From the Guidelines
The treatment for angioedema should be guided by its cause and severity, with hereditary angioedema requiring specific treatments such as C1 esterase inhibitor concentrates, icatibant, or ecallantide, as recommended by the most recent guidelines 1. The approach to treating angioedema varies significantly depending on whether it is allergic, hereditary, or acquired, and understanding the underlying mechanism is crucial for effective management.
- For hereditary angioedema, C1 esterase inhibitor concentrates (Berinert, Cinryze), icatibant (30mg subcutaneously), or ecallantide (30mg subcutaneously) are recommended for acute attacks 1.
- In cases of angioedema caused by ACE inhibitors, discontinuation of the medication is essential, with symptoms typically resolving within 24-72 hours 1.
- Airway management is critical in cases involving throat swelling, and emergency care should be sought immediately if breathing difficulties occur 1.
- Long-term management for recurrent cases may include identifying and avoiding triggers, carrying emergency medication, and in some cases, prophylactic treatments like tranexamic acid or attenuated androgens for hereditary angioedema 1. It's also important to note that epinephrine, corticosteroids, and antihistamines are not efficacious and are not recommended for the treatment of hereditary angioedema 1, highlighting the need for a tailored approach based on the specific type of angioedema.
From the FDA Drug Label
The safety and efficacy of KALBITOR to treat acute attacks of hereditary angioedema in adolescents and adults were evaluated in 2 randomized, double-blind, placebo-controlled trials 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 treatment for angioedema includes:
- Ecallantide (SQ): 30 mg subcutaneous for acute attacks of hereditary angioedema in adolescents and adults 2
- C1 esterase inhibitor (IV): for the treatment of acute abdominal, facial, or laryngeal hereditary angioedema (HAE) attacks in adult and pediatric patients 3
From the Research
Treatment Options for Angioedema
The treatment for angioedema depends on the underlying cause, which can be either allergic or non-allergic.
- For allergic angioedema, antihistamines, corticosteroids, and adrenalin can be used as treatment options 4.
- However, these treatments are ineffective in acute attacks of non-allergic angioedema.
Non-Allergic Angioedema Treatment
Non-allergic angioedema can be further divided into subforms, three of which are mediated by bradykinin:
- Renin-angiotensin-aldosterone system (RAAS)-blocker-induced angioedema (RAE)
- Hereditary angioedema (HAE)
- Acquired angioedema (AAE) For these subforms, the bradykinin-B2-receptor antagonist icatibant (in HAE or RAE) or C1-INH concentrate (in HAE or AAE) are therapeutic options for rapid alleviation of acute angioedema 4.
Alternative Treatment Options
Fresh frozen plasma (FFP) has been used as an alternative treatment for hereditary angioedema (HAE) due to the lack of C1-esterase inhibitor concentrates 5. FFP has also been used to treat angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema, which is usually not effective with conventional methods such as epinephrine, steroids, and antihistamines 6, 7. C1 esterase inhibitor (Berinert) has also been used to treat ACEI-induced angioedema, with successful results in some cases 8.