Angioedema is a clinical entity defined as self-limiting edema localized in the deeper layers of the skin and mucosa and lasting for several days (Kazandjieva J, Christoff G 2019). Angioedema is not itchy but may be painful and warm (Brown K et al 2006).
Angioedema primarily affects the face, lips, mouth upper airway and the extremities (Brown K et al 2006). It can be provoked by bradykinin and/or mast cell mediators, including histamine (Kazandjieva J, Christoff G 2019).
Angioedema and acute urticaria appear to be among the most common symptoms of food-induced allergic reactions (Sampson H 2004). Exposure to insect bites, some medications, or latex can also result in angioedema (Lifschitz C. and Szajewska H 2015).
Children with immediate-type IgE-mediated CMA may react with erythema, angioedema, urticaria, or vomiting within minutes of ingestion of even minute quantities of milk/dairy (Fiocchi et al 2010; Sampson H 2004).
Acute angioedema in infants is one of the many cutaneous symptoms of IgE-mediated Cow’s Milk Protein Allergy (CMPA), primarily affecting the lips or eyelids (Lifschitz C. and Szajewska H 2015). In one study, in infants with IgE-mediated CMPA, angioedema along with erythema and urticaria was seen in 94% of cases (Martorell A et al 2006).
However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Høst & Halken 1990; Høst et al 1994).
Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022).
Respiratory
