36 yr old male with facial puffiness after exposure of unknown smoke ....

36 yr old male patient came with the c/o facial puffiness since yesterday.
Patient was apparently a symptomatic till yesterday evening,then developed facial puffiness and lips  (gradual in onset ,progressive in nature ) after exposure to an unknown smoke .c/o change of voice since yesterday.
C/o difficulty in swallowing both liquid and solid since yesterday not associated with SOB ,pain abdomen .H/o angioedema since 15 yrs .H/o intermittent urticaria on thigh on contact with allergens like smoke ,agarbathi , spirit , plastic waste burns , hand wash , soaps (other than Santoor),ice (other cold substance)
Contact food (brinjal ,wheat,fish, mutton ,gongura,ice cream ) 
H/O tracheostomy done twice (2006 and 2017)
Not k/c/o HTN,DM 
Not on any known medications 
No c/o pedal edema ,burining micturition ,fever , cold , palpitations and giddiness .
GENERAL EXAMINATION-
Pt is c/c/c , moderately build and nourished .
Vitals- 
Temp:afebrile
BP: 130/80mmhg
PR : 118bpm 
RR: 21cpm
GRBS: 155mg/dl







DIAGNOSIS- Angioneurotic edema.
TREATMENT-
Inj DECADRON 4cc IM/stat 
TAB TECZINE 10mg/OD *4 weeks 
Inj AVIL 2cc/IV/SLOW -BD
InJ HYDROCORTISONE 100mg /IV/STAT
NEB with BUDECORT and ASTHALIN -12th hourly

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