Angioedema: what it is, symptoms, causes and treatment

Angioedema is a sudden swelling that sits deeper in the skin than hives. NHS inform explains that it is caused by a build-up of fluid in the deeper layers of the skin, and the NHS describes it as swelling that is often caused by an allergic reaction.

The swelling can appear on any part of the body. The NHS says the commonly affected areas are the face (particularly the lips, tongue and eyelids), the hands or feet and the genitals. NHS inform adds that the swollen area may feel hot or painful.

It can be very serious if the throat becomes swollen and breathing is affected. That is why swelling around the mouth or throat is treated differently from swelling of, say, a hand or foot.

The main symptom is swelling, and it tends to come on suddenly. Other features depend on the cause and on which part of the body is involved.

• Swelling of the lips, tongue or eyelids, sometimes making the face look puffy or uneven.

• Swelling of the hands, feet or genitals.

• A hot or painful swollen area (NHS inform).

• A raised, itchy rash (hives) alongside the swelling when an allergic reaction is the cause (NHS and NHS inform).

• Stomach pain if the bowel swells (NHS and NHS inform).

• Breathing difficulty if the throat swells, which is a medical emergency (NHS).

The NHS says to call 999 if your lips, mouth, throat or tongue suddenly become swollen. It also lists the following signs, which can mean a serious allergic reaction (anaphylaxis) that needs immediate treatment in hospital. The NHS says not to drive yourself to A&E; the 999 call handler will advise you what to do.

• You are breathing very fast or struggling to breathe, may be very wheezy, or feel as if you are choking or gasping for air.

• Your throat feels tight or you are struggling to swallow.

• Your skin, tongue or lips turn blue, grey or pale. On black or brown skin this may be easier to see on the palms of the hands or soles of the feet.

• You suddenly become very confused, drowsy or dizzy, or someone faints and cannot be woken up.

• A child is limp, floppy or not responding as they normally do.

• There is also a rash that is swollen, raised or itchy.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if part of your body suddenly becomes swollen, for example your hands, feet or genitals, and you do not have the emergency signs above. NHS inform similarly advises contacting your GP practice urgently, and phoning 111 if the practice is closed.

If the swelling comes with hives, the NHS hives page also advises getting urgent help if hives keep coming back, because you may be allergic to something, or if you have swelling under the skin that might be angioedema.

The NHS says the cause depends on the type you have. It describes five types.

NHS inform says a healthcare professional will examine the swollen area and ask about your symptoms. This helps them work out whether any further tests are needed.

Tell your doctor about every medicine you take, including over-the-counter painkillers, herbal supplements and vitamins. NHS inform is clear that you should not stop taking any prescribed medicine unless a healthcare professional advises you to.

If your swelling keeps coming back, or no cause is obvious, the NHS notes you may be allergic to something, and your GP can arrange next steps. Sources you can read for the allergic side include the NHS pages on hives and anaphylaxis.

The NHS says you may not need treatment if the swelling is mild or only affects a small area of your body. If it is severe or widespread, or affects your lips, tongue or throat, you will usually need emergency treatment in hospital.

The NHS lists these treatments for angioedema:

• Identifying and avoiding the underlying cause. If a medicine is thought to be responsible, you may be given a different one instead.

• Antihistamine medicine, such as cetirizine, fexofenadine or loratadine.

• Steroid tablets, such as prednisolone.

• For hereditary angioedema, which keeps coming back, medicine to stop attacks happening, with regular reviews to check treatment is working.

Yes. The NHS says non-allergic angioedema is a reaction to a medicine, most commonly an ACE inhibitor, which is a type of blood pressure medicine. NHS inform describes it as a side effect of certain medicines, most often ACE inhibitors.

If you develop swelling of the lips, tongue or face while taking any regular medicine, get urgent advice rather than stopping or carrying on by yourself. The NHS says that where a medicine is thought to be the cause, you may be given a different one to take instead. Tell any clinician that you have had angioedema so it can be taken into account in future prescribing.

Sudden swelling of the mouth, tongue or throat is dealt with through 999 and A&E on the NHS. Swelling that keeps coming back is usually followed up by your GP, who may refer you to a hospital allergy, immunology or dermatology service for tests.

Private specialists can also assess recurrent swelling and arrange allergy tests, and a hereditary form is usually looked after in a specialist service. In either route, ask which type you are thought to have, what to do if swelling starts again, and whether you need an emergency plan.