From the Guidelines
The most effective treatment for a 21-year-old man with severe swelling of the tongue and lip likely due to hereditary angioedema (HAE) is immediate administration of a C1 esterase inhibitor concentrate (such as Berinert or Cinryze) or a bradykinin receptor antagonist (icatibant/Firazyr) 1.
Key Considerations
- For C1 inhibitor concentrates, the typical dose is 20 units/kg IV for Berinert or 1000 units IV for Cinryze.
- Alternatively, icatibant can be administered as a 30 mg subcutaneous injection, which can be repeated after 6 hours if needed, up to 3 doses in 24 hours.
- Recombinant human C1 inhibitor (Ruconest) at 50 units/kg IV is another option.
- These medications work by either replacing the deficient C1 inhibitor protein or blocking bradykinin effects, which is the mediator responsible for the swelling in HAE.
Important Notes
- Airway assessment is critical, and the patient may need emergency airway management if there is significant tongue or laryngeal involvement.
- Unlike allergic angioedema, HAE does not respond to antihistamines, corticosteroids, or epinephrine, so these should not be relied upon 1.
- Epinephrine, corticosteroids, and antihistamines are not efficacious and are not recommended for the treatment of HAE 1.
- Fresh frozen plasma is often effective in abrogating HAE attacks; however, fresh frozen plasma might acutely exacerbate some attacks, and for this reason, caution is required 1.
Long-term Management
- After the acute episode resolves, the patient should be referred to an immunologist for long-term management, which may include prophylactic medications to prevent future attacks.
- Management of HAE attacks can involve symptomatic treatment based on the region of body swelling 1.
From the FDA Drug Label
INDICATIONS AND USAGE 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 most effective treatment for a 21-year-old man with severe swelling of the tongue and lip, likely due to hereditary angioedema (HAE), is C1 esterase inhibitor (IV), such as Berinert 2, 2, 2.
Key points:
- C1 esterase inhibitor (IV) is indicated for the treatment of acute HAE attacks in adult and pediatric patients.
- It is administered intravenously at a dose of 20 International Units per kg body weight.
- Patients should be monitored for signs of hypersensitivity reactions and blood clots during and after administration.
From the Research
Treatment Options for Hereditary Angioedema (HAE)
The patient's symptoms, including severe swelling of the tongue and lip, suggest hereditary angioedema (HAE) as a possible diagnosis. Considering the family history of similar symptoms, HAE is a likely cause. The following treatment options are available:
- Cryoprecipitate: Not mentioned as a primary treatment option in the provided studies.
- Diphenhydramine: Although antihistamines like diphenhydramine are sometimes used to treat angioedema, they are not the most effective treatment for HAE 3.
- Epinephrine: Epinephrine is used to treat acute attacks of HAE, but it may not be the most effective treatment for this patient's symptoms 4, 3.
- Fresh frozen plasma (FFP): FFP has been shown to be effective in treating HAE, particularly in emergency situations or when other treatments are not available 4, 5, 6.
Effectiveness of Fresh Frozen Plasma (FFP)
FFP is a viable treatment option for HAE, especially when C1-esterase inhibitor concentrates are not available. Studies have demonstrated the effectiveness of FFP in reducing the severity and frequency of HAE attacks 4, 5. Additionally, FFP has been used to treat resistant angiotensin-converting enzyme inhibitor angioedema, which suggests its potential benefit in treating other forms of angioedema 6.