From the Guidelines
The treatment of angioedema should prioritize C1-INH, icatibant, or ecallantide for acute attacks, with early administration being crucial to minimize duration and severity, as recommended by guidelines 1.
Key Considerations
- The choice of treatment depends on the cause and severity of angioedema, with hereditary angioedema requiring specific treatments such as C1 esterase inhibitor concentrates, kallikrein inhibitors, or bradykinin receptor antagonists.
- For angioedema caused by ACE inhibitors, the medication should be discontinued immediately and never restarted, with patients being switched to alternative antihypertensives like angiotensin receptor blockers or calcium channel blockers.
- Supportive care, including airway management, is crucial in severe cases, especially those involving upper airway edema, which should be treated as a medical emergency.
Treatment Options
- C1-INH, icatibant, or ecallantide are recommended for the treatment of acute attacks of hereditary angioedema, with on-demand treatment being most effective when administered as early as possible in an attack 1.
- Symptomatic treatment may be necessary for managing individual attacks, including pain medication, antiemetics, and aggressive hydration for abdominal attacks, as well as maintaining airway patency for oropharyngeal and laryngeal attacks 1.
- Epinephrine, corticosteroids, and antihistamines are not efficacious and not recommended for the treatment of hereditary angioedema, as they do not have a significant effect on the swelling seen in patients with HAE 1.
Important Notes
- Patients with hereditary angioedema should carry an acute attack treatment on their person and be trained on self-administration, with the exception of ecallantide.
- The management of oropharyngeal and laryngeal attacks should be focused on maintaining airway patency, with patients being closely monitored for signs and symptoms of impending airway closure.
From the FDA Drug Label
KALBITOR® (ecallantide) is indicated for treatment of acute attacks of hereditary angioedema (HAE) in patients 12 years of age and older. The treatment for hereditary angioedema (HAE) is ecallantide (KALBITOR®) in patients 12 years of age and older 2.
- Key points:
- Age restriction: 12 years and older
- Specific condition: Hereditary angioedema (HAE)
- Treatment: ecallantide (KALBITOR®)
From the Research
Treatment Options for Angioedema
The treatment for angioedema depends on the underlying cause and can be divided into several categories.
- For acute angioedema, initial therapy with adrenalin, antihistamines, and glucocorticoids should be initiated, as stated in 3.
- In cases of hereditary angioedema, specific treatments such as C1 esterase inhibitor concentrate, icatibant, and ecallantide are available, as mentioned in 4, 5.
- For drug-associated forms of angioedema, immediate and lifelong cessation of the medication is crucial, as noted in 3, 4.
- Antihistamines and glucocorticoids are commonly used to treat allergic angioedema, while non-histaminergic angioedema is often resistant to these drugs, as stated in 4, 6.
- Fresh frozen plasma can be considered as an alternative treatment option for hereditary angioedema, as mentioned in 4, 6.
Management of Hereditary Angioedema
Hereditary angioedema requires prompt and effective management to prevent life-threatening complications.
- Acute treatment options for hereditary angioedema include C1-INH concentrate, icatibant, and ecallantide, as stated in 4, 5.
- Self-administration of treatment is recommended and can improve the quality of life for patients with hereditary angioedema, as noted in 5.
- Short- and long-term prophylaxis are also essential components of hereditary angioedema therapy, as mentioned in 5.
General Principles of Angioedema Management
Regardless of the underlying cause, certain general principles apply to the management of angioedema.
- Early recognition of attacks and aggressive airway management are critical, as stated in 6.
- Avoidance of specific triggers and treatment with medication (if indicated) are the mainstays of management for angioedema, as noted in 7.
- Laboratory tests can be used to confirm the diagnosis, but initial treatment is often based on clinical symptoms and medical history, as mentioned in 3, 4.