Angioedema

Reviewed and revised 7/6/2012

OVERVIEW

• Angioedema = post-capillary venule leakage -> subdermal collection of fluid -> well demarcated non-pitting oedema

AETIOLOGY

• (1) IgE mediated: antigen ingestion/injection
• (2) complement mediated: fever, angioedema, arthalgias, urticaria, purpura (serum sickness)
• (3) hereditary: recurrent self-limiting attacks
• (4) idiopathic

Drugs:

• opiates, dextran, ACE-I’s, aspirin, NSAIDS

Triggers:

• food, local trauma, Hymenoptera envenomations

CLINICAL FEATURES

• details surrounding attacks
• FHx
• drug or food exposures
• well demarcated angioedema (face, extremities, genitalia)
• dysphonia
• dysphagia
• airway obstruction
• death

INVESTIGATIONS

• C1 esterase inhibitor (C1INH) – low in heretitary
• dysfunctional C1 esterase inhibitor
• between attacks: low levels of C4

MANAGEMENT

• secure airway (may require nasal AFOI or cricothyroidotomy)
• steroids
• anti-histamines
• adrenaline (SC)
• hereditary: stanozolol (anabolic steroid), danazol (gonadotrophin), aminocaproic acid (prevention), C1INH concentrate or FFP

References and links

 Lifeinthefastlane.com

• ICU Mind Maps by Paul Young – http://lifeinthefastlane.com/exams/cicm-fellowship/icu-mind-maps/