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What is angioedema?
Angioedema is swelling that happens deeper in the skin than a rash. It most often affects the face — the lips, the tongue and the area around the eyes — and it can also affect the hands, the feet, the neck and the throat.
It is not one condition. Angioedema is a pattern of swelling with several different underlying causes, and the cause matters, because it determines what should be investigated and what helps.
When to get urgent help
Swelling of the tongue or throat, difficulty breathing or swallowing, or a change in your voice needs emergency care. Call 999. If you have been prescribed an adrenaline auto-injector, use it.This page is general information about angioedema. It is not a substitute for being seen.
Swelling with hives, and swelling without
Angioedema often appears alongside hives — raised, itchy weals on the skin. When the two come together, they are usually part of the same picture.
Sometimes the swelling happens on its own, with no hives at all. That is also common, and it is not a cause for alarm. But it should be noted by your specialist, as it could indicate that further investigations are required.
What can cause it
Broadly, angioedema falls into a few groups:
- It can be allergic — swelling that follows contact with a particular trigger, such as a food, and that points towards an underlying allergy.
- It can be spontaneous, arising without any identifiable trigger.
Spontaneous angioedema can be acute or chronic. Chronic angioedema is defined as swelling that is continuous or recurrent for six weeks or more.
Flare-ups may be associated with stress, with an illness, or with anti-inflammatory painkillers such as aspirin and ibuprofen.
- And in a very small number of people it is hereditary — an inherited difference in a protein in the blood, which tends to run in families and typically causes swelling without hives.
ACE inhibitor angioedema
A group of blood pressure medicines known as ACE inhibitors, for example ramipril or lisinopril, are also associated with angioedema.
If you take this medication and you have unexplained swelling, tell the doctor who prescribes it. Do not stop taking it on your own.
How angioedema is investigated
There is no single test. The assessment starts with the history — what swelled, for how long, how often, whether hives came with it, what medicines you take and whether anyone in your family has had the same thing.
What follows depends on that history. It may include allergy testing where there is a trigger worth pursuing, and blood tests where there is not. We can arrange complement testing, including C3, C4 and C1 esterase inhibitor, and specialist immunology tests where they are needed. Part of the value of seeing a specialist is being told which tests are not worth doing.
Seeing a specialist
Angioedema sits across allergy and immunology, which is why it is worth seeing someone who works in both.
Adult angioedema at The London Allergy Clinic is handled by Dr Gururaj Arumugakani, Consultant in Allergy and Clinical Immunology. He chaired the urticaria and angioedema multidisciplinary team at St James’s University Hospital in Leeds before moving to UCLH, and he is on the GMC Specialist Register.
First appointments last up to an hour and cost £350, which includes any prescriptions. Any testing is advised first and paid for on the day.
Appointments are usually available within the same week, and no GP referral is needed.If you are not sure whether we are the right clinic for you, book a free 10-minute call and we will help you work out the right next step.