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On evaluation, her clinical history was suggestive of acquired angio-oedema, which was confirmed by bloodwork. This case report underscores key clinical pearls that should prompt clinicians to consider a diagnosis of acquired angio-oedema, a rare bradykinin-mediated disease which can present with acute life-threatening angio-oedema and for which a clinical diagnosis is critical to selecting the appropriate acute therapy. The case also highlights the utility of a complement C4 test when patients present acutely with angio-oedema of unknown aetiology, especially in the emergency department.<\/jats:p>","DOI":"10.1136\/bcr-2025-265525","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T13:40:19Z","timestamp":1747662019000},"page":"e265525","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acquired angio-oedema as a mimicker of drug allergy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-8079","authenticated-orcid":false,"given":"Jane","family":"Liao","sequence":"first","affiliation":[{"name":"Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Department of Medicine, Division of Allergy & Immunology, Montefiore Health System, Bronx, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehr","family":"Mathew","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lina","family":"Elmansy","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence Ida","family":"Hsu","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ami Pearl","family":"Belmont","sequence":"additional","affiliation":[{"name":"Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"2025082700541507000_18.5.e265525.1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12341"},{"key":"2025082700541507000_18.5.e265525.2","doi-asserted-by":"crossref","first-page":"587","DOI":"10.5811\/westjem.2019.5.42650","article-title":"Evaluation and Management of Angioedema in the Emergency Department","volume":"20","author":"Long","year":"2019","journal-title":"West J Emerg Med"},{"key":"2025082700541507000_18.5.e265525.3","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-018-8710-3"},{"key":"2025082700541507000_18.5.e265525.4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.anai.2022.08.996","article-title":"Tryptase in type I hypersensitivity","volume":"130","author":"Michel","year":"2023","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2025082700541507000_18.5.e265525.5","doi-asserted-by":"crossref","DOI":"10.3389\/falgy.2023.1263432","article-title":"Pathophysiology of bradykinin and histamine mediated angioedema","volume":"4","author":"Lima","year":"2023","journal-title":"Front Allergy"},{"key":"2025082700541507000_18.5.e265525.6","article-title":"A Comprehensive Review of Bradykinin-Induced Angioedema Versus Histamine-Induced Angioedema in the Emergency Department","volume":"14","author":"Jayasinghe","year":"2022","journal-title":"Cureus"},{"key":"2025082700541507000_18.5.e265525.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.03.034"},{"key":"2025082700541507000_18.5.e265525.8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12245-017-0141-z","article-title":"Angioedema in the emergency department: a practical guide to differential diagnosis and management","volume":"10","author":"Bernstein","year":"2017","journal-title":"Int J Emerg Med"},{"key":"2025082700541507000_18.5.e265525.9","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1002\/lary.26336","article-title":"The burden of angioedema on United States emergency departments: 2006-2010","volume":"127","author":"Smith","year":"2017","journal-title":"Laryngoscope"},{"key":"2025082700541507000_18.5.e265525.10","unstructured":"Lab manual C4 complement. 2023. Available: https:\/\/labmanual.ynhh.org\/Home\/TestDetails?id=7744&dnId=1&plId=12 [Accessed 9 Feb 2025]."},{"key":"2025082700541507000_18.5.e265525.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.01.017"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:54:26Z","timestamp":1756281266000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":11,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,19]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bcr-2025-265525"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265525","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}