Monday, July 15

Skin diseases - Angioedema treatment

Mild case of angioedema clears up on its own in a few days without any specific treatment. To alleviate the mild symptoms, the patient may have cool bath and apply cold compress on the affected skin area.
Strenuous physical activities must be avoided as the warming up of the body may aggravate the angioedema condition.

Nonprescription antihistamines may be used in the angioedema treatment to get relief from itching and discomfort. If the mild symptoms are not clearing up in three or four days, if the symptoms persist even after taking medication or if there is progression of the condition, treatment of angioedema by a doctor becomes necessary.

Avoiding angioedema triggers

Identifying and avoiding allergins and other triggering factors that cause the angioedema goes a long way in preventing and lessening the intensity of symptoms. The causative factors may include certain types of food, alcohol, medicines, insect stings, insect bites, certain drugs and harsh chemicals. Individuals prone to severe attacks can avoid the severity by starting the treatment early.

Angioedema treatment with medication

A patient with moderate angioedema would be prescribed antihistamines and anti-inflammatory medicines like corticosteroids. For conditions caused by allergins as well as the * idiopathic angioedema, the treatment is the same. However for drug-induced angioedema, the immediate withdrawal of the culprit medicine and use of an alternative medication will provide relief.

Severe cases, where the patient has difficulty in breathing requires maintenance of airway and also use of inhaler medicines, subcutaneous epinephrine injections, antihistamines, corticosteroids and H1 and H2 blockers.

Hereditary angioedema treatment requires a preventative approach. Usually it does not respond to antihistamines, corticosteroids or epinephrine. Medications regulating levels of blood proteins, C1 inhibitor concentrate or inhibitor of plasma kallikrein may be administered to relieve the symptoms.

Antihistamines
Angioedema is an immune response to pathogens and triggering factors resulting in the production of inflammatory mediators such as histamine. The resultant inflammation causes dilation and leakage of blood vessels and fluid accumulation in the intercellular spaces. Antihistamines block the effects of histamine and reduce the inflammatory response. The Histamine-2 receptor antagonists like ranitidine or cimetidine are also effective. They may be used in conjunction with H1 blockers.

Based on the side effects and the chemical composition, antihistamines are categorized as older, first-generation and newer second-generation antihistamines. The new medicines generally do not cause drowsiness or reduce one's reaction time during angioedema treatment. Considering their chemical effects both the new and older medicines are categorized into nonprescription and prescription medicines.

Diphenhydramine and chlorpheniramine are nonprescription first-generation antihistamines. Hydroxyzine is a prescription first-generation antihistamine. Loratadine and cetirizine are nonprescription second-generation antihistamines. Desloratadine, fexofenadine and levocetirizine are prescription second-generation antihistamines.

Corticosteroids
Cotricosteroids (steroids) work by blocking the immune responses. In acute cases of angioedema unresponsive to regular antihistamine treatment, corticosteroids are used. Corticosteroids reduce inflammation and vascular permeability. Corticosteroids like prednisone, prednisolone and methylprednisolone are commonly prescribed.

Hereditary angioedema

In conditions which are hereditary in nature, there are medicines to prevent them and also medications to relieve symptoms. Anabolic steroids like danazol, C1 esterase inhibitor, or a kallikrein inhibitor are prescribed for preventing attacks and relieving symptoms.

Emergency treatment

Angioedema caused laryngeal edema can progress rapidly leading to severe throat swelling and airway obstruction.
It is a life-threatening emergency requiring establishment of airway and maintenance of respiration. Endotracheal tube may have to be inserted into the trachea and connected to oxygen supply to maintain respiration. In cases with excessive swelling of throat, endotracheal intubation becomes impossible. In such cases, the doctor may resort to tracheostomy, a procedure consisting of making an incision on the neck and opening a direct airway through an incision in the trachea.

Severe angioedema may also lead to anaphylaxis requiring immediate administration of epinephrine. Patients prone to anaphylaxis may have to carry a prescribed epinephrine autoinjector for use in case of emergency.
References:
1.68.Bork K, Hardt J, Schicketanz KH, Ressel N. Clinical studies of sudden upper airway obstruction in patients with hereditary angioedema due to C1 esterase inhibitor deficiency. Arch Intern Med 2003; 163:1229.
2.13.Levi M, Choi G, Picavet C, Hack CE. Self-administration of C1-inhibitor concentrate in patients with hereditary or acquired angioedema caused by C1-inhibitor deficiency. J Allergy Clin Immunol 2006; 117:904.

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