Angioedema - Causes 

Causes of angioedema 

Angioedema is often caused by a problem with the immune system, although there are many cases where no cause can be identified.

Allergic angioedema

Normally, your immune system protects your body from illness and infection by detecting germs in the blood and producing white blood cells and chemicals to destroy them and prevent any infection spreading.

In allergic angioedema, your immune system mistakenly reacts like this to harmless substances in your blood. Your body produces the chemical histamine, which causes the blood vessels in the area to expand, leading to swelling of the skin.

Substances known to trigger allergic angioedema include:

Idiopathic angioedema

Cases of angioedema without an identifiable cause are known as idiopathic angioedema. It may be that a problem with the immune system sometimes causes it to ‘misfire’.

If you have idiopathic angioedema, certain triggers may lead to swelling, such as:

  • stress
  • minor infections
  • alcohol
  • caffeine
  • spicy food
  • overheating (such as from a hot bath or shower)
  • wearing tight clothes

Avoiding these triggers whenever possible may improve your symptoms.

Drug-induced angioedema

Some medications can cause angioedema. Angiotensin-converting enzyme (ACE) inhibitors, which are used to treat high blood pressure (hypertension), are usually responsible.

It is estimated that around 1-5% of people taking ACE inhibitors will develop drug-induced angioedema. Black people being treated with ACE inhibitors are three to four times more likely to develop this side effect than white people.

About one in four cases of drug-induced angioedema occurs during the first month of taking an ACE inhibitor. The remaining cases develop many months or even years after treatment begins.

While they are useful in lowering blood pressure, ACE inhibitors can sometimes disrupt the ‘chemical balance’ and trigger an episode of severe swelling.

Less common causes of drug-induced angioedema include:

Hereditary angioedema

Hereditary angioedema is caused by a genetic mutation (a change in the DNA) in the C1-esterase inhibitor (C1-INH) gene. Genes are single units of genetic material that code for characteristics such as eye and hair colour.

As a result of the mutated C1-INH gene, the body does not make enough C1-INH protein. This protein plays an important role in regulating the immune system. Without enough C1-INH protein, the immune system can misfire and trigger the symptoms of angioedema.

Certain factors are thought to trigger hereditary angioedema, such as:

  • trauma, including surgery or infection
  • the oral contraceptive pill
  • pregnancy

The mutated C1-INH gene is passed down through families in a pattern known as autosomal dominant inheritance. This means that if you have hereditary angioedema, you have a 50% chance of passing it on to your children.

Page last reviewed: 25/09/2012

Next review due: 25/09/2014


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