The ulm emergency algorithm for the acute treatment of drug-induced, bradykinin-mediated angioedema

Abstract

Bradykinin-mediated, drug-induced edema like ACE-inhibitor-induced angioedema (ACEiAE) is almost exclusively located in the head and neck region and is potentially life threatening. To date, there are no guidelines or officially-approved treatments available for this pathology. We sought to provide astructured therapeutic algorithm for the acute treatment of drug-induced bradykinin-mediated angioedema. We analyzed data (especially the course of disease and therapy) of all patients with acute angioedema, who presented to the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Ulm (2010-2015). We also conducted aliterature review on PubMed with the terms "acute angioedema", "angioedema emergency", "ACE angioedema", "bradykinin angioedema" and "angioedema therapy". Other fundamental references were the recent German guidelines "hereditary angioedema", "anaphylaxis" and "airway management". An emergency algorithm was generated as aflowchart for the acute therapy of bradykinin-mediated drug-induced angioedema was generated. We focused on the decision criteria for intubation/airway management and pharmacological therapy: antihistamines and glucocorticoids versus anti-bradykinin treatment. Furthermore, recommendations for inpatient monitoring have been derived. To date, therapy of drug-induced bradykinin-mediated angioedema is performed according to an "off-label" use and without officially-approved guidelines. The presented emergency algorithm provides afirst approach for astructured therapeutic concept for apotentially life-threatening pathology.