The south african acare centre approach to recurrent angioedema without urticaria

Angioedema is the most common adult allergy presentation at two Cape Town emergency centres. Our tertiary hospital ACARE centre consults 2-3 new referrals a week, with a high burden of angioedema without urticaria. Many practitioners feel comfortable with the work-up of possible mast-cell-mediated angioedema, which occurs together with urticaria. However, the diagnostic work-up, the availability of certain specialised testing - for example, functional C1-INH testing - and the increasing use of treatment trials is less familiar. In this article we present two cases of recurrent angioedema without urticaria which highlight the differences between bradykinin-mediated and mast-cell phenotypes and the way this has an impact on diagnosis and management. We also present an integrated algorithm that is employed at our South African ACARE centre.