Angioedema in the emergency department: a practical guide to differential diagnosis and management

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Abstract

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.

Related collections

Most cited references 56

Record: found
Abstract: not found
Article: not found

K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.

(2004)

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Record: found
Abstract: found
Article: not found

Fatal laryngeal attacks and mortality in hereditary angioedema due to C1-INH deficiency.

Konrad Bork, Jochen Hardt, Günther Witzke (2012)

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is characterized by relapsing skin swellings, abdominal pain attacks, and, less frequently, potentially life-threatening laryngeal attacks. This study determined the mortality of patients with and without the diagnosis of HAE-C1-INH and analyzed fatal laryngeal attacks. A cohort of 728 patients from 182 families with HAE-C1-INH was evaluated for death cases by analyzing pedigrees. Detailed information on fatal laryngeal attacks in 36 patients was obtained by questioning relatives and treating physicians. Of the 214 patients who had died, 70 asphyxiated during a laryngeal attack. Mortality by asphyxiation was higher in patients with undiagnosed HAE-C1-INH (63 cases) than in patients with diagnosed HAE-C1-INH (7 cases). The lifespan of asphyxiated patients with undiagnosed HAE-C1-INH was on average ∼31 years shorter than patients with undiagnosed HAE-C1-INH who died of other causes. Three phases were distinguished in the fatal laryngeal attacks. Phase 1, the predyspnea phase, lasted on average for 3.7 ± 3.2 hours (range, 0-11 hours). Phase 2, the dyspnea phase, lasted on average for 41 ± 49 minutes (range, 2 minutes to 4 hours). Phase 3, the loss of consciousness phase, lasted on average for 8.9 ± 5.1 minutes (range, 2-20 minutes). The high mortality in patients with undiagnosed HAE-C1-INH underscores the need to identify these patients and diagnose their condition. The analysis of fatal laryngeal attacks gives further insight into their course, thus helping to avoid fatalities in the future. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

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Is Open Access

WAO Guideline for the Management of Hereditary Angioedema

Timothy Craig, Emel Pürsün, Konrad Bork … (2012)

Hereditary Angioedema (HAE) is a rare disease and for this reason proper diagnosis and appropriate therapy are often unknown or not available for physicians and other health care providers. For this reason we convened a group of specialists that focus upon HAE from around the world to develop not only a consensus on diagnosis and management of HAE, but to also provide evidence based grades, strength of evidence and classification for the consensus. Since both consensus and evidence grading were adhered to the document meets criteria as a guideline. The outcome of the guideline is to improve diagnosis and management of patients with HAE throughout the world and to help initiate uniform care and availability of therapies to all with the diagnosis no matter where the residence of the individual with HAE exists.

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Author and article information

Contributors

Jonathan A. Bernstein: 513-558-5533 , jonathan.bernstein@uc.edu

Paolo Cremonesi: paolo.cremonesi@galliera.it

Thomas K. Hoffmann: t.hoffmann@uniklinik-ulm.de

John Hollingsworth: john.hollingsworth@aintree.nhs.uk

Journal

Journal ID (nlm-ta): Int J Emerg Med

Journal ID (iso-abbrev): Int J Emerg Med

Title: International Journal of Emergency Medicine

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1865-1372

ISSN (Electronic): 1865-1380

Publication date (Electronic): 13 April 2017

Publication date PMC-release: 13 April 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 15

Affiliations

[1 ]GRID grid.24827.3b, Division of Immunology/Allergy, , University of Cincinnati, ; 231 Albert Sabin Way, Cincinnati, OH 45267 USA

[2 ]GRID grid.415279.c, Department of Emergency Medicine, , E. O. Galliera Hospital, ; Genoa, Italy

[3 ]GRID grid.410712.1, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, , Ulm University Medical Center, ; Ulm, Germany

[4 ]GRID grid.415598.4, Department of Emergency Medicine, , University Hospital, ; Aintree, Liverpool, UK

Article

Publisher ID: 141

DOI: 10.1186/s12245-017-0141-z

PMC ID: 5389952

PubMed ID: 28405953

SO-VID: 40781535-9c99-4383-80ed-73edce13bf80

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 29 July 2016

Date accepted : 28 March 2017

Funding

Funded by: Shire HGT

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: angioedema,emergency department,histamine-mediated,bradykinin-mediated,guideline

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: angioedema, emergency department, histamine-mediated, bradykinin-mediated, guideline