angioedema
Differentials
- Anaphylaxis
- deep space neck infection
- airway foreign body
- SVC syndrome
hereditary angioedema
| Headline | |
|---|---|
| Etiology | Abnormality of C1 esterase inhibitor |
| Epidemiology | Autosomal dominant, 1:50000 |
| Clinical presentation | +/- urticaria |
| Pathogenesis | |
| Diagnostic investigations | C4 (expect ↓) |
| Management | EXCLUDE Anaphylaxis: any life-threatening compromise of A/B/C A-E - most mortality from airway obstruction C1 esterase inhibitor e.g. Berinet FFP (contains naturally occurring C1 esterase inhibitors) |
allergic angiooedema
| Etiology | |
| Epidemiology | |
| Clinical presentation | Diffuse, symmetric swelling involving lips and eyes, over minutes; itch |
| Pathogenesis | Histamine-mediated |
| Diagnostic investigations | |
| Management | EXCLUDE anaphylaxis Rapidly developing: Chlorphenamine and hydrocort (CKS) → admit Symptomatic requiring treatment: antihistamine +/- short course steroids → will need rv to decide duration of antihistamines Stop ACE-is if present |
non-allergic (bradykinin-mediated) angiooedema
| Etiology | |
| Epidemiology | |
| Clinical presentation | Focal swelling involving tongue, over hours May have gut symptoms → N+V |
| Pathogenesis | Bradykinin-mediated |
| Diagnostic investigations | |
| Management | EXCLUDE anaphylaxis Rapidly developing: Chlorphenamine and hydrocort (CKS) → admit Symptomatic requiring treatment: antihistamine +/- short course steroids → will need rv to decide duration of antihistamines Stop ACE-is if present |