Could My Symptoms Indicate Angioedema? Allergic Reactions

Could it be a symptom of "vascular neurogenic edema"?

Hello, Doctor: I have been experiencing symptoms of "rhinitis" and a "tight and itchy throat" for about a month.
The nasal symptoms include a feeling of congestion and slight swelling, although I don't have much nasal discharge.
My throat sometimes feels tight and itchy, and I occasionally experience short episodes of difficulty breathing.
I have visited several ENT clinics; some diagnosed me with rhinitis, while others mentioned post-nasal drip, but all agreed that my nasal and throat conditions appeared normal.
Two of the clinics, staffed by doctors with credentials from National Taiwan University, concluded that my symptoms are caused by "allergies." They prescribed better medication, which has improved my condition somewhat, but I still occasionally experience the aforementioned symptoms (the frequency has decreased slightly).
During these episodes, while I don't feel particularly uncomfortable, I always have a strange sensation in my nose, throat, and breathing.
I also researched a condition called "angioedema" (a type of urticaria) and learned that if it occurs in the respiratory tract (trachea), it can be serious.
After reading related information, I am quite worried.
Doctor, (1) is it possible that I have allergic symptoms of "angioedema"? (2) If I want to confirm whether I have "angioedema," what kind of tests can I undergo to determine the cause? Thank you, Doctor.

Mr. Wang, 30~39 year old female. Ask Date: 2016/11/23

Dr. Hong Yuanbin reply Internal Medicine

Hello, "angioedema" is indeed a type of allergic reaction and can be considered one of the most severe forms of allergies.
Patients typically have a clear exposure to a specific allergen, most commonly after consuming certain foods, leading to systemic allergic reactions.
This often results in noticeable swelling around the eyes and difficulty breathing.
This condition is usually very acute and will subside after some time.
Based on your description, the symptoms persisting for a while do not align with this condition; rather, your symptoms resemble allergic rhinitis, especially given the recent increase in PM2.5 particulate matter, which can exacerbate allergic conditions.

There are no specific medications for allergic rhinitis; typically, antihistamines are used for symptom control.
However, maintaining a regular routine and engaging in moderate exercise can gradually improve your allergy symptoms.
There aren't many specialized tests for allergies, but you can test for specific allergen reactions; however, the number of allergens that can be tested is currently limited.
You can also pay attention to which substances trigger your allergies, such as dust, pollen, seafood, and alcohol, and try to avoid these allergens to aid in your recovery.
Thank you for your inquiry.

Reply Date: 2016/11/23

More Info

Angioedema, also known as vascular angioedema, is a condition characterized by the rapid swelling of the deeper layers of the skin, often around the eyes and lips, and sometimes the throat. It can be triggered by allergic reactions, medications, or other factors. Given your symptoms of nasal congestion, throat tightness, and occasional shortness of breath, it is understandable that you are concerned about the possibility of angioedema or other allergic reactions.

1. Could your symptoms indicate angioedema?
Based on your description, it is possible that your symptoms could be related to an allergic reaction, particularly if you have a history of allergic rhinitis. The nasal congestion and throat tightness you are experiencing may be indicative of an allergic response, which can sometimes lead to angioedema. However, angioedema typically presents with more pronounced swelling, particularly in the face, lips, or throat, and can lead to difficulty breathing if the airway is compromised. Your symptoms of nasal congestion and throat irritation alone do not definitively indicate angioedema, but they do warrant careful monitoring.

2. What tests can confirm angioedema?
To determine whether you are experiencing angioedema or another allergic condition, several steps can be taken:
- Clinical Evaluation: A thorough history and physical examination by an allergist or an ear, nose, and throat (ENT) specialist can help assess your symptoms and their severity.

- Allergy Testing: Skin prick tests or specific IgE blood tests can help identify potential allergens that may be triggering your symptoms.

- Complete Blood Count (CBC): This test can help rule out other conditions and assess for any signs of infection or inflammation.

- Complement Levels: In some cases, measuring complement levels in the blood can help determine if there is an underlying hereditary angioedema or other immune-related issues.

- Referral to a Specialist: If your symptoms persist or worsen, a referral to an allergist or immunologist may be beneficial for further evaluation and management.

Given that you have already seen multiple ENT specialists who have diagnosed you with allergic rhinitis and prescribed medication, it is essential to continue following their recommendations. If your symptoms improve with the prescribed medications but still persist, it may be worth discussing with your doctor the possibility of adjusting your treatment plan or exploring other options, such as allergy shots (immunotherapy) if appropriate.

In the meantime, it is crucial to monitor your symptoms closely. If you experience any sudden swelling of the face, lips, or throat, or if you have difficulty breathing, seek emergency medical attention immediately, as these could be signs of a severe allergic reaction or anaphylaxis.

Lastly, managing your environment to reduce exposure to known allergens, such as dust mites, pollen, or pet dander, can also help alleviate your symptoms. Over-the-counter antihistamines may provide relief from nasal and throat symptoms, but it is best to consult your healthcare provider for personalized recommendations.

In summary, while your symptoms may not definitively indicate angioedema, they do suggest an allergic component that should be further evaluated. Regular follow-ups with your healthcare provider and appropriate testing can help clarify your diagnosis and guide effective management.

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