Angioedema
CC: swelling lips, …
+/- abdominal pain and vomiting
Diagnosis: Angioedema
With or without urticaria or anaphylaxis
Causes ?
1. Mast cell mediated
with urticaria, bronchospasm, or hypotension
Examples:
allergic reaction (peanuts, shrimp, latex, insect stings)
or
direct mast cell stimulation (NSAIDs, radiocontrast media, opioids)
2. Bradykinin- mediated
No urticaria or pruritis
Examples:
• ACE inhibitor
• DDP-4 inhibitors ( gliptin )
• Hereditary and acquired angioedema due to C1 inhibitor deficiency
Acquired C1 inhibitor deficiency associated with SLE, lymphoma or MGUS
• Hereditary angioedema with normal C1 inhibitor
3. Idiopathic angioedema
What will you do ?
Check vitals, remember Circulation, Airway and Breathing CAB
Antihistamine, epinephrine and steroid
Call ICU
Basic labs like CBC, RFT, LFT, …
ENT consult
Do C4 and C1-inhibitor levels
Stop offending drugs example ACE inhibitors, …
For hereditary:
C1 inhibitor concentrate
If C1 inhibitor concentrate is not available, then fresh frozen plasma (FFP) can be used as an alternative
Other drugs: ecallantide & Icatibant
Remember:
In patients with urticaria and angioedema, do not diagnose hereditary angioedema
