From the Guidelines
Severe varicella with angioedema and syncope requires immediate medical attention, and treatment should focus on managing the varicella infection and preventing further complications from angioedema, with antiviral therapy being instituted immediately if signs or symptoms of varicella disease occur, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1.
Key Considerations
- The presence of angioedema and syncope in severe varicella suggests a potentially life-threatening condition that may compromise the airways, necessitating emergency evaluation and treatment.
- Antiviral therapy should be started promptly if varicella symptoms appear, with the route and duration determined by host factors, extent of infection, and initial response to therapy 1.
- Management of angioedema, especially oropharyngeal and laryngeal attacks, is crucial and may require observation in a medical facility capable of performing intubation or tracheostomy if necessary, as well as close monitoring for signs of impending airway closure 1.
Treatment Approach
- Antiviral medications, as recommended for varicella treatment, should be the primary focus, with adjustments based on the patient's response and the severity of the infection.
- Symptomatic treatment for angioedema, including pain management and hydration, may be necessary, but the primary concern should be maintaining airway patency and managing the varicella infection.
- The use of corticosteroids or other immunomodulators may be considered in specific cases, but their role in treating varicella with angioedema is not well-defined and should be approached with caution.
Important Considerations for Management
- Patients with severe varicella and angioedema should be closely monitored for signs of worsening infection or airway compromise.
- The potential for narcotic addiction in patients requiring frequent pain management for angioedema should be considered, and alternative pain management strategies should be explored when possible 1.
- Immediate availability of backup tracheostomy is necessary in case intubation is not successful in patients with oropharyngeal or laryngeal angioedema.
From the FDA Drug Label
Adrenalin® is a non-selective alpha and beta adrenergic agonist indicated for: Emergency treatment of allergic reactions (Type 1), including anaphylaxis The signs and symptoms associated with anaphylaxis include flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with hypotension, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria or angioedema, swelling of the eyelids, lips, and tongue. Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary
The treatment for severe varicella with angioedema and syncope is epinephrine (IM). The dosage is:
- For adults and children 30 kg (66 lbs) or more: 0.3 to 0.5 mg every 5 to 10 minutes as necessary
- For children 30 kg (66 lbs) or less: 0.01 mg/kg, up to 0.3 mg, every 5 to 10 minutes as necessary 2 2
From the Research
Treatment for Severe Varicella with Angioedema and Syncope
There are no research papers provided that directly address the treatment for severe varicella with angioedema and syncope. The studies provided focus on measles, anaphylaxis, and steroid use in measles, but do not discuss varicella specifically.
Related Conditions and Treatments
- Anaphylaxis, a condition that can cause symptoms similar to angioedema, is treated with epinephrine as the first line of treatment, followed by antihistamines and corticosteroids 3.
- Measles, a highly contagious illness, is managed mainly with supportive therapy, including vitamin A supplementation and monitoring for secondary bacterial infections 4, 5.
- Steroid use in measles has been studied, but there is no clear indication for its use, and no evidence of a worse outcome was found in one study 6.
Limitations
The provided studies do not address the specific treatment for severe varicella with angioedema and syncope, and therefore, no direct recommendations can be made based on this evidence.