[Angioedema 2025 - Advancements in Diagnosis and Treatment]

Angioedema is a pathophysiologic process characterized by increased vascular endothelial hyperpermeability, leading to fluid accumulation and tissue swelling. This process is reversible in most cases; therefore, it is clinically exhibited by exacerbations and remissions. Patients experience paroxysmal, unpredictable, and slowly progressing episodes of swelling of the face, extremities, genitals, tongue, and larynx, and severe abdominal pains. Attacks affecting the oropharyngeal and upper airways impose a considerable life-threatening risk. Intestinal wall edema can cause bowel obstruction, mimicking "acute abdomen" and leading to unnecessary surgical interventions. As a chronic and recurrent disease with an undulating course, angioedema significantly affects the patient's quality of life and coping competence, presenting a considerable burden on health-providing systems. Understanding the pivotal role of C1 Inhibitor in the early 1960s and following research contributed to a better understanding of disease mechanisms. It led to unprecedented advancements in developing treatments for both attacks and prophylaxis. In parallel, international clinical guidelines and a new nomenclature have been established, assisting the diagnosis and treatment. Recently, the scope of angioedema has been expanded to include genetic variants and drug-induced angioedema. Treating angioedema associated with C1INH deficiency differs from treating allergic edema, such as in anaphylaxis and urticaria; therefore, a comprehensive evaluation, including laboratory studies, family history, and genotyping, is required. In such cases, focusing the treatment on bradykinin-dependent mechanisms is indicated for preventing attacks and reducing disease burden. This review aims to update the reader's scope of the various expressions of angioedema syndromes. It encompasses the pathophysiologic mechanisms, clinical algorithms for diagnosis, and an updated appraisal of the recommended pharmacologic treatment options for treating attacks and preventing their recurrence.