Angioedema

Fatima Al-Awadh

Learning objectives• Define Angioedema & Mention its

types.

• State the Etiological Causes.

• Explain the Pathophysiology.

• Mention the Signs & Symptoms.

• Clarify the Diagnostic Investigations.

• Demonstrate the Treatment &

prevention.

Angioedema• Rapid nonpitting edema of the dermis,

subcutaneous tissue, mucosa and

submucosal tissues.

• Self-Limited, subcutaneous edema

resulting from increased vascular

permeability

o Dilation of venules and capillaries

o Limited to the superficial dermis • Generally resolves over 24-48 hours

Etiology

Allergic Angioedema

Ace Inhibitor Induced AngioedemaChronic Idiopathic Angioedema

Acquired Angioedema

Hereditary Angioedema

Allergic Angioedema

• Most Common Type

• Classic histamine response

• Causes; Food, Drugs, Bee

Sting, venom, latex

• Urticaria Present

• Complement assays

normal

Urticaria

Pathophysiology

Mast cellFcɛRIIgE

Histamine

Allergen

1. Allergic reaction

Pathophysiology2. Systemic effects

↑ mucus secretion

BV expansion & edema

Conservative Respiratory

airways

Itching & rash

Ace Inhibitor Induced Angioedema

• Increased Bradykinin

• Airway edema is the most

common presentation

• Causes; nonsteroidal anti-

inflammatory drugs

(NSAIDs) and intravenous

contrast material; aspirin is

the most common culprit.

• Complement assay normal

Bradykinin

• A mediator that functions to;

o Potent endothelium vasodilator

o Contraction of non-vascular

smooth muscle

o Increases vascular permeability

o Involved in mechanism of pain

Chronic Idiopathic Angioedema

• The exact mechanisms are unclear. Some may

be associated with urticaria. Based on responses

to medication, some cases are mediated by

mast cell activation.

• Urticaria present.

• Laryngeal edema rare.

• Causes are, by definition, not identifiable.

• Complement assays normal.

Hereditary Angioedema• Rare (1:50 000-1:150 000)

• Autosomal Dominant

• Cause; chromosome 11 abnormality

• Disorder of C1INH (only regulator of classical

complement pathway activation)

o Type 1 (85%) low levels of C1INH and

functional deficiency

o Type 2 (15%) Normal protein

concentration but functional defect

Hereditary Angioedema

plasmin kallikrein Bradykcinin Vaso-dilation Angioedema

C1-INH

Pathophysiology

Acquired Angioedema• Most similar in mechanism to HAE

• No Family History

• Causes; Deficiency of C1-INH due to

o Type I: Lymphoproliferative Disorder

(MDS/MGUS)

o Type II: Autoimmune Disorder (SLE) 4th

decade of life

• All complement assays are low including

C1q

Signs & Symptoms

• Sudden appearance of red welts, near eyes & lips, also hands, feet, and inside of throat

• Burning, painful, swollen areas; sometimes itchy

• Discolored patches or rash on the hands, feet, face, or genitals

• hoarseness, tight or swollen throat, breathing trouble

Complications

The distinction

between

symptoms of

Angioedema &

complications of

Angioedema is

unclear or

arbitrary.

Anaphylaxis

Life-threatening airway blockage

Diagnosis• The health care provider will

o Look at your skin

o Ask about beening exposed to any irritating

substances.

• A physical exam might reveal abnormal sounds

(stridor) when you breathe in if your throat is

affected.

• The health care provider may perform

o blood tests

o allergy testing

Treatment

Antihistamines

Anti-inflammatory medicines (corticosteroids)

Epinephrine shots

Inhaler medicines that help open up the airways

Ranitidine (Zantac)

• If the person has trouble breathing, seek

immediate medical help.

• Medications include

Prevention

Avoid irritating the affected area.

Stay away from known allergens.

Never take medications that

are not prescribed

References• http://

el.trc.gov.om:4000/htmlroot/MEDICAL/tcolon/biochemistry/General/Presentations/Angioedema.ppt

• http://www.medicine.uottawa.ca/Otolaryngology/assets/documents/Grand_Rounds_Archive/General%20Otolaryngology/Angioedema%20(S.%20Johnson).

ppt

• https://

dl.dropbox.com/s/ly1bc2of9mz31rs/pathophysiology%20of%20Angioedema.pptx?dl=1

• http://

health.nytimes.com/health/guides/disease/angioedema/overview.html

• http://aacallergy.com/angioedema/

• http://www.nlm.nih.gov/medlineplus/ency/article/000846.htm

• http://

emedicine.medscape.com/article/135208-overview#aw2aab6b2b2aa

Fatima AlAwadh