Angioedema

Revision as of 15:01, 21 November 2011 by Jswartz (talk | contribs)

Background

  • Angioedema is paroxysmal, nondemarcated swelling of dermal or submucosal layers of skin or mucosa
    • Swelling is asymmetric, nonpitting, and nonpruritic
  • 4 etiologies:
    • 1. Congenital or acquired loss of C1 esterase inhibitor
    • 2. IgE–mediated type I allergic reaction
    • 3. ACEI adverse reaction
    • 4. Idiopathic

Hereditary Angioedema

Background

  • Due to C1 esterase inhibitor deficiency
    • Leads to unregulated activity of vasoactive mediators associated with complement pathway
    • Autosomal dominant

Diagnosis

  • Suspect in patients with history of recurrent peripheral angioedema and abdominal pain
    • 75% experience onset of symptoms before age 15yr
  • Decreased levels of C1 and C4 esterase inhibitors confirms diagnosis

Treatment

  • Epinephrine IM can produce some improvement in early acute attacks
  • C1 esterase inhibitor (if available)
  • FFP
    • Replaces the missing inhibitor protein
    • Not recommended in life-threatening laryngeal edema (some pts may become more edematous)
      • Instead, pt should undergo fiberoptic intubation w/ preparation for surgical airway

ACE Inhibitor-induced Angioedema

Background

  • Incidence is highest within the first month; however, may occur at anytime
  • Incidence is 0.1-2.2% (more common in blacks)

Treatment

  • Epinephrine 0.3mg IM q15-20min prn
  • Diphenhydramine 50mg IV OR cetirizine 10mg PO
  • Methylprednisolone 125mg IV
  • Awake fiberoptic intubation

Disposition

  • Consider discharge after obs if there is no airway edema and pt improves

Source

Tintinalli