From the Guidelines
Steroids are not recommended for the treatment of hereditary angioedema (HAE) as they are not efficacious in reducing swelling caused by bradykinin-mediated mechanisms. According to the most recent and highest quality study 1, epinephrine, corticosteroids, and antihistamines are not effective in treating HAE. The primary mediator of swelling in patients with HAE is bradykinin, and standard angioedema treatment modalities do not have a significant effect on this mechanism.
Key Points to Consider
- HAE is characterized by relatively prolonged attacks of angioedema involving various parts of the body, and its management depends on early identification of patients 1.
- The treatment of HAE should focus on symptomatic relief and the use of HAE-specific agents, such as C1INH concentrates, a plasma kallikrein inhibitor, or a bradykinin B2 receptor antagonist 1.
- Short-term and long-term prophylaxis strategies, including the use of fresh frozen plasma, C1INH replacement, and anabolic androgens, should be individualized based on the patient's situation 1.
- It is essential to identify the underlying cause of angioedema to determine the most appropriate management strategy, as different forms of angioedema may require distinct treatment approaches 1.
Management Approach
Given the lack of efficacy of steroids in treating HAE, the management approach should focus on:
- Symptomatic relief using HAE-specific agents
- Short-term and long-term prophylaxis strategies tailored to the individual patient's needs
- Identification and addressing of the underlying cause of angioedema to determine the most appropriate management strategy.
From the Research
Angioedema Steroid Treatment
- The use of corticosteroids in the treatment of angioedema is a common practice, although its efficacy is not well established 2.
- A systematic review of pharmacotherapy for angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema found that one study comparing icatibant (a bradykinin B2 receptor antagonist) to corticosteroids and antihistamines showed more rapid symptom improvement with icatibant 2.
- However, another study found that C1 esterase inhibitors, which are used to treat hereditary angioedema, have limited efficacy in treating ACEI-induced angioedema and should not be used routinely 3.
- The treatment of angioedema depends on the subtype, with histaminergic and non-histaminergic forms requiring different approaches 4.
- While corticosteroids are often used in the treatment of angioedema, their efficacy and mechanism of action in this condition require further study 2.
Subtypes of Angioedema
- Histaminergic angioedema is associated with urticaria and pruritus, and is typically treated with antihistamines and corticosteroids 4.
- Non-histaminergic angioedema, such as that caused by ACEIs, is often more severe and may require alternative treatments, such as bradykinin antagonists or C1 inhibitor replacement 2, 5.
Treatment Considerations
- The treatment of angioedema should be individualized, taking into account the patient's disease burden, quality of life, and response to previous treatments 6.
- Patients with hereditary angioedema may require prophylactic treatment, such as attenuated androgens or nanofiltered C1 INH, to reduce the frequency and severity of attacks 6.