Angioedema Workup

  • Author: Huamin Henry Li, MD, PhD; Chief Editor: Michael A Kaliner, MD   more...
 
Updated: Jan 6, 2012
 

Approach Considerations

Most mild cases of angioedema do not require any laboratory tests. Suspected allergies to food, stinging insects, latex, and antibiotics can be screened and diagnosed. Value is limited for aeroallergen screening for patients with angioedema, except to establish atopic status.

Screening laboratory studies have limited value in most cases. For chronic or recurrent angioedema without a clear trigger, one may consider the following (with abnormal tests or if a specific medical condition is suspected, additional tests may be needed):

  • Complete blood count (CBC) with differential
  • Sedimentation rate
  • Urinalysis
  • Comprehensive metabolic profile
  • CH50 and C4
  • Thyroid studies, including thyroid autoantibody levels (antimicrosomal, antithyroglobulin) - These can particularly be considered in women or in patients with a family history of thyroid disease or other autoimmune diseases

Evaluation for possible occult infection can be considered. Other tests to consider if the history and physical examination findings suggest specific problems include the following:

  • C1-INH quantity and function
  • Stool analysis for ova and parasites
  • H pylori workup
  • Hepatitis B and C workup
  • Sinus radiography (if symptomatic)
  • Antinuclear antibody (ANA)
  • Rheumatoid factor
  • Cryoglobulin levels
  • Other imaging studies

When the CH50 or C4 level is low, additional tests for C1-INH function and C1q should be considered. A low C1q level may require additional hematologic evaluation.

Elevated prothrombin fragment F1 + 2 and D-dimer are associated with acute hereditary angioedema (HAE) attacks.[33] Whether these may be used in monitoring other types of angioedema requires additional studies.

The diagnosis of IgE-mediated angioedema usually is made historically; however, epicutaneous skin testing or radioallergosorbent tests for foods may be confirmatory. Assays for serum histamine-releasing factors and evaluation for specific autoantibodies (anti-IgE receptor and anti-IgE) are performed by some research centers. These tests are not approved by the US Food and Drug Administration (FDA) and are available currently from only a few laboratories.

Skin biopsy may be used to rule out other causes of skin swelling but is rarely necessary. Laryngoscopy can help assess the extent of laryngeal swelling.

Histologic findings

Histologic findings in angioedema are nonspecific. Significant inflammation is usually absent; skin morphology is usually intact. Eosinophil infiltration is not a common feature of angioedema (except in Gleich syndrome).

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Imaging Studies

Most angioedema patients do not need any imaging studies. When internal organ involvement is suspected, during acute attacks, the following studies can be performed:

  • Plain abdominal films - May show a "stacked coin" or "thumbprint" appearance of the intestines[34]
  • Chest film - May show pleural effusion
  • Soft tissue neck film - May show soft tissue swelling[35]
  • Abdominal ultrasonography - May show ascites.
  • Computed tomography (CT) scan of the abdomen - May show severe edema of the bowel wall[36]
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Contributor Information and Disclosures
Author

Huamin Henry Li, MD, PhD  Director of Immunology, Institute for Asthma and Allergy; Assistant Professor, George Washington University Medical Center

Huamin Henry Li, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology, and MedChi

Disclosure: Dyax Consulting fee Consulting; Shire/Jerini Consulting fee Consulting; CSL Behring Consulting fee Consulting; Viro Pharma Honoraria Speaking and teaching; Sanofi-Advantis Honoraria Speaking and teaching; Viro Pharma Consulting fee Consulting

Chief Editor

Michael A Kaliner, MD  Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians

Disclosure: Alcon Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting fee Consulting; sunovian Consulting fee Consulting; dey Honoraria Review panel membership

Additional Contributors

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology

Disclosure: Genentech Consulting fee Consulting; American Health Insurance Plans Consulting fee Consulting; Johns Hopkins School of Public Health Consulting fee Consulting; Array BioPharma Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Photographic documentation of swelling.
Types of angioedema.
Pathways for production of prostaglandins and leukotrine from mobilized arachidonic acid.
Bradykinin production and metabolism.
Angioedema secondary to ACE inhibitors.
 
 
 
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