What is the first-line treatment for angioedema?

From the Guidelines

The first-line treatment for angioedema should be C1-INH, icatibant, or ecallantide, as these medications have been shown to be safe and efficacious for the treatment of acute attacks, and should be treated as early as possible, in order to minimize their duration and severity 1.

Key Considerations

• The treatment of acute attacks of hereditary angioedema (HAE) has changed dramatically in recent years, with a focus on using specific medications such as C1-INH, icatibant, or ecallantide, which have been shown to be safe and efficacious for the treatment of acute attacks 1.
• Standard angioedema treatment modalities, such as epinephrine, corticosteroids, or antihistamines, do not have a significant effect on the swelling in patients with HAE, and are not recommended for the treatment of HAE 1.
• The management of ACE-I (or ARB)–associated angioedema is discontinuation of the ACE-I (or ARB), although there might be a significant time lag between discontinuation of the drug and the propensity for angioedema, and treatment with antihistamines, corticosteroids, or epinephrine has not been shown to be efficacious 1.

Treatment Approach

• For hereditary angioedema, the use of C1-INH, icatibant, or ecallantide is recommended as first-line treatment, and should be administered as early as possible in an attack to minimize its duration and severity 1.
• Patients with angioedema should be monitored closely for airway obstruction, as this condition can progress rapidly and become life-threatening, and upper airway edema should be treated as a medical emergency 1.
• Identifying and avoiding triggers is also essential for long-term management of angioedema.

From the Research

First-Line Treatment for Angioedema

The first-line treatment for angioedema typically involves:

• Discontinuation of the offending agent, such as angiotensin-converting enzyme inhibitors (ACEIs) 2
• Observation
• Supportive medications, including:
  • Corticosteroids
  • Antihistamines
  • Epinephrine 2

Alternative Treatment Options

In cases where first-line treatments are ineffective, alternative options may be considered, such as:

• C1 esterase inhibitor (C1-INH) 2, 3, 4
• Fresh frozen plasma (FFP) 2, 5
• Icatibant 2, 6
• Ecallantide 2, 6

Treatment of ACEI-Induced Angioedema

For angioedema induced by ACEIs, the following treatments have shown promise:

• C1-INH 3, 4
• FFP 2
• Icatibant 2
• Ecallantide 2