How Angioedema Is Treated

There are medical treatments that can suppress angioedema. Most of the time, if an allergen  (a substance that triggers an allergy) is identified, it is recommended that you avoid it.

Once you have an established diagnosis of angioedema, your treatment depends on the cause. You might need to take regular treatment with steroids if your symptoms are not the result of an allergy.

If you do have an allergy, particularly if it is not completely clear what you are allergic to, you might need to carry injectable epinephrine with you because emergencies may progress quickly before you can get medical attention.

Home Remedies and Lifestyle

There are a number of effective lifestyle adjustments that you can make if you experience angioedema. Some of the lifestyle modifications are helpful in preventing a reaction if you have a known allergen, and some can help you become more comfortable if you have had a reaction.

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.

There are common culprits, such as strawberries and seafood, but it is possible to have angioedema in response to a substance that you do not know causes such a reaction in people.

You can certainly have an allergy test, but you might learn that you have an allergy to something that you don’t recall having been exposed to, so it is beneficial for you to consider your surroundings carefully as you adapt your lifestyle to avoid future episodes of angioedema.

Avoid Food Triggers

Once you identify the trigger, you can take action to avoid exposure by reading the ingredients of pre-prepared food and even avoiding foods if you cannot figure out how they were prepared.

Avoid Exposure to Chemical Allergens

You might need to be extra vigilant about the chemicals in the products that you use. If you had a reaction to soap, for example, you will need to check if detergents or other body products also contain that allergen. 

Medication Awareness

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

Maintaining Comfort During Episodes of Angioedema

Some people with angioedema use ice packs for comfort, especially if the swelling is very localized 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. Of course, you should 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 diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec) are often helpful in managing and preventing episodes of angioedema. They work by suppressing your overactive immune system, which is often the problem in angioedema.

These medications are taken orally and you should only use them if your doctor has already evaluated your signs and symptoms and has told you that this is a good option. Use the medications according to the package instructions and get medical attention if you begin to feel worse or if you have trouble breathing or feel faint.

If you experience side effects such as sleepiness or drowsiness, consider switching to another antihistamine that you can tolerate.

Antihistamine Creams

Some antihistamine creams can reduce your itchiness and rash if you have these symptoms. They are generally well tolerated and they are more likely to reduce your symptoms if you had a reaction to something that you came into contact with through your skin.

Steroid Creams

OTC steroid creams work locally in the area of a rash or itching, and they may also reduce some of the swelling.

Hypoallergenic Creams

You might not necessarily need a medicated cream to soothe your skin if you have angioedema. Creams that lubricate your skin without necessarily having an active medical ingredient may be enough to give you relief.

Prescriptions

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

Antihistamines

Prescription strength antihistamines such as cyproheptadine (Periactin), hydroxyzine (Atarax, Vistaril) and desloratadine (Clarinex) work in the same way as OTC antihistamines—by suppressing the immune system—except that they have a stronger effect and may also produce more noticeable side effects of sleepiness and drowsiness. Antihistamines can be used regularly or as needed, depending on your situation.

Oral (by mouth) Steroids

Some people with angioedema need to regularly take oral steroids to prevent a reaction. In some instances, your doctor may recommend that you take oral steroids for a certain length of time to help your symptoms resolve.

Intravenous (IV) Steroids

Your medical team may consider giving you IV instead of oral steroids, 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 difficulties or heart involvement.

If you have this tendency, your doctor may recommend that you keep an EpiPen with you at all times so that you can inject yourself or have someone inject you if you begin to have a dangerous reaction.

Specialist-Driven Procedures

In general, you should not need surgery or special procedures for 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.

Hereditary Angioedema

The treatments used for angioedema that is not hereditary, often referred to as acquired angioedema, are not the same as those used for hereditary angioedema. In fact, antihistamines and steroids may make hereditary angioedema worse.

Several FDA approved treatments for hereditary angioedema include the following.

C1 Esterase Inhibitors (C1-INH)

Medications include Berinert, Cinryze, Haegarda, and Ruconest. These medications need to be self-injected and they can be used if you feel an event coming on.

Kallikrein Inhibitor

Ecallantide (Kalbitor) is an injectable medication that prevents bradykinin synthesis. Bradykinin promotes inflammation, so reducing bradykinin can help prevent flare-ups of hereditary angioedema.

Bradykinin Antagonism

Another medication, icatibant (Firazyr), directly blocks bradykinin activity to prevent excess inflammation in hereditary angioedema.

Complementary Medicine

Alternative treatments have been used for the symptoms of mild angioedema, and some alternative treatments have also been considered possibly useful for prevention.

Some of these treatments are very comforting and provide relief for episodes of angioedema, although they do not cure the condition if you have the hereditary type, nor do they prevent you from having a reaction to something that you are allergic to.

Nevertheless, if you experience respite from your symptoms, it makes sense to use a method that helps you as long as it is approved by your doctor.

Vitamins

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

There is some evidence that suggests that vitamin D deficiency may contribute to angioedema. To the contrary, there are reports of angioedema that may have been triggered by vitamins. It is unclear whether the vitamins cause angioedema or whether another component of the tablets themselves could be the trigger.

Oatmeal

Soothing treatments such as oatmeal are sometimes recommended for the rash and itchiness of angioedema. In general, soothing your skin does not diminish the hyperactive immune activity of angioedema.

While there is no specific evidence supporting the effectiveness of using oatmeal on the skin, it is a popular approach for angioedema. If a soothing treatment on your skin makes you feel better as you are recovering from an episode, then you should use whatever makes you physically comfortable.

Milk Baths

As with oatmeal, there is no specific evidence that milk baths actually relieve the inflammation of angioedema. However, this is a popular treatment for the skin discomfort that many people experience.

Sources:

Goetz DW. Vitamin D treatment of idiopathic itch, rash, and urticaria/angioedema. Allergy Asthma Proc. 2010 Mar-Apr;31(2):158-60. doi: 10.2500/aap.2010.31.3322.

Riedl M. Hereditary angioedema therapy: kallikrein inhibition and bradykinin receptor antagonism. World Allergy Organ J. 2010 Sep;3(9 Suppl):S34-8. doi: 10.1097/WOX.0b013e3181f20dbc.