Angioedema: differential diagnosis and acute management

Postgrad Med. 2021 Sep;133(7):765-770. doi: 10.1080/00325481.2021.1945219. Epub 2021 Jul 26.

Abstract

A clinical vignette illustrates a typical presentation of a patient seeking help for acute angioedema. Despite the risks of SARS-CoV-2 (COVID-19) exposure, it is critical to evaluate patients with acute angioedema in person, because there is always the potential for angioedema to progress to the head, neck, or lungs, which can rapidly compromise the airways and require immediate intervention to avoid potential asphyxiation. There are three mediators of angioedema, histamine, leukotriene, or bradykinin, each requiring different management. This article provides clinicians essential information for differentiating between these types of angioedema, including an overview of the underlying pathogenies of angioedema, and the subjective and objective findings that are useful in differentiating between angioedema types. The article ends with the appropriate management for each type of acute angioedema, including the medications approved by the FDA for on-demand treatment of an HAE attack.

Keywords: Angioedema; asphyxiation; bradykinin; hereditary angioedema; swelling.

Publication types

  • Editorial

MeSH terms

  • Acute Disease
  • Angioedema / diagnosis*
  • Angioedema / physiopathology
  • Angioedema / therapy
  • Anti-Allergic Agents / therapeutic use
  • Bradykinin / biosynthesis
  • COVID-19 / epidemiology*
  • Cyclooxygenase 2 Inhibitors / therapeutic use
  • Diagnosis, Differential
  • Histamine / biosynthesis
  • Histamine Antagonists / therapeutic use
  • Humans
  • Leukotrienes / biosynthesis
  • Omalizumab / therapeutic use
  • Otorhinolaryngologic Surgical Procedures / methods
  • Physical Examination
  • SARS-CoV-2

Substances

  • Anti-Allergic Agents
  • Cyclooxygenase 2 Inhibitors
  • Histamine Antagonists
  • Leukotrienes
  • Omalizumab
  • Histamine
  • Bradykinin