Tag Archives: allergy

anaphylaxis quick hits

3 Feb

tying into a recent anaphylaxis theme, via a recent review in AAEM’s Common Sense mag (work a quick read, if you’ve got time):


10-second quick hits on ANAPHYLAXIS:

IM epi(nephrine) better than SC — higher plasma concentrations with IM

  • remember, for patient teaching, LATERAL thigh (away from big vessels)


in refractory cases, consider atropine and/or vasopressin


H2 blockers might be helpful to toss in with your H1 (e.g. diphenhydramine)


biphasic reactions are rare (also covered a bit here).


There you go.


References: AAEM article (pg 45-46); picture




fresh frozen plasma for angioedema

10 May


angioedema from multiple etiologies (e.g. hereditary, ACE inhibitors)

some treatments, e.g. FFP, C1 concentrate, derived from hereditary angioedema data

in the ED, may not know the etilogy

if its due to ACE inhibitor use, will FFP still help?


frequency of ACE inhibitor induced angioedema = 0.1-0.7% (so….rare)

authors reviewed a case series of 7 


methylprednisolone (125mg IV)

epinephrine (0.3mg 1:1000 IM)

diphenhydramine (50mg IV)

famotidine (20mg IV)

—no observed response after some hours, so they tried:

FFP (1-3 units)

progression of swelling stopped within 2-4 hrs after FFP given


small sample size, but if you’ve thrown everything at ’em but the kitchen sink and there’s no change, might as well try the kitchen sink (e.g. FFP)

don’t forget about controlling that airway, too.

References: JEM article; picture

Angioedema (of the face) – QUICK HITS

22 Apr

Self limited swelling of the lips/mouth/uvula/face (Another type of angioedema, bowel wall angioedema, will not be covered here.)

-can occur with or without other signs/symptoms of allergic reaction.   

-Causes can include Hereditary angioedema, Mast cell mediated angioedema (allergic ractions), or in bradykinin induced angioedema


Mast Cell Mediated Angioedema

-Symptoms begin with minutes of exposure and resolve in 24-48 hours

-Associated with other symptoms/signs of allergic reaction including

  • urticaria,
  • pruritis,
  • bronchospasm,
  • hypotension,
  • throat tightness


Bradykinin Induced Angioedema

Generally isolated to swelling with no other symptoms (no urticaria or other signs of systemic involvement)

-Usually develops slower, over 24-36 hours, and can last two to four days

-No clear association with when this may occur- for ACE inhibitor angioedema, can occur at onset of medication use, after a recent medication dose change, or after years of use

Immunosuppressed patients are more likely to experience this type of reaction even from medications they have been on for a long time

-Unilateral angioedema is more commonly related to ACE inhibitor induced angioedema


Hereditary Angioedema

-Caused from C1 inhibitor deficiency

-About 25% of patients have with Hereditary angioedema have a new mutation, so no family history does not rule out hereditary angioedema as a cause


Idiopathic Angioedema

-Recurrent episodes of angioedema without any systemic symptoms who have no drug exposure or complement pathway deficiency



-Without a clear cause general treatment is the same for all three groups:

            –AIRWAY: Intubate if patient exhibits impending airway loss

            -If laryngeal or other respiratory involvement consider Epinephrine IM or SC and/or albuterol



            –H1 and H2 antihistamines

-Note:  if Bradykinin induced angioedema, the main treatment is cessation of the medication causing the reaction           


Common Medication Causes for All Types of Angioedema

-ACE inhibitor or ARB


-Calcium channel blockers




Submitted by J. Grover. 


Sources:  Chan YF and Kalira D.  “Angiotensin-Converting Enzyme Inhibitors as a Cause of Unilateral Tongue Angioedema in a 68 Year old Woman.”  American Journal of Emergency Medicine 2005: 9:249-250.; Kuhlen JL and Forcucci J.  “Angiotensin-Converting Enzyme Inhibitor-induced Unilateral Tongue Angioedema.”  American Journal of the Medical Sciences 2012: 344:5;416-417.; Uptodate.  An Overview of Angioedema:  Clinical Features, Diagnosis, and Management; picture