Background and Aims Allergic rhinitis (AR) is a significant disease that affects children and adults and often under-diagnosed which has a deleterious impact on quality of life. Chronic recurrent severe lip angioedema secondary to AR was not previously reported.
Methods We describe a 5-year-old boy who suffered from chronic recurrent severe lip angioedema for more than 2-years. His symptom was not associated with facial rash or any food ingestion. He was also suffering from dental carries therefore dental extraction was performed for that possibly of secondary gingivitis associated lip angioedema, but without improvement. In occasions he had oral ulcers and the possibility of Behçet’s disease was considered for which colchicines was used for more than 3-weeks without benefits. Cervical lymph node biopsy ruled out malignancies.
Results He was found to have chronic congested nasal mucosa. Skin prick test (SPT) for environmental allergens was strongly positive for hose dust mites, cockroaches, grass and molds. Nasal findings and SPT confirmed the diagnosis of AR. Over 2-months he has significant improvement (> 70%) in his symptoms with AR treatment (ie; fluticasone spry BID, montelukaste 4mg PO OD and loratidine 2.5mg PO OD). Normal C1 esterase level and function ruled out hereditary angioedema.
Conclusion AR is a common disease that should be considered in the differential diagnosis of chronic recurrent lip angioedema. Diagnosis in children may be delayed because of the overlapping diseases (i.e.; viral upper respiratory tract infections). However, hereditary angioedema needs to be ruled out as an important cause of recurrent angioedema.