From the Guidelines
The duration of steroids for angioedema is not recommended as they are not efficacious for the treatment of hereditary angioedema (HAE) and should not be used as a primary treatment option 1.
Treatment Approach
The treatment of acute angioedema depends on its cause and severity. For hereditary angioedema, specific treatments such as C1 esterase inhibitor concentrates (Berinert or Cinryze), icatibant (30mg subcutaneously), or ecallantide (30mg subcutaneously) are recommended 1.
- These medications have been shown to be safe and efficacious for the treatment of acute HAE attacks.
- On-demand treatment is most effective when administered as early as possible in an attack.
Supportive Care
Supportive care is essential, including:
- Airway management with possible intubation for severe cases affecting the upper airway.
- Patients should be monitored closely for at least 4-6 hours after symptom resolution, as recurrence can occur.
- Identifying and removing triggers (such as medications like ACE inhibitors or allergens) is crucial for preventing future episodes.
Key Considerations
- Standard angioedema treatment modalities, such as epinephrine, corticosteroids, or antihistamines, do not have a significant effect on the swelling in patients with HAE 1.
- The use of one of the newer specific medicines is preferred for treatment of angioedema attacks.
- Narcotic addiction is a risk for patients with HAE who experience frequent attacks, and out-of-hospital use of potent narcotics should be avoided 1.
From the Research
Treatment for Acute Angioedema
- The recommended treatment for acute angioedema depends on the underlying cause, which can be either histamine-mediated or bradykinin-mediated 2, 3, 4, 5, 6.
- Histamine-mediated angioedema is typically treated with antihistamines, steroids, and epinephrine intramuscularly 6.
- Bradykinin-mediated angioedema, on the other hand, is more challenging to treat and may require the administration of a bradykinin inhibitor or a C1 esterase inhibitor substitute 2, 3, 5.
Duration of Steroids for Angioedema
- There is limited information available on the specific duration of steroid treatment for angioedema 2, 3, 4, 5, 6.
- Steroids are not effective for bradykinin-mediated angioedema, and their use is generally limited to histamine-mediated cases 2, 6.
- The treatment approach for angioedema should be tailored to the individual patient's specific form of angioedema, and the duration of treatment will depend on the severity and underlying cause of the condition 3, 5, 6.
Management of Angioedema
- The management of angioedema involves a combination of acute treatment, long-term prophylaxis, and on-demand therapy 5, 6.
- Patients with hereditary angioedema (HAE) require C1 esterase inhibitor sparing therapy and a treat-the-cause approach to reduce the risk of recurrent attacks 2, 5.
- Airway management is critical in cases of angioedema, particularly for bradykinin-mediated forms, and may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy 6.