emDocs Cases - Jun 10, 2019 - Authors: Long B and Gottlieb M - Edited by: Koyfman A
"Key Points:
- Transient, non-dependent, non-pitting edema is the most common presentation of angioedema. Commonly involved sites include the face, lips, extremities, and GI system.
- Two forms include histamine- and bradykinin-mediated forms. Histamine-mediated angioedema presents similarly to anaphylaxis, while bradykinin-mediated angioedema is slower in onset, more severe, and more commonly affects the oropharynx.
- Management should focus on the airway initially.
- Histaminergic-mediated angioedema can be treated with medications such as epinephrine, antihistamines, and steroids. However, these medications are not as effective for bradykinin-mediated angioedema.
- C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists are agents that may benefit bradykinin-mediated angioedema.
- Airway management can be challenging and is improved with fiberoptic or video laryngoscopy, with preparation for cricothyrotomy.
- Disposition is also challenging, dependent on the involved sites."