Because it can rapidly compromise the airway, early recognition and airway protection are critical.”
???? PROVIDE:
???? What Is Angioedema?
- Localized, non-pitting swelling of subcutaneous and submucosal tissues
- Can affect face, lips, tongue, pharynx, larynx, and neck
- Caused by increased vascular permeability due to histamine or bradykinin mediated pathways
???? Types / Causes
1. Histamine-mediated (allergic)
- IgE-mediated hypersensitivity (e.g., food, insect sting, drugs)
- Associated with urticaria and itching
- Responds to antihistamines, steroids, epinephrine
2. Bradykinin-mediated
- ACE inhibitor-induced angioedema (most common drug cause)
- Hereditary angioedema (HAE): C1 esterase inhibitor deficiency or dysfunction
- Acquired angioedema: Due to lymphoproliferative or autoimmune disorders
???? Clinical Features
- Sudden onset swelling of lips, face, tongue, or neck
- Swelling without itching or rash (especially in bradykinin-mediated)
- Possible dysphagia, dysphonia, hoarseness
- Stridor or respiratory distress if airway involved
- No fever, pain, or erythema (usually)
???? Diagnosis
- Clinical diagnosis — rapid recognition crucial
- Consider labs if hereditary or acquired:
- C4 and C1-INH levels and function (for HAE)
- Identify history of:
- ACE inhibitor use
- Allergens
- Family history of angioedema
????️ Management
???? 1. Airway Management
- Assess airway immediately
- Prepare for early intubation if airway compromise suspected
- Difficult airway likely — involve anesthesia/ENT early
- Surgical airway (cricothyrotomy/tracheostomy) if intubation impossible
???? 2. Medical Treatment
Histamine-mediated:
- Epinephrine IM (if anaphylaxis)
- Antihistamines (H1 blockers like diphenhydramine)
- Systemic corticosteroids (e.g., methylprednisolone)
- Supportive care (oxygen, IV fluids)
Bradykinin-mediated:
- Discontinue ACE inhibitors immediately
- C1-INH concentrate (for hereditary or acquired cases)
- Icatibant (bradykinin receptor antagonist)
- Fresh frozen plasma (if C1-INH unavailable)
???? Disposition
- Admit patients with airway involvement or progressive swelling
- Observe for delayed airway compromise (especially ACEi angioedema)
- Provide patient education on avoiding triggers and emergency plans
❗ Clinical Pearls
“Facial swelling without itching or rash suggests bradykinin-mediated angioedema — standard allergy meds won’t help.”
“Always assess the airway first — swelling in neck or tongue can worsen rapidly.”
“ACE inhibitors are a common hidden cause — always ask about medications.”
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