Current and future therapies for the treatment of histamine-induced angioedema

Expert Opin Pharmacother. 2017 Feb;18(3):253-262. doi: 10.1080/14656566.2017.1282461. Epub 2017 Jan 25.


Introduction: Angioedema, a sudden, self-limited swelling of localized areas of any part of the body that may or may not be associated with urticaria, is thought to be the result of a mast-cell mediated process versus a bradykinin etiology. Understanding the mechanism is key in determining the proper treatment. Areas Covered: Clinical presentation of varying angioedema types may be similar; however, the appropriate treatment algorithm is dependent upon clinicians' knowledge of the underlying pathophysiology and classification of angioedema. Literature review of recent guidelines, available medications, and alternative therapies was completed to provide an overview of options.

Conclusion: There are no formal guidelines for treatment of acute or chronic histamine-mediated angioedema, and therefore, algorithms for the treatment of acute and chronic urticaria should be followed until such information becomes available. Differentiating histamine-mediated versus bradykinin mediated angioedema is essential, as treatments and treatment responses are quite different. Further research is needed to better understand idiopathic angioedema that is unresponsive to H1/H2 antagonists, LTMAs, or medications designed to treat bradykinin-mediated angioedema.

Keywords: Angioedema; guidelines; histamine; histamine-mediated; mechanism; pathophysiology; treatment.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Angioedema / drug therapy*
  • Angioedema / immunology
  • Bradykinin / immunology*
  • Chronic Disease
  • Diagnosis, Differential
  • Histamine Antagonists / administration & dosage
  • Histamine Antagonists / therapeutic use*
  • Histamine H1 Antagonists / administration & dosage
  • Histamine H1 Antagonists / therapeutic use
  • Histamine H2 Antagonists / administration & dosage
  • Histamine H2 Antagonists / therapeutic use
  • Histamine Release / drug effects*
  • Histamine Release / immunology
  • Humans
  • Leukotriene Antagonists / administration & dosage
  • Leukotriene Antagonists / therapeutic use*
  • Mast Cells / drug effects*
  • Mast Cells / immunology
  • Practice Guidelines as Topic
  • Urticaria / drug therapy
  • Urticaria / immunology


  • Adrenal Cortex Hormones
  • Histamine Antagonists
  • Histamine H1 Antagonists
  • Histamine H2 Antagonists
  • Leukotriene Antagonists
  • Bradykinin