What is the recommended treatment for angioedema at home?

Home Treatment for Angioedema

For hereditary angioedema (HAE), patients should self-administer specific HAE medications at home at the earliest recognition of symptoms, as early treatment dramatically reduces attack duration and severity. 1

Immediate Assessment at Home

When angioedema symptoms begin, immediately assess for:

• Laryngeal involvement: voice changes, difficulty swallowing, breathing difficulty, or throat tightness—these require immediate treatment AND emergency medical attention 2, 3
• Location of swelling: face, tongue, abdomen, or extremities 1
• Presence or absence of hives: hives suggest histamine-mediated angioedema; absence suggests bradykinin-mediated (HAE or ACE inhibitor-induced) 4, 5

Treatment Based on Angioedema Type

For Hereditary Angioedema (HAE)

First-line home treatment options (administer as early as possible):

• Icatibant 30 mg subcutaneously in the abdominal area—can repeat every 6 hours if inadequate response, maximum 3 doses in 24 hours 6, 2
• Plasma-derived C1 inhibitor concentrate (if trained for self-administration) 1, 2

Critical timing considerations:

• Treatment within 1 hour of symptom onset reduces attack duration to 6.1 hours versus 16.8 hours when delayed 1
• Treatment within 6 hours shows hazard ratios of 3.36-4.30 for symptom relief compared to placebo 1
• Self-administration allows treatment 44% of the time within 1 hour versus 22% with healthcare provider administration 1

DO NOT use standard allergy treatments (antihistamines, corticosteroids, epinephrine)—these are completely ineffective for HAE and waste critical time 2, 7, 8

For laryngeal attacks:

• Administer HAE-specific medication immediately 2
• Call emergency services and proceed to emergency department even after treatment 2, 3
• Historical mortality rate is approximately 30% without treatment 3, 7

For Histamine-Mediated Angioedema (with hives/urticaria)

Immediate treatment:

• Intramuscular epinephrine (0.5 mL of 1:1000 for adults) if significant symptoms or any airway involvement 1, 3
• Oral antihistamines: cetirizine 10-20 mg or loratadine 10-20 mg 1
• Oral corticosteroids: prednisolone 50 mg for adults 1

If epinephrine auto-injector available:

• Use 300 mcg dose for adults/adolescents >12 years 1
• Can repeat if no significant relief after first dose 1
• Seek emergency care after administration 3

For ACE Inhibitor-Induced Angioedema

• Stop the ACE inhibitor permanently 2
• Consider icatibant 30 mg subcutaneously if available 2
• Standard allergy treatments are ineffective 2
• Symptoms may recur for weeks to months after stopping medication 4
• Seek emergency care for facial, tongue, or throat swelling 8

Supportive Care at Home

For abdominal attacks:

• Aggressive oral hydration 2, 3
• Antiemetics for nausea/vomiting 3
• Analgesics for pain (avoid creating narcotic dependence in frequent attackers) 3

For peripheral attacks (extremities, face without airway involvement):

• Treat promptly rather than "wait-and-see" to prevent avoidable pain and disability 7

When to Seek Emergency Care

Immediately call emergency services if:

• Any laryngeal symptoms (voice changes, difficulty swallowing, breathing difficulty) 2, 3
• Tongue or throat swelling 2
• Symptoms not improving or worsening after home treatment 2
• First episode of angioedema without known diagnosis 3

Essential Home Preparedness for HAE Patients

Medication supply:

• Keep enough medication to treat 2 attacks at all times 1
• Carry medication everywhere 1
• Ensure family members/friends are trained in administration if needed 1

Patient education:

• Train on self-administration technique 1, 2
• Recognize early symptoms for immediate treatment 1
• Understand that early treatment (within 1 hour) provides dramatically better outcomes 1

Common Pitfalls to Avoid

• Never delay HAE-specific treatment waiting to see if attack resolves—early treatment is critical 1
• Never use antihistamines, steroids, or epinephrine as primary treatment for HAE—they are ineffective and delay appropriate therapy 2, 7, 8
• Never assume laryngeal attacks will self-resolve—always seek emergency care even after home treatment 2, 3
• Never discharge yourself from observation with ongoing throat/tongue swelling—these can progress rapidly 3