Angioedema is swelling in the deeper layers of the skin, most often around the eyes and lips, but also the tongue, hands, feet or genitals. It can happen on its own or together with hives (urticaria), and each episode usually settles within one to three days.
Many people assume swelling must be an allergy, but most recurrent angioedema is not. Finding the cause matters, because the different types are treated in different ways.
If you have swelling of the tongue or throat, difficulty breathing or swallowing, or feel faint, call 999 straight away.
Allergy Clinic
Dr John Reed is a consultant dermatologist with a specialist interest in urticaria, angioedema and allergy. His allergy consultation is longer than a standard appointment, so there is time to go through your reactions in detail.
Where it will help, he can arrange skin prick testing and blood tests at Derma.
Symptoms of Angioedema
Angioedema causes swelling that is often tight, uncomfortable or painful rather than itchy. Common features include:
- swelling of the lips, eyelids, tongue, hands, feet or genitals
- swelling that develops over minutes to hours and settles over one to three days
- hives (raised, itchy wheals) at the same time, in many but not all people
- tummy pain, nausea or vomiting if the bowel wall swells, which is more common in hereditary angioedema
Swelling without hives that does not improve with antihistamines can point to a non-allergic cause, and should be assessed by a dermatologist.
Causes of Angioedema
There are three main types of angioedema:
- Spontaneous (idiopathic) angioedema – the most common type when swelling keeps coming back. No external trigger is found, and it is often linked to chronic urticaria. It is not an allergy, so cutting out foods rarely helps.
- Allergic angioedema – a reaction to a food, medicine, insect sting or latex, usually within minutes to two hours and often with hives. See our food allergy page.
- Bradykinin-related angioedema – caused by some blood pressure tablets (ACE inhibitors), sometimes after years of use, or by a rare inherited or acquired lack of C1 inhibitor (hereditary angioedema). It causes swelling without hives, and does not respond to antihistamines or adrenaline.
Episodes can also be triggered or made worse by infections, stress, anti-inflammatory painkillers such as ibuprofen and aspirin, alcohol, heat and pressure on the skin.
Diagnosis of Angioedema
The most important part of the diagnosis is a detailed history: what the swelling looks like, how long it lasts, whether you also get hives, which medicines you take, and whether anyone in your family has similar episodes. Photos of the swelling are very helpful.
Depending on your history, your dermatologist may recommend blood tests, including C1 inhibitor levels if hereditary angioedema is possible, or an allergy consultation with skin prick testing if a specific trigger is suspected.
Treatment at Derma for Angioedema
Treatment depends on the cause. It may include:
- daily non-drowsy antihistamines, often at higher than usual doses, for recurrent swelling with or without hives
- stopping or changing a medicine that is causing swelling, such as an ACE inhibitor, in discussion with your GP
- avoiding a confirmed allergic trigger
- a written plan for what to do if swelling happens, and adrenaline auto-injectors if you are at risk of anaphylaxis
- referral to a specialist immunology service if hereditary angioedema is confirmed
Further reading: Patient leaflet from the British Association of Dermatologists
Frequently Asked Questions
When should I call 999?
Call 999 if you have swelling of the tongue or throat, difficulty breathing or swallowing, or feel faint or dizzy. These can be signs of anaphylaxis or of swelling blocking your airway.
Is angioedema always caused by an allergy?
No. Most recurrent angioedema has no external trigger and is not an allergy. Allergy tests are only helpful when your history points to a specific trigger.
Can blood pressure tablets cause angioedema?
Yes. ACE inhibitors, such as ramipril, lisinopril and perindopril, can cause swelling even after many years without problems. Do not stop a medicine without speaking to your doctor, but do mention it at your appointment.
Do I need to see Dr Reed?
No. Any of our consultant dermatologists can assess angioedema. If an allergy is suspected, you may be offered an allergy consultation with Dr Reed.
Related Specialists at Derma
Special interest
Dr John Reed
Consultant Dermatologist
General dermatologySkin surgery
Specialist interest in urticaria, angioedema and allergy.
Also seen by
Any of our consultant dermatologists can assess angioedema.
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Dr Rachel Fisher
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Dr Sabrina Khan
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Dr Inge Kreuser-Genis
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