What is the treatment for angioedema of the face?

From the Guidelines

Angioedema of the face should be treated with a C1INH concentrate, a plasma kallikrein inhibitor, or a bradykinin B2 receptor antagonist as soon as possible, as these medications have been shown to be safe and efficacious for the treatment of acute HAE attacks 1. For patients with hereditary angioedema (HAE), the primary mediator of swelling is bradykinin, and standard angioedema treatment modalities such as epinephrine, corticosteroids, or antihistamines are not efficacious and not recommended 1. Some key points to consider in the treatment of angioedema of the face include:

• The use of fresh frozen plasma (FFP) may be effective in aborting attacks, but it can sometimes cause a sudden worsening of symptoms and carries the inherent risk of viral transmission 1.
• The optimum dose of FFP is unknown, but at least 20 ml/kg is likely required 1.
• Tranexamic acid used acutely during an ongoing attack has been reported to potentially prolong the attack, but some patients have found that very early treatment during a well-defined predictive prodromal period or very shortly after the onset of an attack may be effective at reducing severity 1.
• Attenuated androgens are unlikely to contribute to resolution of established attacks, but may be effective in reducing severity if taken immediately upon recognition of prodromal symptoms 1. It is essential to seek immediate medical attention if the swelling affects the lips, tongue, or throat, or if difficulty breathing is experienced, as this can be life-threatening. While waiting for medical help, applying cold compresses to the affected area and sitting upright can help minimize swelling. Removing any potential triggers like certain foods, medications, or allergens is also crucial. For recurrent episodes, identifying and avoiding triggers is essential, and long-term preventive medications may be necessary.

From the FDA Drug Label

Epinephrine also alleviates pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder To treat angioedema of the face, epinephrine (IM) can be used as it alleviates angioedema. The treatment should be administered parenterally and has a rapid onset of action. 2

From the Research

Treatment Options for Angioedema of the Face

• The treatment of angioedema involves identifying and avoiding triggers, early recognition of attacks, and aggressive airway management when warranted 3.
• Initial treatment for most forms of angioedema includes antihistamines and glucocorticoids if required, with epinephrine administered if there is concern for laryngeal edema 3.
• For patients with a known history of hereditary angioedema, C1 esterase inhibitor concentrate or fresh-frozen plasma may be used 3.
• In cases of angioedema induced by angiotensin-converting enzyme inhibitors (ACEIs), discontinuation of the causative drug is recommended, although therapeutic options such as C1-inhibitor concentrates, icatibant, and ecallantide may be considered 4, 5.

Pharmacotherapy for ACEI-Induced Angioedema

• The efficacy of treatment of ACEI-induced angioedema with bradykinin antagonists, kallikrein inhibitor, and C1 inhibitor warrants further study 5.
• One study found that icatibant, a bradykinin B2 receptor antagonist, resulted in more rapid symptom improvement compared to a control group treated with corticosteroids and antihistamines 5.
• However, other studies found no significant benefit of ecallantide, a plasma kallikrein inhibitor, or C1 inhibitor replacement over control 5.

Airway Management and Novel Pharmacologic Agents

• Securing the airway remains the most important intervention in the management of angioedema, followed by administration of established and novel pharmacologic interventions based on disease pathology 6.
• Novel medications, such as C1 inhibitor concentrates and icatibant, are available for the acute treatment of angioedema syndromes 6.
• ED physicians must be aware of the different pathophysiologic pathways that lead to angioedema in order to efficiently and effectively manage these potentially fatal conditions 7.