From the Guidelines
The most effective treatment for Angioedema, particularly hereditary angioedema, involves the use of C1 esterase inhibitor concentrates, kallikrein inhibitors, or bradykinin receptor antagonists, as these directly address the bradykinin pathway implicated in the condition. The treatment approach for angioedema should be guided by the severity and cause of the condition. For hereditary angioedema, the primary mediator of swelling is bradykinin, and thus, treatments that target this pathway are most effective 1.
Key Considerations
- Epinephrine, corticosteroids, and antihistamines are not recommended for the treatment of hereditary angioedema as they do not effectively address the bradykinin-mediated swelling and may not alter the course of the attack 1.
- Fresh frozen plasma may be effective in abrogating HAE attacks but can also potentially exacerbate some attacks, and its use should be approached with caution, considering the balance of potential benefits and harms, including viral safety concerns 1.
- The most recent guidelines emphasize the importance of treating all attacks of hereditary angioedema with C1-INH, icatibant, or ecallantide as early as possible to minimize duration and severity, with a focus on patient access to effective, on-demand treatments 1.
Treatment Options
- C1 esterase inhibitor concentrates (e.g., Berinert, Cinryze) are effective for treating acute attacks of hereditary angioedema.
- Kallikrein inhibitors (e.g., ecallantide) and bradykinin receptor antagonists (e.g., icatibant) are also recommended for the treatment of acute attacks.
- For angioedema caused by ACE inhibitors, discontinuation of the medication and replacement with an alternative antihypertensive is necessary.
Supportive Care
- Supportive care, including airway management and close monitoring, is essential in all severe cases of angioedema.
- Patients with recurrent episodes should identify and avoid triggers, carry emergency medication, and consider prophylactic treatment if episodes are frequent.
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 hereditary Angioedema (HAE) is icatibant administered subcutaneously at a dose of 30 mg in the abdominal area. If symptoms persist or recur, additional doses may be given at intervals of at least 6 hours, with a maximum of 3 injections in 24 hours 2.
Key points:
- Drug: Icatibant
- Dose: 30 mg
- Route: Subcutaneous
- Frequency: As needed, with a maximum of 3 injections in 24 hours
- Interval: At least 6 hours between doses
From the Research
Treatment Overview
The treatment for Angioedema (Angioneurotic Edema) depends on the underlying cause and can be divided into different approaches based on whether the condition is histamine-mediated or bradykinin-mediated 3, 4, 5, 6, 7.
Initial Emergency Treatment
In cases of doubt, initial therapy with:
- Adrenalin
- Antihistamines
- Glucocorticoids should be initiated 3 This initial emergency treatment is comparable to the treatment of allergic reactions.
Specific Treatments
For diagnosed or suspected hereditary angioedema, specific treatments are available, including:
- C1-INH protein replacement
- Kallikrein inhibitor
- Bradykinin receptor antagonists 4, 7 For drug-associated forms, immediate and life-long cessation of the medication is crucial 3, 4, 6.
Airway Management
Recognition of impending airway obstruction and securing the airway is of highest priority 3, 5, 7. Airway intervention may require:
- Fiberoptic or video laryngoscopy
- Preparation for cricothyrotomy 7
Treatment of Resistant Angioedema
In some cases, fresh frozen plasma (FFP) can be used to treat resistant angioedema, particularly in cases caused by angiotensin-converting enzyme (ACE) inhibitors 4.
Disposition
Disposition is dependent on the patient's airway and respiratory status, as well as the sites involved 7.