Allergy/Imm

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Acute episode or chronic problem?
JAAPA, 08/10/09

Monroe JR – A 59–year–old man presented with acute swelling of his lips and face. The swelling began about 2 hours before he arrived and was slowly resolving. Although the patient had experienced this swelling before, this instance was the first time his lips were affected. The patient denied any shortness of breath but admitted to a lifelong history of atopy marked by asthma, hives, seasonal allergies, and eczema. In the past, his primary– care physician treated his condition by prescribing antibiotics and a Medrol dosepak. This time the patient's condition was more severe, so the physician referred the patient to an allergist, who, in turn, sent him to the authors' dermatology department...The most likely diagnosis is angioedema, a deeper form of urticaria that causes painless, focal swelling of acute onset that typically lasts from a few minutes to 24 hours. While the lips are among the most commonly affected areas, angioedema can be seen on the eyelids, tongue, genitalia, and hands. It is most often idiopathic, but like ordinary urticaria it also can be stress–induced, related to ingestants, or caused by exposure to cold, heat, vibration, or ultraviolet light.

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