Angioedema (quick review)

30 Nov

WHAT IS IT?:
–soft tissue swelling, from the release of inflammatory mediators that cause dilation and increased permeability

–affects head/neck commonly (mouth/tongue/throat is bad for airway); bowel wall causing abdominal pain.

–generally develops over minutes to hours and resolves in 24 to 48 hours

CAUSES:
allergic/mast cell mediated

–hereditary/Deficiency of C1 (complement protein) inhibitor

–drug related (classically ACE inhibitors , but seen with other meds too—e.g. ARBs, NSAIDs, aspirin, calcium channel blockers)
rare: occurs in only 0.1 to 0.7 percent of patients treated with an ACE inhibitor; half these cases within 1 week of starting the med, but can occur years later;
–38% idiopathic (no trigger identified)

TREATMENT TOOLBOX:

ABC’s

–stop the drug (if ACE inhibitor related, etc)
–allergic reaction meds: antihistamines, steroids, epinephrine (efficacy not proven, may not work if not mast cell mediated)
FFP (fresh frozen plasma) a possibility (complement?)
10-SECOND VERSION:
–angioedema: things swell; airway swelling = not awesome
–from allergic reaction, complement deficiency, ACE I’s or other drugs, or idiopathic
–treatment options: airway, antihistamines, steroids, epi, FFP

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