Several months ago i started getting large hives on the bottom of my feet. That was diagnosed by a Dr. as Angeoedema. Since that time, i have had several attacks of this swelling on my feet, hands stomach, and inner thigh. Last Saturday night after a dinner out, which was finished about 8 p.m. I went home, and took some Benedryl about 40 mg and went to sleep. I awoke at 2:30 a.m. with a swelling of the toungue and wound up at the emergency which the doctor diagnosed as angioedema. This was a very scary situation for me. Tonight I got another angioedema at the bottom of my foot. I was wondering if these two incidences are related and how i can go about determing what it is that i am allergic to and giving me these outbreaks. And how am i to know whether what happened in my tounge was anaphylaxis to maybe a peanut that wound up in my dish at dinner or just some random angeoedema swelling like tonight but unluckily wound up last week on my toungue? And yes, i am now allergic to peanuts and tree nuts after a flew shot injection in 2004. I am 49 years old.
Please help me with any advice, I dont know where else to turn to.
What you describe suggests angioedema. As you can see from the table below, there are many, many causes of both angioedema and urticaria. One of the more well defined causes is Heriditary Angioedema and Acquired C-1 INH Deficiency (below).
Angioedema is a dangerous condition. You should strongly consider seeking consultation at a regional medical center (such as the Mayo Clinic) where the physicians are actively engaged in research and treatment of this condition.
Hereditary Angioedema and Acquired C1- INH Deficiency
Hereditary angioedema is an autosomal dominant disorder caused by the absence of C1- INHin which patients may have attacks of swelling involving almost any portion of the body. A traumatic episode can initiate an attack. However, such a triggering event may not be evident, and the swelling appears to occur spontaneously. It is not associated with urticaria, and patients with both urticaria and angioedema without a family history invariably have a normal C1- INH concentration. In addition to the family history, the presence of visceral involvement suggests the hereditary disorder. The most severe complication is laryngeal edema, which has been a major cause of mortality in this disease. Patients can also have abdominal attacks lasting 1 to 2 days, consisting of vomiting, severe abdominal pain, and guarding in the absence of fever, leukocytosis, or abdominal rigidity. This can occasionally be difficult to distinguish from an acute abdominal condition; however, the attacks are self-limited and are caused by edema of the bowel walldemonstrates angioedema of the hand in a patient with hereditary angioedema.
Treatment for attacks of hereditary angioedema generally involves intermittent administration of subcutaneous epinephrine. However, no studies of epinephrine support the efficacy of this treatment, because attacks usually abate in 3 to 4 days even if no medication is given. A tracheostomy is indicated if laryngeal edema occurs, and mild analgesics may be used to relieve the discomfort of severe swelling and abdominal pain. Intravenous fluids may be necessary if the patient is unable to eat or drink. Successful prevention has been reported with the administration of androgensand large doses of antifibrinolytic agents such as epsilon aminocaproic acid[The precise mechanism of action of these last agents is unknown, but there are multiple possible effects.
The major causes of urticaria and angioedema that should be considered when any patient is being evaluated are as follows:
1. Drug reactions
2. Foods or food additives
3. Inhalation, ingestion of, or contact with antigens
4. Transfusion reactions
5. Infections: bacterial, fungal, viral, and helminthic
6. Insects (papular urticaria)
7. Collagen vascular diseases
a. Cutaneous vasculitis
b. Serum sickness
8. Malignancy: angioedema with acquired C1 and C1- inactivator (C1- INH) depletion
9. Physical urticarias
a. Cold urticaria
b. Cholinergic urticaria
d. Pressure urticaria (angioedema)
e. Vibratory angioedema
f. Solar urticaria
g. Aquagenic urticaria
10. Urticaria pigmentosa: systemic mastocytosis
11. Hereditary diseases
a. Hereditary angioedema
b. Familial cold urticaria
c. C3b inactivator deficiency
d. Amyloidosis with deafness and urticaria
12. Chronic idiopathic urticaria and chronic angioedema
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