Medication is the main treatment for angioedema, although many cases get better after a few days without treatment.
Allergic angioedema and idiopathic angioedema are usually treated in the same way, using a combination of antihistamines and corticosteroids to help relieve the swelling.
Drug-induced angioedema can usually be treated by using an alternative medication to the one causing your symptoms.
If you also had symptoms of anaphylaxis during an episode of angioedema, you will probably be given an adrenaline auto-injector pen in case your symptoms return.
Read more about treating anaphylaxis.
Hereditary angioedema cannot be cured and does not respond to adrenaline, antihistamines or steroids, so a preventative approach is taken. A number of different medications are used to stabilise the protein levels in your blood to help prevent symptoms developing.
Antihistamines work by blocking the effects of a protein called histamine, which is one of the chemicals responsible for causing your skin to swell.
A 2-week course of a non-sedating type of antihistamine (which does not cause drowsiness) is usually recommended – these include fexofenadine and cetirizine. Cetirizine can be bought over the counter in pharmacies and supermarkets without a prescription.
Antihistamines can also be given by injection at hospital or your GP surgery.
If you also have urticaria (hives) and are being kept awake at night by itchy skin, your GP may prescribe an older type of antihistamine to take before going to bed. These types cause drowsiness and should help you sleep.
A minority of people will still experience drowsiness after taking the newer type of antihistamines. If you find yourself feeling drowsy, you should avoid:
- drinking alcohol
- operating complex or heavy machinery
Other side effects of the newer antihistamines include:
- dry mouth
- dry nose
These side effects are usually short-lived and should pass quickly.
Corticosteroids (steroids) work by blocking many of your immune system's actions. In most cases, a 3 to 5 day course of steroid tablets is recommended. A steroid called prednisolone is the preferred choice.
Side effects of prednisolone include:
- abdominal (stomach) pain
- oral thrush – a fungal infection inside your mouth
If you feel dizzy after taking prednisolone, avoid driving and operating heavy machinery. These side effects should pass once you finish the course of treatment.
Steroid injections may be needed for more severe cases of angioedema. These are usually administered in hospitals or at specialist clinics by an allergy specialist or immunologist (a doctor who specialises in treating conditions that affect the immune system).
Medication for hereditary angioedema
The medication used to treat hereditary angioedema falls into 1 of 2 categories:
- medication used to prevent angioedema
- medication used to relieve symptoms
Danazol is a synthetic hormone that is effective in preventing the symptoms of angioedema because it helps boost levels of the C1-inh protein.
However, danazol can cause a number of unpleasant side effects if used on a long-term basis. For example, it may cause:
- weight gain
- disruption to the menstrual cycle – such as irregular periods or absent periods
- high blood pressure
- in women, changes to the body that are usually associated with men – such as excessive body hair growth, flattening of the chest, deepening of the voice and an increase in muscle tone
- liver problems
Due to these side effects, many people with hereditary angioedema are uneasy about using danazol on a long-term basis. Stanozolol is a similar medication that is slightly better tolerated.
Tranexamic acid is also an alternative medication to danazol. It can be as effective as danazol, but does not cause as many side effects and is preferred for use in women.
Icatibant is a relatively new medication used to treat acute (short-lasting) episodes of swelling. It works by blocking the effects of some of the chemicals that are responsible for causing the swelling in cases of hereditary angioedema.
Icatibant is given by injection under the skin, and a second injection is often required.
Common side effects of icatibant include:
- adverse skin reactions at the site of the injection – such as pain, redness, swelling or itchiness
- itchiness in other areas of the skin
Purified C1-inhibitor concentrate is widely used to replace the missing protein in the blood. It's needed for patients undergoing surgery, to prevent attacks caused by surgical trauma. It's used to treat acute attacks and is injected directly into the vein.
Many patients will keep supplies of their concentrate at home for emergency use.
Icatibant and C1-inhibitor concentrate will be prescribed by the specialist immunology unit caring for the patient with hereditary angioedema.