Angioedema in the emergency department

Abstract

Acute angioedema is mostly found in the head and neck region. Therefore, it can be life threatening by potentially endangering air way patency. Pathophysiologically angioedemas can be divided into mast cell-mediated or bradykinin-mediated forms. Differentiation is essential due to the different therapeutic strategies. In cases of doubt, initial therapy with adrenalin, antihistamines, and glucocorticoids should be initiated. This initial emergency treatment is comparable to the treatment of allergic reactions. For diagnosed or suspected hereditary angioedema, specific treatments are available. For drug-associated forms, immediate and life-long cessation of the medication is crucial. In the emergency situation, diagnosis can only be based on medical history and clinical symptoms. Recognition of impending airway obstruction and securing the airway is of highest priority; final diagnosis must be confirmed later.