A family history could be informative, since angioedema can be familial. Such triggers are often difficult to identify. His family history was noteworthy for breast cancer in his mother.Ī thorough history of possible exposures, including oral (e.g., food), inhaled (e.g., pollen, fumes, or solvents), and topical (e.g., creams or plants), is important in the elucidation of possible triggers for any patient in whom an allergic reaction or angioedema may be likely. He did not smoke tobacco or consume alcohol. The patient had no pets, reported no exposures to new environments or foods, and had not had recent contact with sick persons. He had traveled to China, Japan, and Mexico in the preceding 3 years but had not left the Boston area in the preceding 6 months. He worked in real estate development and lived alone in Boston. He took no prescription medications and had not used any new over-the-counter medications in the preceding month. The patient was allergic to shellfish but had no known recent exposure. Although orbital cellulitis and trichinella also cause periorbital swelling, these conditions are typically associated with pain and fever and not with oropharyngeal symptoms. Although hypothyroidism can cause eyelid edema and vocal hoarseness owing to fluid accumulation in the vocal cords, swelling usually occurs in both eyelids and is associated with generalized myxedema and other findings suggestive of hypothyroidism (e.g., bradycardia, fatigue, sensitivity to cold temperatures, and dry skin). Mast-cell–mediated reactions generally last for 12 to 36 hours, whereas bradykinin-induced reactions may persist for 2 to 4 days. In contrast, angioedema with urticaria is typically mediated by mast cells and IgE in response to interaction with an allergen, causing the release of chemokines and cytokines that leads to inflammation. Typical mediators of bradykinin-induced angioedema include angiotensin-converting–enzyme inhibitors, which decrease bradykinin degradation, and acquired or inherited C1 inhibitor deficiencies, which increase bradykinin production. Isolated angioedema without pruritus or urticaria is often the result of increased levels of bradykinin, which increases vascular permeability and dilatation, leading to angioedema. The asymmetric distribution of angioedema is common. In a patient presenting with periorbital edema and oropharyngeal symptoms, angioedema should be considered to be present until proved otherwise, given the risk of airway compromise if the angioedema is not treated appropriately. He reported no fevers, fatigue, gastrointestinal symptoms, or recent illness. During the 3 days before presentation, it had become difficult for him to swallow solids, and he felt as if food was sticking in his throat. He was hoarse but did not have wheezing or shortness of breath. He reported no pruritus, photophobia, diplopia, headache, changes in visual acuity, or pain. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ī 47-year-old man with a history of hypertension presented to an urgent care ambulatory clinic with a 3-day history of swelling around his left eye and a sensation of tightness in his throat. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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