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Published on: October 22, 2014
Angioedema without urticaria: a large clinical survey
Lorenza C Zingale1, Laura Beltrami, Andrea Zanichelli
1Department of Internal Medicine, San Giuseppe Hospital, University of Milan, Milan, Italy. lorenza.zingale@unimi.it
Summary
Angioedema without hives is complex, with diverse causes including external agents, ACE inhibitors, and C1 inhibitor deficiency. This study proposes a classification and diagnostic approach for non-urticarial angioedema.
Area of Science:
- Immunology
- Allergy
- Dermatology
Background:
- Angioedema without urticaria (hives) is poorly understood, with diverse causes and unclear pathogenic mechanisms.
- This study reports on 11 years of experience to classify patients with angioedema unaccompanied by urticaria.
Purpose of the Study:
- To propose a classification for patients with angioedema without urticaria.
- To suggest a diagnostic work-up for this condition.
Main Methods:
- Examined 929 consecutive patients with recurrent angioedema without urticaria from 1993-2003.
- Conducted detailed history, physical examination, routine laboratory tests, and complement parameter measurements.
- Performed further testing based on clinical findings and assessed response to H1-antihistamine when other causes were negative.
Main Results:
- Classified 776 cases: 16% external agents, 11% ACE inhibitors, 7% autoimmune/infection, 25% C1 inhibitor deficiency.
- Etiology remained undiscovered in 41% of cases (33% idiopathic histaminergic, 5% idiopathic nonhistaminergic).
Conclusions:
- Angioedema without urticaria can be classified by clinical and pathogenic features.
- A structured diagnostic work-up is proposed for patients with this condition.
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