Med. praxi. 2025;22(3):181-186 | DOI: 10.36290/med.2025.048

Hereditary angioedema and its differential diagnosis

MUDr. Irena Krčmová, CSc.

Ústav klinické imunologe a alergologie, FN Hradec Králové, LF UK Hradec Králové

Angioedema is swelling involving the subcutaneous and/or submucosal layers of tissue that affects the face, lips, neck and extremities, oral cavity, larynx, and/or intestinal mucosa. The differential diagnosis of angioedema is interdisciplinary. From a pathophysiological perspective, angioedema can be classified as histamine-mediated angioedema and bradykinin-mediated angioedema. Histamine-mediated angioedema is more common and is associated with activation and degranulation of mast cells and basophils, and is often accompanied by pruritic and erythematous urticaria. Bradykinin-mediated angioedema can include forms of hereditary angioedema, acquired C1 inhibitor deficiency, and angioedema associated with angiotensin-converting enzyme inhibitors or other drugs. It is characterized by excessive local production of bradykinin with the development of painful angioedema, is not associated with pruritic urticaria, has a longer duration, and often has abdominal symptoms. It is resistant to standard therapies such as adrenaline, glucocorticoids, and antihistamines. As part of the differential diagnosis in the acute phase, it is appropriate to perform a laboratory test for tryptase to differentiate histamine angioedema in conjunction with anaphylaxis and the C4 component of complement as a screening for bradykinin angioedema. Hereditary angioedema (HAE) is a rare, genetically determined disease with autosomal dominant transmission and a variable spectrum of bradykinin angioedema. In a broader context, it is an immunodeficiency disease, classified into HAE with C1 inhibitor deficiency (HAE-C1-INH) and HAE with normal levels and function of C1 inhibitor (HAE nC1-INH), with mutations of another (often still unknown) type. The establishment of centers for the diagnosis and care of patients with HAE and acquired bradykinin angioedema (AAE) has significantly improved the lives of these patients. Patients with atypical angioedema (with a predominance of bradykinin etiology) are also referred to the centers.

Keywords: hereditary angioedema, diagnostics, differential diagnostics, therapy.

Received: April 29, 2025; Revised: May 28, 2025; Accepted: May 28, 2025; Published: June 26, 2025  Show citation