The role of serial physical examinations in the management of angioedema involving the head and neck: A prospective observational study

Abstract

ObjectiveTo elucidate the progression of angioedema of the head and neck with routine management and to assess the utility of serial physical exams and fiberoptic laryngoscopy in its management.MethodsThis study was a prospective observational research. From 2013 to 2014, a prospective observational study was conducted at a tertiary referral center. Forty patient were approached, 7 refused, 33 (18–90 years old) were enrolled. Patients presented with angioedema involving the head and neck over a 12 month period were asked to participate in the study. Physical examination and fiberoptic laryngoscopy were performed at presentation and then repeated at least 1 h later.ResultsThirty-three patients with head and neck angioedema from any cause were enrolled (mean age 58, range 23–89 years). The upper lip was the most commonly involved site (58%). On reevaluation, 82% of patients reported subjective improvement in symptoms. The association between subjective improvement and the physical exam, including fiberoptic laryngoscopy findings, was statistically significant (P < 0.001).ConclusionIn stable patients with angioedema of any head and neck subsite, self-reported symptoms are associated with clinical stability or improvement as assessed by physical signs and fiberoptic laryngoscopy. Patients' symptoms may be an appropriate surrogate to monitor clinical status without the need for routine serial physical examinations or fiberoptic laryngoscopy, though further study is needed.

Air Pollution and Angioedema

“…3 While this condition can affect any part of the body, it most commonly occurs in the face and perioral region. 4 Currently, angioedema is broadly categorized based upon the presence or absence of an inheritance pattern. 5 Most cases in the United States are acquired angioedema and most commonly associated with angiotensin-converting enzyme inhibitors (ACE-I).…”

What Is the Role of Laryngoscopy in Angioedema Isolated to the Lips, Without Laryngeal Symptoms?

“…On exam, the upper lip was the most commonly involved site (58%), followed by the lower lip (45%), anterior tongue (30%), face (21%), soft palate (18%), supraglottis (18%), floor of mouth (15%), base of tongue (12%), and neck (9%). No glottic edema was observed in any of the patients, and more than one site was involved in 76% of patients 4 . Only four patients (12%) went on to require intubation.…”

“…No glottic edema was observed in any of the patients, and more than one site was involved in 76% of patients. 4 Only four patients (12%) went on to require intubation. Linkov et al found that no anatomic site had a statistical association with intubation.…”

“…Only four patients (12%) went on to require intubation. Linkov et al found that no anatomic site had a statistical association with intubation 4 …”

Recurrent angioedema: Experience at a tertiary care urban medical center

“…Our institution, a large tertiary‐care urban medical center, treats a large volume of patients who present with primary angioedema, and we have previously described our experiences with ACE‐I related angioedema 8‐10 . However, in our clinical practice, we have come to recognize an unexpectedly large group of patients who present with recurrent episodes of angioedema, most of whom fall under the acquired idiopathic primary angioedema category.…”