Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment

European Journal of Internal Medicine
Federica DepetriM Cugno

Abstract

Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localised increase of microvascular permeability whose mediator may be histamine or bradykinin. Patients present to emergency department when angioedema involves oral cavity and larynx (life-threatening conditions) or gut (mimicking an acute abdomen). After initial evaluation of consciousness and vital signs to manage breathing and to support circulation if necessary, a simple approach can be applied for a correct diagnosis and treatment. Forms of edema such as anasarca, myxedema, superior vena cava syndrome and acute dermatitis should be ruled out. Then, effort should be done to differentiate histaminergic from non-histaminergic angioedema. Concomitant urticaria and pruritus suggest a histaminergic origin. Exposure to allergens and drugs (mainly ACE inhibitors and non steroidal anti-inflammatory drugs) should be investigated as well as a family history of similar symptoms. Allergic histaminergic angioedema has a rapid course (minutes) whereas non histaminergic angioedema is slower (hours). Since frequently the intervention needs to be immediate, the initial diagnosis is only clinical. However, laboratory tests can be subsequently confirmatory....Continue Reading

Citations

May 20, 2020·Clinical Practice and Cases in Emergency Medicine·Amy Rossi, Lesley Osborn
Jul 10, 2019·Frontiers in Immunology·Massimo CugnoAngelo Valerio Marzano
Aug 9, 2020·Journal of Asthma and Allergy·Amalie Hartvig PallEva Rye Rasmussen
Dec 22, 2020·Journal of Stomatology, Oral and Maxillofacial Surgery·Simon RasteauNicolas Sigaux
May 24, 2021·Allergology International : Official Journal of the Japanese Society of Allergology·Satoshi MoriokeMichihiro Hide
Aug 28, 2021·International Journal of Molecular Sciences·Akane WadaMotonobu Nakamura

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