How Angioedema Is Treated

There are medical treatments that can suppress angioedema, a condition in which the deeper layers of the skin swell, often due to an allergic reaction. Most of the time, if an allergen (a substance that triggers an allergy) is identified, you will need to avoid it.

Treatment for angioedema depends on the cause. If your symptoms are not caused by an avoidable allergen, you might need to take steroid medications regularly. If you do have an allergy, you might need to carry injectable epinephrine (adrenaline) with you, as allergic reactions can rapidly become life-threatening.

This article discusses treatment options for angioedema. It covers home remedies and lifestyle changes, over-the-counter (OTC) and prescription drugs, surgeries, and alternative therapies.

Home Remedies and Lifestyle

There are a number of effective lifestyle adjustments that you can make if you experience angioedema. Some lifestyle adjustments can help you prevent reactions to a known allergen, while others can help you stay comfortable when an angioedema episode occurs.

Identify Triggers

If you have had recurrent episodes, especially if they are mild, it may be challenging to identify the cause of your angioedema. Thinking about the different foods, drinks, and materials you may have been in contact with can help you determine what may have caused your reaction.

Sometimes an allergy test can help in identifying the substance that is causing your reaction.

Avoid Food Triggers

Once you identify the trigger, you can take action to avoid exposure. This will likely entail reading ingredients lists closely, making restaurant personnel aware of your food allergy, and avoiding any foods that you are unsure about. So, for example, if you attend a party and can't figure out how a food was prepared, your safest option will be to avoid that food entirely.

Watch for Medication Reactions

Be sure to tell your healthcare provider if you experience angioedema in response to a medication. Angiotensin-converting enzyme (ACE) Inhibitors commonly cause episodes of angioedema. These medications are used to treat heart problems such as high blood pressure and heart failure.

Manage Episodes of Angioedema

Some people use ice packs for comfort during episodes of angioedema, especially if the swelling is limited to one area or if there is associated pain or burning. 

If you have swelling throughout your body, you might consider a cold bath as a way to relieve the discomfort. Be sure not to spend more than a few minutes in cold water.

Over-the-Counter Therapies

If you have recurrent angioedema that does not advance to become severe, you might respond well to over-the-counter medications. If one of these medications has worked for you in the past, it is a good idea to have it handy in case your symptoms recur.

Oral Antihistamines

Antihistamines such as Benadryl (diphenhydramine), Vistaril (hydroxyzine), and Zyrtec (cetirizine) are often helpful in managing and preventing episodes of angioedema. They work by blocking histamine, a natural compound your body makes in response to an allergen that causes inflammation.

These medications are taken orally. You should only use them if your healthcare provider has already evaluated your signs and symptoms and has told you that this is a good option.

If you experience side effects such as sleepiness or drowsiness, ask your doctor if you should switch to another antihistamine that you can tolerate. In general, non-sedating antihistamines like cetirizine, which don't cause drowsiness, are preferred over sedating versions like diphenhydramine and hydroxyzine.

Prescriptions

You might need prescription medications if you have recurrent angioedema or if your symptoms are severe. 

Antihistamines

Your doctor may prescribe prescription-strength antihistamines such as Periactin (cyproheptadine), and Clarinex (desloratadine).

Intravenous (IV) Steroids

Your medical team may consider giving you steroids by IV instead of orally, particularly if you cannot swallow or if you need a faster effect than what is expected with oral steroids.

Epinephrine

Epinephrine is a powerful medication that suppresses the immune system more quickly than steroids and antihistamines. It is used as an injection when you have a severe, sudden reaction and when you are prone to respiratory (breathing) difficulties or heart involvement.

Surgeries and Specialist-Driven Procedures

In general, you should not need surgery or special procedures for treatment of angioedema. However, there are rare circumstances in which you could need special procedures if your breathing is affected.

Tracheostomy

If your tongue or throat becomes extremely swollen, you might need to have a lifesaving procedure called a tracheostomy. This is a procedure in which a hole is placed in the neck and windpipe and a tube is placed in the hole so that air can get to your lungs. This hole will be surgically repaired after you recover. 

Mechanical Ventilation

If you experience respiratory difficulties or respiratory arrest, you may need mechanical ventilation that provides the pressure needed to move air in and out of your lungs as you recover.

Respiratory involvement is a different problem from airway obstruction, which is caused by physical swelling of the tongue or throat. Severe respiratory difficulties are the consequence of the inflammatory effect of angioedema on the lungs and bronchi (airways).

Complementary and Alternative Medicine (CAM)

You might come across advice to use complementary treatments for angioedema, but it is important for you to know that they are not effective and they can be unsafe.

Vitamins

Vitamins have been recommended for the prevention and treatment of angioedema, with little solid evidence.

In particular, vitamin C is claimed to lower histamine levels, although there is very little scientific proof. Furthermore, vitamin C supplements may interact with other medications you may already be taking, such as chemotherapy drugs, warfarin, or estrogen.

Vitamin B12 injections have also been studied as a possible treatment to reduce the frequency of recurring angioedema attacks. But again, there is not a lot of evidence.

Herbs

Herbs have long been used in traditional medicine for treating diseases. But just because they are natural, doesn't mean they are always safe.

An herb called goldenseal is sometimes recommended to people with food allergies to prevent or treat reactions. However, goldenseal is known to interact with blood thinners, cyclosporine, and other medications, and may also lower blood sugar.

Another well-known herb, chamomile, has traditionally been used to soothe hives. If you are taking antihistamines, you shouldn't use chamomile, as it can increase the antihistamines' sedative effects. Chamomile is also known to interact with estrogen and birth control medications, and you should not use it if you are allergic to ragweed.

Summary

The first step to treating and preventing angioedema is to identify the cause. Once identified, known triggers need to be avoided. If angioedema causes systemic (whole body) symptoms, you may need to carry a EpiPen at all times and educate yourself on how to use it.

Your doctor may recommend or prescribe oral antihistamines to block the immune response that causes angioedema. In very severe cases, specialist-driven procedures may be necessary to help you breathe during an angioedema episode.

A Word From Verywell

While trying to identify the trigger behind angioedema episodes, you may find it helpful to keep a record of when your symptoms occur and what items you ingested or were in contact with leading up to the episode. Keeping a consistent journal may help you and your healthcare provider see a pattern and ultimately identify the trigger. Do keep in mind, however, that external allergens like food or medications are not always the cause of angioedema, so you may need further testing by a healthcare provider.