Viagra, Cialis And Angioedema: A Side Effect You Should Not Neglect

Angioedema is an inflammatory reaction of the skin, similar to the urticaria, characterized by the sudden appearance of an area of swelling of the skin, mucous membranes and submucosal tissues. Symptoms of angioedema can affect any part of the body, but the areas most commonly concerned are eyes, lips, tongue, throat, genitals, hands and feet. Angioedema In more severe cases, the internal lining of the respiratory tract and the upper part of the intestine may also be affected, causing chest or abdominal pain. Angioedema is short-lived: Usually, swelling in an area lasts from one to three days.

Angioedema: facial swelling

In common language, the term ‘swollen face’ identifies a particular condition of the human face, which appears to be quite bloated and ‘enlarged’. Generally, swollen face is the result of excessive local fluid buildup (edema), often – but not always – resulting from a local inflammatory reaction. Even though angioedema can affect any area of the face, it is more pronounced in the area of the lips, cheeks and eyelids. Equally often, the condition is accentuated by a swollen neck, more easily correlated with overweight and obesity.

In most cases, the reaction is harmless and leaves no lasting signs even in the absence of treatment. The only danger is throat or tongue involvement, as their severe swelling can cause fast pharyngeal, dyspnea and loss of consciousness.

Angioedema and urticaria are the result of the same pathological process, so they are similar to several aspects: often, both clinical manifestations coexist and overlap: urticaria accompanies angioedema in 40-85% of cases, whereas angioedema can occur without hiccups in only 10% of cases. Hives are less serious, as they only affect the superficial skin layers. Angioedema, on the other hand, involves deep subcutaneous tissue. Hives are characterized by the temporary onset of an erythematous and pruriginous reaction in areas of the well defined dermis (appearance of more or less reddened and raised pomegranates). In the angioedema, the skin retains a normal appearance, remaining devoid of pomphi. Also, it can manifest without itching.

The main differences between urticaria and angioedema are shown in the following table:

Characteristics	Angioedema	Urticaria
Tissues involved	Hypoderms (subcutaneous layer) and subcutaneous (under the dermis) tissues	Epidermis (outer skin layer) and dermis (inner skin layer)
Organs affected	Cutaneous mucous tissues and, especially eyelid, lips and oropharynx	Only skin
Transitional duration	(24-96 hours) transition	(Usually <24 hours)
Physical signs	Edema (swelling) under the surface of the skin	Erythmatosis and pruriginous and raised skin on the surface of the skin
Symptoms	Irritation may be present or not. Often angioedema is accompanied by pain and swelling.	The dermis associated with rash is generally pruriginal.Pain and swelling are not common symptoms.

Causes of angioedema

Excessive swelling of the face can be triggered by:

traumas or face surgery,
allergies (insect bites and allergic reactions of various kinds),
facial neoplasms,
increased fluid retention (common in pregnancy),
malnutrition,
kidney or heart failure,
angioedema,
pre-eclampsia,
local infections (dental abscesses, bacterial or viral conjunctivitis, infectious cellulite, ears, sinusitis, orzoa),
obesity,
hypothyroidism,
hypopituarism (pathological condition characterized by decreased secretion of pituitary hormones)
intake of certain medications (such as Cialis or Viagra).

More specifically, depending on the cause of origin, angioedema can be classified into several forms: acute allergic, drug-induced (non-allergic), idiopathic, hereditary and acquired.

Type of angioedema and clinical features	Causes
Allergic angioedema	Swelling is caused by an acute allergic reaction, almost always associated with hives, which occurs within 1-2 hours of exposure to the allergy. Sometimes, it accompanies anaphylaxis. Reactions are self-limiting and retrograde within 1-3 days, but may occur again in case of repeated exposures or interaction with cross-reactants. Food allergy, in particular nuts, crustaceans, milk and eggs; ingestion of foods containing particular additives such as Tartrazine Yellow or Sodium Glutamate Some types of drugs, for example, penicillin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), sulphonates and vaccines; Means of contrast (imaging techniques); Insect bites, in particular, of bee and bee; bites of serpents or jellyfish; Natural rubber latex, e.g. gloves, catheters, balloons and contraceptive devices.
Non-allergic drug-induced reaction	Some drugs may cause angioedema as a side effect. The onset may occur days or months after the first intake of the drug, for a cascade of effects that trigger the activation of the kinin-callicrein system, the metabolism of arachidonic acid and the generation of nitric oxide. Angiotensin converting enzyme inhibitors (ACE inhibitors), used to treat hypertension, are usually the major cause of angioedema. About four out of the drug-induced form occurs during the first month of taking an ACE inhibitor. The remaining cases develop many months or even years after the onset of treatment. Less common causes of drug-induced angioedema include the intake of: PDE5 inhibitors (Viagra, Cialis, Levitra, Stendra – know more about this new product) Bupropion; Vaccines; Selective serotonin reuptake inhibitors (SSRIs); Selective COX-2 Inhibitors; Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; Angiotensin II Receptor Antagonists (ARB); Statins; Proton pump inhibitors (IPPs).
Idiopathic angioedema	In some cases, there is no known cause for angioedema, although some factors can trigger the symptoms. The idiopathic form is often chronic and relapsing and usually occurs with the orthosis. In some people, where the condition lasts for years without a clear cause, there may be an autoimmune process at the base. In most cases, the cause of angioedema is unknown; Some particular stimuli can cause idiopathic angioedema, such as stress, infections, alcohol, caffeine, spicy food, extreme temperatures (e.g. hot bath or shower) and wearing tight clothes. Avoiding these triggered factors may, whenever possible, improve symptoms; Recent research indicates that 30-50% of cases of idiopathic angioedema may be associated with some types of autoimmune disorders, including systemic lupus erythematosus.
Hereditary angioedema	Dominant autosomal hereditary disease. Hereditary angioedema is characterized by low levels of a serine protease inhibitor (C1 or C1-INH inhibitor), which helps keep blood vessels stable and regulates fluid leakage in tissues. The decreased activity of C1 inhibitor leads to an excess of callicrein, which in turn produces bradykinin, a potent vasodilator. Hereditary angioedema is a very rare but serious genetic disease; The condition usually occurs in quite young patients (during adolescence rather than early infancy); Hereditary angioedema is usually not accompanied by urticaria; may cause sudden, severe and rapid onset of the face, arms, legs, hands, feet, genitals, digestive system and respiratory tract. Abdominal cramps, nausea and vomiting are the result of digestive tract involvement, while breathing difficulties are caused by swelling in the airways. Rarely, urinary retention may occur. Hereditary angioedema can occur without any provocation or be induced by precipitating factors, including local trauma, exercise, emotional stress, alcohol, and hormonal changes. Edema spreads slowly and can last for 3-4 days. 3 types: Type I and II – mutation of C1NH (SERPING1) gene on chromosome 11, which encodes for serpine protein inhibitor; type III – gene mutation on chromosome 12, which encodes for coagulation factor XII. Type I: decrease of C1INH levels; Type II: Normal levels, but reduced function of C1INH; Type III: No detectable anomaly in C1INH affects primarily the female sex (X-linked dominant).
Acquired angioedema	Acquired inhibitor C1 deficiency C1-INH deficiency can be acquired over the course of life (not just genetically inherited). This is possible in people with lymphoma and in some types of autoimmune diseases such as systemic lupus erythematosus. Whatever the cause of angioedema, the underlying pathological process is the same in all cases: swelling is the result of the loss of liquid from the walls of the small blood vessels that irrigate the subcutaneous tissues. In the skin, histamine and other inflammatory chemical mediators that release redness, itching and swelling are released. Mast cells of the dermis or mucosa are involved in various events. Mast cell degranulation releases vasoactive primary mediators such as histamine, bradykinin and other quinine; Subsequently, secondary mediators, such as leukotrienes and prostaglandins, are released that contribute to inflammatory responses both early and late, with increased vascular permeability and liquid spills in surface tissues. The triggering factors and the mechanisms involved in the release of these inflammatory mediators allow to define the different types of angioedema.

Facial swelling linked to Viagra and Cialis

When facial swelling appears as a result of non-allergic PDE5 inhibitor-induced reaction, it is often accompanied by other symptoms, such as redness of the face. The combination of these symptoms is a rather serious complication that calls for an immediate medical attention.

Redness of the face is a symptom characterized by the appearance of a reddish or reddish color on the face, particularly accentuated on cheeks, nose, chin and forehead. It can be transient or persistent.

The face may blush for a strong sensitivity to emotional stimuli (anger, embarrassment and anxiety) or temperature fluctuations (hot, cold, wind, and physical strain). Even the ingestion of hot drinks or spicy foods, alcohol intake, intense headaches, digestion and hot flashes in menopause can predispose to this manifestation. Wrinkles in the face may also be manifested by the effects of certain drugs (in particular, vasodilators and anti-hypertensives), headaches (especially in the case of cluster headaches), hypertension and allergic reactions (e.g. insect bites or cosmetics for the face). Persistent flushing, however, may occur with specific skin conditions, such as couperose, rosacea, acne, dermatitis, sunburn, or solar erythema.

Angioedema symptoms

Clinical signs of angioedema may vary slightly between the different forms, but in general the following manifestations appear:

Localized swelling usually involves peripheral, lips, tongue, oropharyngeal and genital areas;
Skin may appear normal, ie without hives or other skin rashes;
Pain, heat, itching, tingling or burning in the affected areas;
Other symptoms may include:
Abdominal pain caused by swelling of the gastrointestinal mucosa, with nausea, vomiting, cramps and diarrhea;
Swelling of the bladder or urethra, which can cause difficulty urinating;
In severe cases, swelling of the throat and / or tongue can make breathing and swallowing difficult.

Diagnosing angioedema is relatively simple. Due to its distinctive appearance, a physician should be able to recognize it after a simple physical examination and a detailed history.

Further tests, such as, for example, blood tests may be needed to precisely define the type of angioedema. The prick test can be performed to detect any allergens (allergic angioedema). Hereditary angioedema can be diagnosed with a blood test to control the protein level regulated by the C1-INH gene: a very low level confirms the disease. The diagnosis and management of hereditary angioedema are highly specialized and must be performed by a specialist in clinical immunology. Angioedema may be associated with other medical problems such as iron deficiency, liver disease and thyroid problems, which doctors will investigate through simple blood tests (useful to check or exclude the presence of these conditions). Idiopathic angioedema is usually confirmed by a process known as ‘exclusion diagnosis’; in practice the diagnosis is confirmed only after the various investigations have excluded any other illness or condition from similar manifestations.

Remedies for facial swelling caused by Viagra or Cialis

The most suitable therapy for swelling should aim to resolve the causes that caused it. In case with angioedema caused by the use of Viagra, Cialis, Levitra – or any other PDE5 inhibitor, for that matter – the first thing to do is to promptly discontinue the use of the medicine until further notice from your prescriber. In future, you might require a dose adjustment.

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When swollen face is the mere consequence of a sleepless night or a slight trauma of the face, it may be useful to place the local ice application in the form of wraps, to keep it in place for 10-15 minutes (avoid direct ice application , but wrap it in a cloth to avoid burns). Another well-known remedy is the local application of tea bags that are left out of the water extraction: while the beverage acts from the inside stimulating the diuresis and counteracting the water retention, the sachets, once cooled, are applied on the skin to exploit the astringent action of tannins (useful to reduce facial swelling).

Treatment of angioedema depends on the severity of the condition. In cases where the respiratory tract is involved, the first priority is to ensure that airways are pervasive. Patients may need emergency hospital care and need intubation.

In many cases, swelling is self-limiting and resolves spontaneously after a few hours or days.

Meanwhile, in order to alleviate the mild symptoms, you can try to put these measures into practice:

Eliminate specific triggering stimuli;
Have a cold shower (but not too much) or apply a cold compress on the affected area;
Wear large clothes;
Avoid rubbing or scratching the affected area;
Take an antihistamine to relieve itching.
In the most severe cases, if swelling, itching or pain is persistent, the following drugs may be indicated:
Oral or intravenous corticosteroids;
Antihistamines by orally or by injection;
Adrenaline injections (epinephrine).

The goal of treatment for angioedema is to reduce the symptoms to a tolerable level and able to guarantee normal activities (e.g. night work or rest). Angioedema associated with chronic autoimmune or idiopathic urticaria is often difficult to treat and drug response is variable. Generally, the following treatment steps are recommended, where each step is added to the previous one if it does not produce an inadequate response:

Phase 1: non-sedative antihistamines, such as cetirizine;

Phase 2: sedative antihistamines, for example, diphenhydramine;

Step 3: a) oral corticosteroids, for example, prednisone; b) immunosuppressants, for example ciclosporin and methotrexate.

Discontinue Viagra (Cialis, Levitra, etc.) and see a doctor if:

Generally a symptom must be considered as much more alarming as the more sudden is its onset and violent its manifestation.

Facial swelling deserves the immediate demand for health care when it comes suddenly, associated with symptoms such as skin rash, hives, severe cough and difficulty breathing, cyanosis and pallor, choking, generalized swelling of the body, itching in the throat or in the throat severe mouth and malaise (all indications of a likely anaphylactic shock).

Facial swelling should be promptly subjected to medical attention when accompanied by symptoms such as mild to moderate fever, headache, pain during swallowing, bad eye or blush, facial pain, redness of the skin or vesicle appearance skin filled with liquid or pus.

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