immunology allergic disorders
Angioedema
Treatment of Angioedema
Airway management For mast cell-mediated angioedema, an antihistamine and sometimes a systemic corticosteroid andepinephrine For ACE inhibitor–related angioedema, occasionally fresh frozen plasma andC1 inhibitorconcentrate For recurrent idiopathic angioedema, an oral antihistamine given twice a day Securing an airway is the highest priority. If angioedema involves the airways, Epinephrine is given subcutaneously or IM as for anaphylaxis unless the mechanism is obviously bradykinin-mediated (eg, due to use of an ACE inhibitor or to known hereditary or acquired angioedema). In mast cell–mediated angioedema, treatment usually rapidly reduces airway edema; however, in bradykinin-mediated angioedema, edema usually takes > 30 minutes to decrease after treatment begins. Thus, endotracheal intubation is more likely to be needed in bradykinin-mediated angioedema. Treatment of angioedema also includes removing or avoiding the allergen and using drugs that relieve symptoms. If a cause is not obvious, all nonessential drugs should be stopped. drugs that may relieve symptoms include Antihistamines . Patients who have severe mast cell–mediated reactions should be advised to always carry a prefilled, self-injecting syringe ofepinephrineand oral antihistamines and, if a severe reaction occurs, to use these treatments as quickly as possible and then go to the emergency department. There, they can be closely monitored and treatment can be repeated or adjusted as needed. , corticosteroids, and antihistamines have not been shown to be effective. Angioedema due to ACE inhibitor use usually resolves about 24 to 48 hours after stopping the drug. If symptoms are severe, progressing, or refractory, Treatment can be tried. They include fresh frozen plasma, Foridiopathic angioedema,a high dose of a nonsedating oral antihistamine can be tried. 