From the Guidelines
The treatment for angioedema should prioritize the use of C1 esterase inhibitor concentrates, kallikrein inhibitors, or bradykinin receptor antagonists for hereditary angioedema, as these have been shown to be effective in reducing swelling and preventing complications 1. For hereditary angioedema, the most recent and highest quality study recommends the use of C1-INH, icatibant, or ecallantide for the treatment of acute attacks, with the goal of minimizing their duration and severity 1. The management of angioedema attacks can also involve symptomatic treatment based on the region of body swelling, including pain medication, antiemetics, and aggressive hydration for abdominal attacks, as well as close monitoring for signs and symptoms of impending airway closure for oropharyngeal and laryngeal attacks 1. For angioedema caused by ACE inhibitors, discontinuation of the medication is necessary, with symptoms typically resolving within 24-72 hours, and treatment with antihistamines, corticosteroids, or epinephrine has not been shown to be efficacious 1. Some key points to consider in the treatment of angioedema include:
- The use of fresh frozen plasma as a treatment option for acute angioedema attacks, particularly in cases where plasma-derived C1-INH and icatibant are not available 1
- The importance of individualizing treatment based on the patient's situation, including the severity and frequency of attacks, as well as the presence of any underlying medical conditions 1
- The need for patients to carry an acute attack treatment with them and be trained on self-administration, with the exception of ecallantide 1
- The potential risks and benefits of different treatment options, including the use of narcotics for pain management and the risk of addiction 1.
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) Do not administer more than 3 injections in 24 hours. (2.1)
The treatment for angioedema is icatibant injection, which is administered subcutaneously in the abdominal area at a dose of 30 mg. If the response is inadequate or symptoms recur, additional injections of 30 mg may be given at intervals of at least 6 hours, with a maximum of 3 injections in 24 hours 2.
- Key points:
- Icatibant is a bradykinin B2 receptor antagonist.
- Indicated for treatment of acute attacks of hereditary angioedema (HAE) in adults 18 years of age and older.
- Dosage: 30 mg injected subcutaneously in the abdominal area.
- Maximum dosage: 3 injections in 24 hours.
From the Research
Treatment Options for Angioedema
- Conventional therapy, including antihistamines and corticosteroids, is often used to treat angioedema 3, 4
- Epinephrine may be administered in severe cases, particularly when there is airway obstruction 4, 5
- Fresh frozen plasma (FFP) has been shown to be effective in treating resistant ACE inhibitor-induced angioedema 3, 6
- The treatment of angioedema depends on the subtype, with histaminergic and non-histaminergic forms requiring different approaches 7, 5
Management of Angioedema
- Discontinuation of the offending drug, such as ACE inhibitors, is crucial in preventing further episodes of angioedema 4
- Securing the airway is the most important intervention in cases of angioedema with airway obstruction 5
- Novel pharmacologic agents, such as bradykinin receptor blockers, may be used in the treatment of angioedema 5, 6
Specific Treatments for ACE Inhibitor-Induced Angioedema
- FFP has been shown to be effective in breaking down accumulated bradykinin and improving symptoms of ACE inhibitor-induced angioedema 3, 6
- Antihistamines, corticosteroids, and epinephrine may not be effective in treating ACE inhibitor-induced angioedema, and alternative treatments such as FFP may be necessary 4, 6