From the Guidelines
The current treatment for angioedema depends on its type and severity, with first-line treatments for acute attacks of hereditary or bradykinin-mediated angioedema including C1 esterase inhibitor concentrates, icatibant, or ecallantide, as supported by evidence from studies such as 1 and 2. For acute attacks of hereditary or bradykinin-mediated angioedema, the following treatments are recommended:
- C1 esterase inhibitor concentrates (Berinert, Cinryze)
- Icatibant (Firazyr, 30mg subcutaneously)
- Ecallantide (Kalbitor, 30mg subcutaneously) These treatments have been shown to be safe and efficacious for the treatment of acute HAE attacks, as demonstrated in studies such as 1 and 2. For histamine-mediated angioedema, treatment involves:
- Antihistamines (diphenhydramine 25-50mg or cetirizine 10mg)
- Corticosteroids (prednisone 40-60mg)
- Epinephrine (0.3-0.5mg intramuscularly) for severe cases affecting the airway However, it is essential to note that epinephrine, corticosteroids, and antihistamines are not efficacious and are not recommended for the treatment of HAE, as stated in 3. Severe cases of any type may require airway management. For long-term prevention of hereditary angioedema, options include:
- Lanadelumab (Takhzyro, 300mg every 2 weeks)
- Berotralstat (Orladeyo, 150mg daily)
- Prophylactic C1 inhibitor Angiotensin-converting enzyme inhibitor-induced angioedema requires immediate discontinuation of the medication and switching to an alternative class, as recommended in 4. Treatment should be initiated promptly as angioedema can progress rapidly and become life-threatening, particularly when it affects the upper airway. The different approaches reflect the distinct pathophysiological mechanisms: histamine-mediated angioedema responds to antihistamines and steroids, while bradykinin-mediated forms require targeted therapies that inhibit the bradykinin pathway. It is crucial to consider the underlying cause of angioedema and choose the most appropriate treatment option, as supported by evidence from studies such as 1, 2, and 4.
From the FDA Drug Label
Icatibant injection is a bradykinin B2 receptor antagonist indicated for treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older. Icatibant injection is indicated for the treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older. Icatibant injection is a bradykinin B2 receptor antagonist indicated for treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older.
The current treatment for angioedema is icatibant (SQ), a bradykinin B2 receptor antagonist, which is indicated for the treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older 5, 6, 7.
- The recommended dosage is 30 mg injected subcutaneously in the abdominal area.
- If response is inadequate or symptoms recur, additional injections of 30 mg may be administered at intervals of at least 6 hours.
- Patients may self-administer upon recognition of an HAE attack.
From the Research
Current Treatment for Angioedema
The current treatment for angioedema depends on the underlying cause and whether it is histaminergic or non-histaminergic in nature.
- For histaminergic angioedema, treatment options include: + Epinephrine intramuscularly 8 + Antihistaminergic medications 8, 9 + Steroids 8, 9
- For non-histaminergic angioedema, treatment options include: + C1-INH protein replacement 10, 8, 9 + Kallikrein inhibitor (ecallantide) 10, 11 + Bradykinin receptor antagonists (icatibant) 10, 11 + Fresh frozen plasma if C1-INH concentrates are not available 10
Airway Management
Airway management is crucial in cases of angioedema, especially when there is involvement of the larynx or oropharynx.
- Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy 8
- Disposition is dependent on the patient's airway and respiratory status, as well as the sites involved 8
Discontinuation of Causative Drug
If the angioedema is caused by a drug, such as an ACE inhibitor, discontinuation of the drug is recommended 10, 11