Brief Answer:
In that case, should think of other possible causes

Detailed Answer:
Hello XXXX,

Thank you for asking at HCM.

As you are getting episodes even without relation with vitamin D, I would like to suggest you as follows:

1. I would like to know the results of your allergy tests.

2. Angioedema can be due to various causes, can be allergic as well as non-allergic.

3. Common allergies can be foods (commonly milk, egg, fish, shellfish, tree nuts, peanut, wheat, soy, etc, some fresh vegetables and fresh fruits) or air-borne allergens like pollens, etc.

Allergy skin tests are available for both food allergens and air-borne allergens.

4. Angioedema can also occur due to non-allergic reactions to preservatives, coloring agents, flavoring agents, etc that are present in canned foods, packed foods or drugs. Unfortunately tests are not available for these types of substances.

5. Other causes of non-allergic angioedema are acquired angioedema (you have already been tested for); physical factors like extreme temperature changes, pressure over any body part, exercise, sunlight, cold water, vibration, etc; infections like intestinal parasites, some bacterial/viral infections, thyroid disorders.

6. Drugs like pain-killers (NSAIDs like ibuprofen, diclofenac, etc), antihypertensives - ACE inhibitors (captopril, enalepril, etc), oestrogen pills (for example birth control pills), etc can cause angioedema.

7. Rarely angioedema can be associated with immune-mediated or hormonal conditions. Unfortunately, despite extensive lab testing, it may not be possible to identify the cause of angioedema in approximately 20-30% of cases (We call them "idiopathic" angioedema).

7. I have mentioned the possible causes in order to give some clues to you as what could be the possible causes.

To summarize, as angioedema has occurred without exposure to vitamin D as well, I would suggest you to think about all possible causes of angioedema. Details of all your medical conditions, drugs, possible allergen exposures, digestive symptoms (if any), allergic respiratory symptoms, environment, etc may give clues towards possible cause.

Till the cause of angioedema is identified, I usually suggest my patients to take antihistamine drugs like hydroxyzine or cetirizine or chlorpheniramine (can cause sedation) for symptom control. If episode is severe, your doctor may prescribe corticosteroids.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up.

Wish you the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar

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