Angioedema

T78.3 + (Y34.99/Y57.9/Y14.99)

DESCRIPTION

Two major groups of angioedema should be differentiated: allergic angioedema forming part of a systemic reaction to an allergen, and non-allergic angioedema caused by bradykinin excess.

In allergic angioedema, features of allergy or anaphylaxis will often be present, including urticaria, bronchospasm, hypotension or gastrointestinal upset. Anaphylaxis should be treated urgently. See section 20.7: Anaphylaxis/anaphylactic shock.

Non-allergic angioedema is most commonly caused by ACE-inhibitors in susceptible individuals. It may also be caused by hereditary angioedema or acquired C1 esterase deficiency. Associated features of allergy are absent.

Symptoms

Swelling usually occurs around eyes and lips but may occur elsewhere.

Life-threatening airway obstruction can occur with angioedema of the upper airways.

GENERAL MEASURES

Stop all suspected agents, e.g. ACE-inhibitor.

In case of angioedema with airway obstruction, early airway management is essential. If oedema is extensive or progressive, establish a definitive airway. The most skilled person available must handle airway interventions.

Avoid re-exposure to the offending agent and provide an alert bracelet.

MEDICINE TREATMENT

In severe cases of hypersensitivity where airway obstruction may be imminent:

Note: A definitive airway may be required before patient responds to medical treatment. Low threshold to surgical airway tracheostomy.

In cases where angioedema is part of anaphylaxis, treat as anaphylaxis.

See Anaphylaxis/Anaphylactic shock.

If urticaria and/or itch present (no imminent airway compromise):

  • Hydrocortisone, IV, 100 mg as a single dose.

LoEIII

AND

Promethazine, IV, 25–50 mg as a single dose.

OR

  • Cetirizine, oral, 10 mg as a single dose.

LoEIII

Severe ACE-inhibitor induced angioedema with threatened airway:

Note: A definitive airway may be required before patient responds to medical treatment. Low threshold to surgical airway tracheostomy.

  • Lyophilised plasma, IV, 2 units.

LoEIII

If lyophilised plasma is unavailable:

  • FFP, IV, 2 units.

LoEII [12]

Observe all cases until resolution.