Vibratory angioedema is a sometimes referred to as vibratory urticaria or vibratory urticaria/angioedema. It is characterized by red wheals or swelling in response to skin exposure to vibration. For example while jogging, running, cycling, riding a motorcycle, massaging or mowing the lawn. The skin lesions are associated with an itch or burning sensation that occurs at the skin sites exposed to vibration. After vibratory exposure, the symptoms typically arrive within a few minutes and disappear within 24 hours. This involves histamine and other mediators released from activated skin mast cell by degranulation.
Vibratory angioedema is a very rare condition. Other than avoiding vibratory conditions, the use of second generation H1-antihistamines and Xolair are currently recommended.
Vibratory angioedema can be hereditary or acquired. Systemic symptoms can also occur, symptoms reported have been dizziness, tachycardia, low blood pressure, chest tightness.
The different triggers can range widely for patients with vibratory angioedema, others triggers reported by patients were: use of a towel, playing a musical instrument, clapping the hands, using a buttonhole machine, jackhammering, vibration due to a dental procedure, skiing, bowling, sexual intercourse and snoring.
Generally lab testing or a skin biopsy was not helpful nor did it benefit the workup. The diagnosis is made clinically. Provocation can be done by using a vortex mixer at 780 to 1380 revolutions/min for 5 minutes on a patients forearm. The test sites is assessed 10 minutes alter and the presence of erythematous wheals or cutaneous swelling at the stimulated site is considered a positive result.
The treatment options begin with the second-generation H1 antihistamines such as Claritin, Allegra, Zyrtec or Xyzal in higher than normal dosages. Besides Xolair, cyclosporine, steroids, singulair, dapsone, methotrexate and other drugs have been used. Epinephrine can be used for anaphylaxis if it occurs. Some practitioners have attempted vibratory desensitization, although the studies are very limited.