Evaluation and management of angioedema in the emergency department

Brit Jeffrey Long, Alexander Koyfman, Michael Gottlieb

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency physicians with a focused overview of the evaluation and management of angioedema. Two primary forms include histamine-mediated and bradykinin-mediated angioedema. Histamine-mediated forms present similarly to anaphylaxis, while bradykinin-mediated angioedema presents with greater face and oropharyngeal involvement and higher risk of progression. Initial evaluation and management should focus on evaluation of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes. Histamine-mediated angioedema should be treated with epinephrine intramuscularly, antihistaminergic medications, and steroids. These medications are not effective for bradykinin-mediated forms. Other medications include C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists. Evidence is controversial concerning the efficacy of these medications in an acute episode, and airway management is the most important intervention when indicated. Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy. Disposition is dependent on patient's airway and respiratory status, as well as the sites involved.

Original languageEnglish (US)
Pages (from-to)587-600
Number of pages14
JournalWestern Journal of Emergency Medicine
Volume20
Issue number4
DOIs
StatePublished - Jan 1 2019

Fingerprint

Angioedema
Hospital Emergency Service
Bradykinin
Histamine
Complement C1 Inhibitor Protein
Laryngeal Edema
Laryngoscopy
Kallikreins
Airway Management
Anaphylaxis
Epinephrine
Edema
Emergencies
Steroids
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Evaluation and management of angioedema in the emergency department. / Long, Brit Jeffrey; Koyfman, Alexander; Gottlieb, Michael.

In: Western Journal of Emergency Medicine, Vol. 20, No. 4, 01.01.2019, p. 587-600.

Research output: Contribution to journalReview article

Long, Brit Jeffrey ; Koyfman, Alexander ; Gottlieb, Michael. / Evaluation and management of angioedema in the emergency department. In: Western Journal of Emergency Medicine. 2019 ; Vol. 20, No. 4. pp. 587-600.
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