Diagnosis and Management of Hereditary Angioedema: An Emergency Medicine Perspective

Difficulties encountered in the emergency department by patients with hereditary angioedema experiencing acute attacks

“…The mortality rate of larynx edema during an HAE attack ranges from 14% to 33%. 8 Early diagnosis and appropriate management of rare diseases, e.g., HAE, are associated with the level of awareness of the disease. The majority of physicianbased studies of HAE management are voluntary online questionnaires, and a small minority of the invited physicians responded to the survey (response rate 3.1-4.2%), 5,9 which represents a possible source of bias in interpreting the results of these studies.…”

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

“…If ACEI-AE is suspected, it is recommended that the ACEI treatment be immediately discontinued to prevent progression and recurrence of angioedema. 3 However, discontinuation of use of the drug does not usually result in rapid resolution of angioedema, and frequently the angioedema can persist and even progress for 24 to 48 hours or longer despite standard therapy with antihistamines and corticosteroids. 3 A 5-year medical record review of all patients with angioedema seen at community and tertiary care hospital EDs found that patients diagnosed as having ACEI-AE tend to be 65 years or older and have unilateral angioedema symptoms in the absence of urticaria or itching.…”

“…3 However, discontinuation of use of the drug does not usually result in rapid resolution of angioedema, and frequently the angioedema can persist and even progress for 24 to 48 hours or longer despite standard therapy with antihistamines and corticosteroids. 3 A 5-year medical record review of all patients with angioedema seen at community and tertiary care hospital EDs found that patients diagnosed as having ACEI-AE tend to be 65 years or older and have unilateral angioedema symptoms in the absence of urticaria or itching. 29 Moreover, hospital admission for angioedema is strongly related to a patient having ACEI-AE and especially those with a lack of improvement despite treatment with conventional therapy.…”

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

“…Swelling attacks in bradykinin-mediated angioedema typically last 2–5 days and are characteristically unresponsive to antihistamines and/or corticosteroids. (6, 12–14)…”

“…Swelling attacks in bradykinin-mediated angioedema typically last 2 to 5 days and are characteristically unresponsive to antihistamines and/or corticosteroids. 6,[13][14][15] Summary Statement 2: Angioedema secondary to ACE inhibitors is a common side effect of this class of drugs and occurs when decreased metabolism of bradykinin leads to excess accumulation. (LB) Angioedema is a well-known side effect associated with use of ACE inhibitors.…”