inhibitor that helps increase levels of the C1 inhibitor protein. It is injected under the skin and is the only injectable treatment that is approved by the U.S. Food and Drug Administration (FDA) to help prevent acute attacks of hereditary or acquired angioedema.

Once they occur, these acute attacks may be treated with intravenous C1 inhibitor concentrates such as Ruconest, Berinert, and Cinryze. Like Haegarda, these medications increase the body’s level of C1 inhibitor protein.

Two other FDA-approved medications help disrupt the swelling process in acute attacks of hereditary or acquired angioedema. icatibant, sold under the brand name Firazyr blocks the action of bradykinin, one of the proteins involved in the swelling process. Similarly, Kalbitor blocks kallikrein, another protein involved in the swelling process.

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Angioedema News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Meredith Walker BNS Writer
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Meredith Walker BNS Writer