What is the treatment for Angioedema (Angioneurotic Edema)?

From the Guidelines

Angioedema treatment should prioritize the use of C1-INH, icatibant, or ecallantide for acute attacks, as these medications have been shown to be effective in reducing the duration and severity of attacks, especially in cases of hereditary angioedema 1. The treatment approach for angioedema varies depending on the severity and cause of the condition.

• For hereditary angioedema, specific treatments include:
  • C1 esterase inhibitor concentrates (Berinert, Cinryze)
  • Icatibant (30mg subcutaneously)
  • Ecallantide (30mg subcutaneously)
• These medications have been shown to be effective in reducing the duration and severity of attacks, and should be administered as early as possible to minimize the impact of the attack 1.
• Epinephrine, corticosteroids, and antihistamines are not recommended for the treatment of hereditary angioedema, as they do not have a significant effect on the swelling seen in patients with this condition 1.
• Fresh frozen plasma may be effective in abrogating HAE attacks, but its use is controversial due to the potential for exacerbating some attacks, and caution is required 1.
• Long-term prophylaxis for recurrent angioedema may involve medications like danazol, tranexamic acid, or omalizumab, but the decision to use these medications should be individualized based on the patient's situation and values 1.
• Identifying and avoiding triggers is crucial for prevention, and patients should be educated about the potential for airway compromise and when to seek emergency care.
• The primary mediator of swelling in patients with hereditary angioedema is bradykinin, and treatment should be targeted towards inhibiting this mediator 1.

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 angioedema using icatibant is:

• Subcutaneous injection of 30 mg in the abdominal area.
• If response is inadequate or symptoms recur, additional injections of 30 mg may be administered at intervals of at least 6 hours.
• Do not administer more than 3 injections in 24 hours 2.

From the Research

Angioedema Treatment Overview

• Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localized increase of microvascular permeability whose mediator may be histamine or bradykinin 3.
• The treatment of angioedema depends on the subtype, with allergic angioedema being sensitive to standard therapies such as epinephrine, glucocorticoids, and antihistamines, whereas non-histaminergic angioedema is often resistant to these drugs 3.

Histaminergic vs Non-Histaminergic Angioedema

• Histaminergic angioedema is characterized by concomitant urticaria and pruritus, and has a rapid course (minutes), whereas non-histaminergic angioedema is slower (hours) 3.
• Non-histaminergic angioedema, such as ACE inhibitor-induced angioedema, can be accurately diagnosed by physical examination and has little physiologic rationale for epinephrine use, with much risk 4.

Treatment Options

• Therapeutic options for angioedema due to C1-inhibitor deficiencies include C1-inhibitor concentrates, icatibant, and ecallantide 3.
• For ACE inhibitor-induced angioedema, the discontinuation of the causative drug is recommended, and medications such as icatibant, ecallantide, and C1 inhibitor replacement may be considered, although their efficacy is still being studied 4, 5.
• Fresh frozen plasma can be considered if other medications are not available 3.

Management in the Emergency Department

• In the emergency department, it is essential to quickly identify acute angioedema and establish a likely working diagnosis to administer the most effective treatment 6.
• A systematic approach to assessment and treatment, including cross-disciplinary collaboration, is necessary to manage angioedema effectively 7.