D1.13 - A rare case of isolated histaminergic angioedema

Angioedema is a localized swelling of the deep layers of the skin, subcutaneous tissues and mucous membranes. Histaminergic angioedema is associated most often with urticaria, although it could be separate. It affects predominantly the lips, eyelids and tongue, and it is accompanied by pruritus. The most common triggers are food, drugs and insect bites. Quite often, angioedema appears to be an interdisciplinary problem because it could occur in polymorbid patients on different medications, with or without concomitant immunoallergic pathology.

The official medical documentation with registered results from clinical and paraclinical diagnostic procedures is used for description of the case, with a written consent from the patient.

The case was discussed at a clinician council with the participation of specialists in clinical allergology, internal diseases, pulmonology, occupational diseases, otorhinolaryngology, and toxicology. After analysis and interpretation of the results, we established the presence of isolated acute (with duration less than 6 weeks) histaminergic angioedema based on its rapid onset after consumption of whole wheat biscuits and meringue, its relation to food allergens – eggs and wheat flour, its localization on the tongue, lips and eyelids, the concomitant pruritus, the positive results from serum specific IgE test and component-resolved diagnostics for egg white (extract and Gal d 1 – ovomucoid), the favorable response to the treatment with corticosteroids and antihistamines. Supporting our thesis are also the resolution of the edema in 24 hours, the lack of improvement after withdrawing the ACE inhibitor, taken by the patient, as well as the laboratory criteria excluding hereditary angioedema.

Isolated angioedema without urticaria could be histaminergic and sometimes be triggered by food allergens. The key to the correct and accurate identification of the etiologic factor and the leading pathophysiological mechanism is the personalized diagnostic approach. The most important factors in this case are the precise medical history, purposeful clinical thinking, interdisciplinary collaboration, analysis of the clinical and laboratory investigations and implementation of component-resolved diagnostics. The prompt start of antiallergic therapy with antihistamines and corticosteroids is pivotal for the resolution and subsidence of the symptoms, without residual consequences.