Angio-Oedema

Acute swelling affecting eyes and lips, maybe linked with urticaria.

Angio-oedema is thought to be the result of immediate allergy and the release of histamine from a number of immune cells. Angio-oedema describes the acute swelling, which affects some people's eyes, lips and face, causing temporary changes in one's facial features. If the tongue also swells up, the voice and breathing may be affected. Sometimes angio-oedema can coincide with hives, also known as urticaria. Both are the result of fluid flushing into the skin and other tissues causing acute swelling. Occasionally, the symptoms are severe and may lead to anaphylaxic shock. Skin irritation can occur on its own, without any visible skin changes, often triggered by the same causes.

In Search of a Cause

In most cases, angio-oedema is thought to be auto-immune or idiopathic, which suggests that a cause is difficult to confirm. Sometimes angio-oedema may occur in combination with urticaria. In our experience, allergic reactions to some foods, e.g. peanuts or seafood, are uncommon causes but, due to their serious nature, they have to be investigated thoroughly.

Common Causes of Angio-oedema

Type B delayed food allergy or food intolerance
Intolerance to common colourings and other additives, often seen in children, and some preservatives
Reactions to common medications, such as penicillin
Reaction to some chemicals naturally found in some foods
Sensitivity to some fungi, otherwise known as yeasts
Allergy to common inhalant allergens i.e. pollens, cat or dog dander, horse hair and house dust mites

Most of the above factors tend to mimic, i.e disguise themselves as an immediate, severe allergy, but often involve different mechanisms from those causing an immediate allergy, without its dangers. Contrary to popular belief, intestinal parasites do not cause urticaria or angio-oedema.

Investigations

If immediate severe allergy is suspected, it is safer to carry out allergy tests with blood samples. As in allergy to seafood or peanuts, skin prick tests are best avoided as they carry a risk of potentially severe reactions. Skin prick tests are flawed by the fact that they frequently miss delayed allergies to food intolerance, salicylates in various foods and candida. In the absence of accurate laboratory tests, these diagnoses currently remain outside the repertory of day-to-day medicine.

Treatment

Once the cause has been indentified, if avoidance is too difficult or impractical, we offer treatment with safe, low-dose methods of desensitisation to enhance a better tolerance of the offending items.

SPECIALIST TIPS AND NOTES

Life threatening allergies are uncommon causes of angio-oedema but on the increase; it is important they are properly investigated.
It is possible to identify one or more causes of these symptoms. This process involves skin tests, simple dietary changes or blood tests for allergy antibodies.
In most cases, the allergen(s) can be avoided or preventative measures can be used.
If the offending items are more than one, as is the case with food intolerance, or too difficult to avoid, as with pollen allergy, safe, low-dose methods of desensitisation can be used to enhance a better immunity to these items.