Angioedema from instant coffee

Acute allergic angioedema is an abrupt-onset, unpredictable inflammatory reaction of the skin and mucous membranes. Without treatment, the condition may resolve within hours; however, when swallowing or breathing is affected, emergent medical attention is required. We report an atypical presentation of this condition, with a unique dietary cause. A 50-year-old man with no relevant medical history emergently presented with acute angioedema of the lower lip, without urticaria. The inflammation spread to other facial structures but gradually dissipated after subcutaneous epinephrine was administered. Despite thorough questioning of the patient, the cause of the angioedema was not determined. Five days later, during tapered prednisone therapy, the angioedema recurred, and the patient acted to reverse the attack. Instant coffee was identified as the trigger. Beverages are very rarely reported as primary causes of angioedema. To our knowledge, this is the first report of an adult with angioedema triggered not by the caffeine in coffee, but by another characteristic of it.