A Consensus Parameter for the Evaluation and Management of Angioedema in the Emergency Department

Abstract

Despite its relatively common occurrence and life‐threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic‐mediated angioedema from bradykinin‐mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin‐mediated angioedema. With this background in mind, this consensus parameter for the evaluation and management of angioedema attempts to provide a working framework for emergency physicians (EPs) in approaching the patient with angioedema in terms of diagnosis and management in the ED. This consensus parameter was developed from a collaborative effort among a group of EPs and leading allergists with expertise in angioedema. After rigorous debate, review of the literature, and expert opinion, the following consensus guideline document was created. The document has been endorsed by the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM).

Effectiveness of ecallantide in treating angiotensin-converting enzyme inhibitor–induced angioedema in the emergency department

“…The Evaluation and Management of Angioedema in the Emergency Department guidelines reflect this gap in treatment by emphasizing the need for a real-time biomarker to measure bradykinin or metabolites to confirm nonhistaminergic angioedema and more effective treatment approaches for patients with ACEI-AE. 30 The results of this phase 2 study reveal a trend that patients receiving standard therapy plus ecallantide met criteria for discharge home from the ED within 4 hours after initiating treatment when compared with standard therapy plus placebo. Furthermore, ecallantide is to use in the ED for the treatment of ACEI-AE because no significant adverse events were noted throughout the trial.…”

Current state of hereditary angioedema management: A patient survey

“…11 Barriers to early diagnosis, including poor recognition of HAE symptoms and lack of understanding diagnostic labs, need to be addressed by the medical community, but also patients need to be encouraged to seek evaluation themselves. Several guidelines 14,15 addressing these barriers have recently been published. However, continued educational efforts targeting physicians and patients appear necessary to reduce this diagnostic delay.…”

The Story of Angioedema: from Quincke to Bradykinin

“…& Also in 2014, a new Canadian evidence-based consensus paper updating the current data on disease expression, classification, and management was issued [191]. & Another consensus paper was published in 2014 in the USA addressing the recommended evaluation and emergency departments' approach to the diagnosis and treatment of HAE [192]. & In 2014, Italian clinical guidelines were developed by experts from different centers [193].…”