From the Guidelines
Angioedema treatment should prioritize the use of C1-INH, icatibant, or ecallantide for acute attacks, as these medications have been shown to be effective in reducing the duration and severity of attacks 1.
Key Considerations
- The primary goal of treatment is to minimize morbidity, mortality, and improve quality of life.
- Hereditary angioedema (HAE) requires specialized treatment, as standard angioedema treatment modalities such as epinephrine, corticosteroids, or antihistamines are not efficacious and are not recommended 1.
- For severe cases, especially those involving airway compromise, immediate administration of C1-INH, icatibant, or ecallantide is crucial, followed by emergency medical attention.
Treatment Options
- C1 esterase inhibitor concentrates (Berinert, Cinryze) are effective for treating HAE attacks 1.
- Kallikrein inhibitors (ecallantide) and bradykinin receptor antagonists (icatibant) are also effective treatment options for HAE attacks 1.
- For angioedema caused by ACE inhibitors, the medication should be discontinued immediately and permanently, with alternative antihypertensives prescribed.
Patient Education
- Patients should be educated to identify and avoid triggers, carry emergency medication if prescribed, and seek immediate medical attention for any facial, tongue, or throat swelling.
- Regular monitoring for side effects by blood testing and periodic hepatic ultrasounds should be implemented for patients receiving attenuated androgens as long-term prophylaxis 1.
From the FDA Drug Label
BERINERT is a plasma-derived C1 Esterase Inhibitor (Human) indicated for the treatment of acute abdominal, facial, or laryngeal hereditary angioedema (HAE) attacks in adult and pediatric patients. The recommended treatment for angioedema is C1 esterase inhibitor (IV), specifically BERINERT, which is indicated for the treatment of acute abdominal, facial, or laryngeal hereditary angioedema (HAE) attacks in adult and pediatric patients 2.
- The safety and efficacy of BERINERT in the treatment of acute abdominal or facial HAE attacks in subjects with hereditary angioedema were demonstrated in a placebo-controlled, double-blind, prospective, multinational, randomized, parallel-group, dose-finding, three-arm, clinical study 2.
- BERINERT was well tolerated and no signs of toxicity were observed up to the highest dose administered in animal studies 2. Key points:
- BERINERT is indicated for the treatment of acute abdominal, facial, or laryngeal HAE attacks.
- BERINERT has demonstrated safety and efficacy in clinical studies.
- BERINERT was well tolerated in animal studies.
From the Research
Angioedema Treatment Overview
- Angioedema is a potentially life-threatening condition that requires systematic assessment and treatment 3
- The most effective treatment depends on the identification of the causative mechanism and the clinician's knowledge and experience with innovative therapeutic regimens 4
Classification and Treatment of Angioedema
- Angioedema can be classified into histaminergic and non-histaminergic forms, with different treatment approaches for each type 5
- Treatment options include established pharmacologic interventions, such as antihistamines, and novel medications that target specific pathophysiological mechanisms 3, 6
- A comprehensive personal and family history, physical examination, and monitoring of response to therapy are essential for diagnosis and treatment 4
Specific Treatment Approaches
- For hereditary angioedema, emerging treatments include targets of prekallikrein, DNA vector technology replacing C1-INH protein, and CRISPR technology targeting prekallikrein 6
- For acquired angioedema, treatment depends on the underlying cause, such as drug intake or allergic/pseudoallergic reactions 5
- For idiopathic angioedema, a novel algorithm can guide clinicians in the workup and management of patients unresponsive to conventional therapy with antihistamines 6