Background: Angioedema is a common presentation in the emergency department (ED). Airway angioedema can be fatal; therefore, prompt diagnosis and correct treatment are vital.
Objective of the review: Based on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED.
Review: The most common pathophysiology underlying angioedema is mediated by histamine; however, ED staff must be alert for the less common bradykinin-mediated forms of angioedema. Crucially, bradykinin-mediated angioedema does not respond to the same treatment as histamine-mediated angioedema. Bradykinin-mediated angioedema can result from many causes, including hereditary defects in C1 esterase inhibitor (C1-INH), side effects of angiotensin-converting enzyme inhibitors (ACEis), or acquired deficiency in C1-INH. The increased use of ACEis in recent decades has resulted in more frequent encounters with ACEi-induced angioedema in the ED; however, surveys have shown that many ED staff may not know how to recognize or manage bradykinin-mediated angioedema, and hospitals may not have specific medications or protocols in place.
Conclusion: ED physicians must be aware of the different pathophysiologic pathways that lead to angioedema in order to efficiently and effectively manage these potentially fatal conditions.
Keywords: Angioedema; Bradykinin-mediated; Emergency department; Guideline; Histamine-mediated.
Novelties in the Diagnosis and Treatment of AngioedemaM Cicardi et al. J Investig Allergol Clin Immunol 26 (4), 212-21; quiz two pages after page 221. PMID 27470642. - ReviewAngioedema is defined as local, noninflammatory, self-limiting edema that is circumscribed owing to increased leakage of plasma from the capillaries located in the deep l …
Diagnosis and Treatment of Bradykinin-Mediated Angioedema: Outcomes From an Angioedema Expert Consensus MeetingTJ Craig et al. Int Arch Allergy Immunol 165 (2), 119-27. PMID 25401373.Several types of angioedema exist beyond hereditary angioedema (HAE) types I/II; however, the diagnostic and treatment needs of these conditions are not well understood. …
Angioedema Related to Angiotensin-Converting Enzyme Inhibitors: Attack Severity, Treatment, and Hospital Admission in a Prospective Multicenter StudyN Javaud et al. Medicine (Baltimore) 94 (45), e1939. PMID 26559262.The number of cases of acquired angioedema related to angiotensin converting enzyme inhibitors induced (ACEI-AAE) is on the increase, with a potential concomitant increas …
Effect of C1-Esterase-inhibitor in Angiotensin-Converting Enzyme Inhibitor-Induced AngioedemaJ Greve et al. Laryngoscope 125 (6), E198-202. PMID 25583256.The results suggest a role for C1-INH as an effective and safe therapeutic option in patients with ACEi-induced angioedema, which needs to be confirmed by further larger …
Angioedema and Emergency Medicine: From Pathophysiology to Diagnosis and TreatmentF Depetri et al. Eur J Intern Med 59, 8-13. PMID 30220453. - ReviewAngioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localised increase of microvascular permeability whose mediator may be histamine or b …
Cited by 18 PubMed Central articles
Unilateral Tongue Angioedema Induced by Angiotensin Converting Enzyme Inhibitor: A Case ReportZK Al-Hoqani et al. Oman Med J 35 (1), e92. PMID 32042467. - Case ReportsTongue angioedema is a well-recognized side effect of angiotensin-converting enzyme inhibitor particularly during the first few months of initiation. Unilateral tongue in …
Clinical Features of Angioedema Induced by Renin-Angiotensin-Aldosterone System Inhibition: A Retrospective Analysis of 84 PatientsA Pfaue et al. J Community Hosp Intern Med Perspect 9 (6), 453-459. PMID 32002148.Background and objectives: Bradykinin-mediated angioedema (AE) induced by antihypertensive drugs primarily affect the head and neck region and may occur even after …
The Influence of ACE Inhibition on C1-Inhibitor: A Biomarker for ACE Inhibitor-Induced Angioedema?J Hahn et al. Biomed Hub 4 (2), 1-9. PMID 31993426.A dose-dependent effect on C1-INH levels in captopril-incubated blood samples of healthy test persons was shown. In patients with new ACE inhibitor treatment, heterogeneo …
ACE-Inhibitor Related Angioedema Is Not Sufficiently Reported to the Danish Adverse Drug Reactions DatabaseJEL Cornwall et al. Drug Healthc Patient Saf 11, 105-113. PMID 31908540.ACEi-AE was found to be severely underreported in Denmark, greatly limiting the available incidence data for this potentially life-threatening adverse reaction.
Significant Predictive Factors of the Severity and Outcomes of the First Attack of Acute Angioedema in ChildrenYJ Syue et al. BMC Pediatr 19 (1), 423. PMID 31707983.The co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predicto …