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Angioedema is an allergic reaction that results in the swelling of the face, lips and eyes.

Reason for swelling

The body responds to allergies by releasing chemical compounds called histamines. When released into tissues, histamines cause swelling which is usually limited to one side of the face and the tongue. Similar swellings can occur in other parts of the body as well. While this chemical is released in normal individuals as well, an increased disproportionate release is seen in the case of angioedema.

Signs and symptoms:

- The most obvious symptom of this condition is of course the swelling which is immediately apparent. The size of the swelling can vary, however it is almost always significant enough for the patient to seek medical attention.

- Along with the swelling, patients also complain of an itching sensation. This is because the pathology behind the causation of angioedema and urticaria is very similar.

Both conditions involve the release of histamine in the body. This itching need not be in the area of the swelling. In fact, more often than not this itching sensation will be accompanied by rashes and be distributed all over the body.

- There will be no other cause of swelling like an apparent focus of bacterial infection that could be seen as causative.

- The episodes of swelling will be short-lived and multiple in nature. As the exposure to the allergen wanes, the symptoms will resolve on their own only to return again at the time of the next exposure.

Management

The first step is the identification of the causative agent. This is not an easy task and can take multiple attempts and tests. The allergen in question can be anything or any ingredient of food being ingested, cosmetic products like shampoos or even a particular brand of toothpaste. Even medication needs to be examined as a potential allergen.

Certain investigations may need to be done to see whether there is an increase in the level of anti-allergen antibodies being produced by the body. An increase in the level of complement factors which play a role in the defense against allergens should also be done.

Patch tests on the skin to see the response to known allergens will also be done.

Differential Diagnosis:

Some other conditions that cause a swelling in the facial regions and can thus mimic angioedema to some extent are:

- Contact Dermatitis

- Auto immune diseases like dermatomyositis

- Myxedema ( very low thyroid activity)

- Trichinosis

Treatment

After the allergen has been identified, the patient will have to take precautions to avoid coming in contact with it. Medications that help regulate the response to an allergen will also need to be taken.

This includes oral anti-histamines, corticosteroids (oral or injectible) and other emergency medication in case of an anyphylactic response.

The anti-histamines may need to be taken life-long in some cases, however this should not affect the quality of life for the patient in any way.

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