From the Guidelines
The immediate treatment for angioedema should prioritize C1-INH, icatibant, or ecallantide, and should be treated as early as possible to minimize duration and severity, with upper airway edema being treated as a medical emergency. According to the most recent guidelines 1, all attacks should be treated with these medications, and patients should carry an acute attack treatment on their person and be trained on self-administration. The treatment approach should focus on the specific pathophysiological mechanisms of angioedema, with C1-INH, icatibant, and ecallantide being the preferred treatments for hereditary angioedema.
Some key points to consider in the treatment of angioedema include:
- Early treatment is crucial to minimize duration and severity of attacks
- Upper airway edema should be treated as a medical emergency, with consideration of early intubation or tracheotomy if necessary
- Patients should carry an acute attack treatment on their person and be trained on self-administration
- C1-INH, icatibant, and ecallantide are the preferred treatments for hereditary angioedema, with plasma being an alternative option if these are not available
It's also important to note that standard angioedema treatment modalities, such as epinephrine, corticosteroids, or antihistamines, are not efficacious for the treatment of hereditary angioedema 1. Instead, these medications may be used for symptomatic treatment, such as pain control and hydration, but should not be relied upon as the primary treatment for angioedema. Continuous monitoring of vital signs, especially respiratory status, is essential as angioedema can progress rapidly, and oxygen supplementation should be provided as needed.
From the FDA Drug Label
ICATIBANT injection, for subcutaneous use Initial U. S. Approval: 2011 INDICATIONS AND USAGE 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. (1) DOSAGE AND ADMINISTRATION 30 mg injected subcutaneously in the abdominal area. (2. 1) If response is inadequate or symptoms recur, additional injections of 30 mg may be administered at intervals of at least 6 hours. (2.1)
The immediate treatment for a patient presenting with angioedema is icatibant injection 30 mg administered subcutaneously in the abdominal area 2.
- The patient may self-administer upon recognition of an HAE attack.
- If response is inadequate or symptoms recur, additional injections of 30 mg may be administered at intervals of at least 6 hours.
- Do not administer more than 3 injections in 24 hours.
- It is also advised that patients seek immediate medical attention following treatment of laryngeal attacks with icatibant injection 2.
From the Research
Immediate Treatment for Angioedema
The immediate treatment for a patient presenting with angioedema involves several steps:
- Evaluation of consciousness and vital signs to manage breathing and support circulation if necessary 3
- Assessment of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes 4
- Differentiation between histaminergic and non-histaminergic angioedema, as the treatment approaches differ 3, 4, 5
Treatment Options
Treatment options for angioedema depend on the underlying cause:
- Allergic histaminergic angioedema: sensitive to standard therapies such as epinephrine, glucocorticoids, and antihistamines 3, 4
- Non-histaminergic angioedema: often resistant to standard therapies, with options including C1-inhibitor concentrates, icatibant, and ecallantide 3, 4, 6
- ACE inhibitor-induced angioedema: discontinuation of the causative drug is recommended, with variable results from medications such as icatibant and ecallantide 3, 6
Airway Management
Airway management is critical in cases of angioedema, particularly when there is involvement of the oral cavity and larynx: