From the Research
The incidence of airway involvement in spontaneous angioedema is approximately 50-60% of cases, with life-threatening upper airway obstruction developing in about 15-30% of patients, as reported in the most recent study 1.
Key Points
- Hereditary angioedema (HAE) has the highest risk, with laryngeal edema occurring in up to 50% of patients at some point in their lives.
- Acquired and drug-induced forms (particularly ACE inhibitor-related) show airway involvement in 20-30% of cases.
- Immediate management includes securing the airway, administering epinephrine (0.3-0.5mg IM for adults), antihistamines (diphenhydramine 25-50mg IV/IM), and corticosteroids (methylprednisolone 125mg IV) 2.
- For HAE specifically, C1-esterase inhibitor concentrates, icatibant (30mg SC), or ecallantide (30mg SC) are first-line treatments, as supported by the study 1.
Pathophysiology
- Allergic angioedema involves IgE-mediated histamine release.
- HAE results from unregulated bradykinin production due to C1-inhibitor deficiency, explaining why HAE doesn't respond well to standard antihistamine treatments 2.
Management
- Patients with a history of airway angioedema should carry emergency medications and have an action plan.
- The study 3 highlights the importance of a structured approach to airway management in patients with angioedema.
- The use of icatibant, a bradykinin B2 receptor antagonist, has shown promise in the treatment of ACEI-induced angioedema, as reported in the study 1.