Angioedema histamine-mediated T78.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 22.12.2020

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Definition
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  • Acute, mostly histamine-mediated, single or recurrent swelling of the skin and/or mucous membrane, lasting 1-7 days. Frequent occurrence in the face (periorbital and on the lips), induced by massive edema formation in the subcutis. But also other lower and/or upper extremities.
  • Most frequent form of angioedema with close causal association with urticaria. Often occurring in the context of chronic idiopathic urticaria, intolerant urticaria or other forms of urticaria.
  • Occurrence of chronic recurrent ("idiopathic") angioedema is also possible without simultaneous presence of urticaria, hereditary angioedema or renin-angiotensin-aldosterone system blocker-induced angioedema (e.g. by ACE inhibitors).

Etiopathogenesis
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  • Often IgE-mediated(similar to an anaphylactic or anaphylactoid reaction) or non-immunological mechanism.
  • Infectious causes (dental root granulomas, sinusitis, urinary tract infections) are found in about 5% of cases. > 40% of the cases remain etiologically unexplained. In children, infections are considered the most common causes of histamine-mediated angioedema. Viral infections (herpes simplex viruses, Coxsackie A viruses, hepatitis B viruses, Epstein-Barr viruses) and bacterial infections (otitis media, sinusitis, tonsillitis and urinary tract infections) have been described as triggering factors. Parasitic infections are less frequent ( Strongyloides, Toxocara, Filaria). Helicobacter pylori has been shown to be an exacerbating factor in hereditary angioedema.

Manifestation
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No familial clustering. Beginning in adulthood.

Localization
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Predominantly located in the area of the face, especially on the eyelids and around the lips.

Clinical features
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Frequent occurrence of urticaria in the medical history. Frequent occurrence of unilateral and periorbital oedema. Occurrences of edema of the tongue and glottis are rather rare. The duration of angioedema is 1-5 days, followed by restitutio ad integrum. In contrast to kinin-mediated angioedema, gastrointestinal symptoms are rare to absent. Histamine-mediated angioedema usually occurs in combination with urticaria.

Laboratory
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For IgE-mediated reactions, detection of specific allergens in the RAST test. A significantly increased IgE may also indicate parasitosis (e.g. echinococcosis). Otherwise often no pathological laboratory findings.

Differential diagnosis
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  • Hereditary angioedema (important DD, because the therapeutic procedure differs especially in laryngeal edema): can be excluded by the anamnestic data.
  • Erysipelas: bright red, painful and feverish. Painful regional lymphadenitis. Leukocytosis and elevation of CRP are almost obligatory in acute erysipelas.
  • Contact eczema: Acute contact eczema (especially of the capillitium) can be accompanied by a considerable reactive swelling of the facial skin. The history of itchy, weeping scalp is diagnostic.
  • Photodermatitis: medical history, sharply defined, bright red dermatitis.

Therapy
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Clarification of the cause and consecutive prevention. This form of angioedema can also be described as "cortisone-sensitive". Antihistamines and glucocorticoids can be used if necessary. S.a.u. chronic urticaria.

Note(s)
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Due to the different tissue texture compared to the skin, generalized urticaria does not lead to the development of wheals but always to angioedema.

Literature
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  1. Anliker MD et al (2003) Acute urticaria and angioedema due to ehrlichiosis. Dermatology 207: 417-418
  2. Wedi B et al (2010) Infection focus and chronic spontaneous urticaria. dermatologist 61: 758-764

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 22.12.2020