Abstract
Angioedema is a sudden, transient swelling of well-demarcated areas of the dermis, subcutaneous tissue, mucosa, and submucosal tissues that can occur with or without urticaria. Up to 25% of people in the US will experience an episode of urticaria or angioedema during their lifetime, and many will present to the emergency department with an acute attack. Most cases of angioedema are attributable to the vasoactive mediators histamine and bradykinin. Histamine-mediated (allergic) angioedema occurs through a type I hypersensitivity reaction, whereas bradykinin-mediated (non-allergic) angioedema is iatrogenic or hereditary in origin.Although their clinical presentations bear similarities, the treatment algorithm for histamine-mediated angioedema differs significantly from that for bradykinin-mediated angioedema. Corticosteroids, and epinephrine are effective in the management of histamine-mediated angioedema but are ineffective in the management of bradykinin-mediated angioedema. Recent advancements in the understanding of angioedema have yielded pharmacologic treatment options for hereditary angioedema, a rare hereditary form of bradykinin-mediated angioedema. These novel therapies include a kallikrein inhibitor (ecallantide) and a bradykinin β2 receptor antagonist (icatibant). The physician’s ability to distinguish between these types of angioedema is critical in optimizing outcomes in the acute care setting with appropriate treatment. This article reviews the pathophysiologic mechanisms, clinical presentations, and diagnostic laboratory evaluation of angioedema, along with acute management strategies for attacks.
Highlights
Angioedema is a sudden, transient swelling of well-demarcated areas of the dermis, subcutaneous tissue, mucosa, and submucosal tissues that can occur with or without urticaria
Angioedema resulting from the biochemical cascade initiated by the release of bradykinin is distinct from that caused by histamine release; the resulting clinical signs and symptoms may be quite similar
This review focuses on angioedema induced by histamine or bradykinin release, and not pseudoallergic and idiopathic angioedema, which are discussed only briefly [1]
Summary
The advent of innovative pharmacologic treatment options for acute angioedema, catalyzed by an improved understanding of pathophysiologic processes, has made possible disease-specific therapies that have a positive impact on morbidity and mortality. Authors’ contributions JAB and JM meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE), were fully responsible for all content and editorial decisions, retained full control over all content contained in this manuscript, and were involved with all stages of manuscript development. They received no honorarium for their roles as authors of this manuscript. Dyax Corp. was not involved in the writing or editing of this manuscript and was not permitted to censor any content from the authors
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