Angioedema: Treatment

Angioedema can have a variety of treatments, depending on the cause. In cases where a specific trigger (allergen, medication, etc.) can be identified, treatment includes removal of that trigger to stop current swelling and to prevent swelling in the future.

In cases where the angioedema is related to a rheumatologic condition, the underlying condition must improve or be treated in order for the angioedema to improve. 

In mild cases, cold compresses may relieve the pain and swelling, as well as wearing loose cotton clothing.

In severe or persistent cases of mast cell-mediated angioedema, angioedema medications such as antihistamines, steroids and even epinephrine are needed acutely to resolve the angioedema. Daily antihistamines are often used to help prevent recurrence of the angioedema. Some antihistamines can have side effects, including drowsiness, so be sure to discuss these with your doctor. Avoid driving or drinking alcohol if they have this effect on you.

People with facial swelling will often be given an epinephrine auto-injector to carry with them in case of airway closure during an angioedema episode. Leukotriene modifiers and mast cell stabilizers can sometimes help prevent further cases of angioedema as well. If these medications are insufficient in stopping the angioedema, there are other immune suppressants that your doctor may want to try.

Hereditary angioedema (HAE) and acquired angioedema (AAE) do not respond to these treatments. However, there are several possible therapies for HAE and AAE. Many of these medications act by replacing the missing or dysfunctional C1 esterase inhibitor enzyme. This is the case not only in the acute setting to help stop an attack in process, but also prophylactically to help prevent angioedema episodes if they are occurring frequently enough.

Other medications that treat HAE and AAE include inhibitors of molecules and receptors of the bradykinin pathway—ecallantide, icatibant and lanadelumab-flyo.