Angioedema in ENT practice

Angioedema is characterized by subcutaneous or submucosal swelling, which often affects the lips, tongue and oral or pharyngeal sites. Laryngeal oedema can be potentially life-threatening. The pathogenesis of angioedema is thought to involve the release of histamine and other mediators with subsequent extravasation of fluid. Over 90% of cases of chronic angioedema are clinically idiopathic. The known causes are allergic and more commonly pseudo-allergic (IgE-independent) reactions, especially drug or food hypersensitivity. Pseudo-allergic angioedemas are mainly evoked by a direct release of mediators or activation of the complement system. At the Department of Otolaryngology (Medizinische Hochschule Hannover) we performed a retrospective evaluation of the clinical histories of inpatients with angioedemas. The most common was swelling of the tongue, with laryngeal edema noted in five cases. Only one patient, whose case is reported, required a tracheostomy. In seven patients the causes of angioedema were determined as drug or food intolerance. The treatment of acute attacks is outlined.