The diagnosis of angioedema

The diagnosis of angioedema is made clinically, i.e. on the basis of the symptoms and through targeted inspection and questioning by the doctor. In known similar cases in the family, genetic testing for C1 esterase inhibition deficiency may be considered as a further diagnostic test. Otherwise, the diagnosis is “ex juvantibus” i.e. by cure. In this case, the substance suspected to be the trigger is avoided. If the patient does not develop any further edema, the diagnosis can be confirmed.

Therapy

Treatment depends on the cause: Angioedema caused by a particular medication can be cured by stopping the medication. In allergic angioedema, antihistamines and glucocorticoids have the best effect because they modulate the immune system. Both vascular permeability and the inflammatory reaction can be reduced.

Antihistamines and glucocorticoids are injected intravenously to achieve a rapid and far-reaching effect. In the case of less allergic reactions, an oral antihistamine can also be taken if swallowing is still possible. Hereditary oedema can be treated by enzyme substitution as described above.

Alternatively, a drug called Icatibant, a bradykinin receptor antagonist, may be used. As an antagonist, it works against bradykinin and blocks the receptors so that bradykinin can no longer bind to them. As a result, increased vascular permeability is prevented and the liquid kit remains in the vessel.

Enzyme substitution via plasma substitution may also be considered. For this purpose fresh frozen plasma (FFP) would be used. Androgens that intervene in hormone metabolism have proven to be effective prophlyaxes.

Their mechanism in relation to angioedema has not yet been clarified. In glottal edema, intensive medical management is necessary to ensure oxygen supply and breathing. The corresponding therapy is intravenous high-dose glucocorticoids.

Duration of angioedema

Depending on the mechanism of development and the spread of the edema, angioedema can persist untreated for days to weeks. In the case of allergic edema, acute antihistamine therapy can be used to treat the edema directly and should resolve within a few hours. The same applies to the use of glucocorticoids, which are extremely effective as a decongestant.

The course of the angioedema

Angioedema can be harmless to life-threatening. Relatively harmless are singular swellings of eyelids and lips. If swellings on the tongue or glottis (so-called glottis) obstruct the airways, they can be life-threatening.

Rapid securing of the airway supply by drug treatment or intubation or tracheotomy is then necessary. As soon as drug treatment is initiated at the same time, the angioedema should recede and disappear within several days to weeks. The course of the disease can be positively accelerated, for example, by taking prescribed medication punctually and correctly or, in severe cases, by administering glucocorticoids through the vein, as this allows them to reach the site of action faster.