Internal and Emergency Medicine

, Volume 9, Issue 1, pp 85–92 | Cite as

Guidance for diagnosis and treatment of acute angioedema in the emergency department: consensus statement by a panel of Italian experts

  • Marco Cicardi
  • Paolo Bellis
  • Giuliano Bertazzoni
  • Mauro Cancian
  • Maurizio Chiesa
  • Paolo Cremonesi
  • Pietro Marino
  • Nicola Montano
  • Claudia Morselli
  • Francesco Ottaviani
  • Roberto Perricone
  • Massimo Triggiani
  • Andrea Zanichelli
EM - ORIGINAL

Abstract

Angioedema attacks, characterized by the transient swelling of the skin and mucosae, are a frequent cause of visits to the emergency department. Swellings of the oral cavity, tongue, or larynx can result in life-threatening airway obstruction, while abdominal attacks can cause severe pain and often lead to unnecessary surgery. The underlying pathophysiologic process resulting in increased vascular permeability and plasma extravasation is mediated by vasoactive molecules, most commonly histamine and bradykinin. Based on the mediator involved, distinct angioedema forms can be recognized, calling for distinct therapeutic approaches. Prompt recognition is challenging for the emergency physician. The low awareness among physicians of the existence of rare forms of angioedema with different aetiologies and pathogenesis, considerably adds to the problem. Also poorly appreciated by emergency personnel may be the recently introduced bradykinin-targeted treatments. The main objective of this consensus statement is to provide guidance for the management of acute angioedema in the emergency department, from presentation to discharge or hospital admission, with a focus on identifying patients in whom new treatments may prevent invasive intervention.

Keywords

Acute angioedema Emergency management Consensus statement C1 inhibitor 

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Copyright information

© SIMI 2013

Authors and Affiliations

  • Marco Cicardi
    • 1
    • 8
  • Paolo Bellis
    • 2
  • Giuliano Bertazzoni
    • 3
  • Mauro Cancian
    • 4
  • Maurizio Chiesa
    • 5
  • Paolo Cremonesi
    • 6
  • Pietro Marino
    • 7
  • Nicola Montano
    • 8
  • Claudia Morselli
    • 9
  • Francesco Ottaviani
    • 10
  • Roberto Perricone
    • 11
  • Massimo Triggiani
    • 12
  • Andrea Zanichelli
    • 8
  1. 1.Medicina Interna, Ospedale Luigi SaccoUniversità degli Studi di MilanoMilanItaly
  2. 2.Medicina d’UrgenzaP.O. S. Maria di Loreto Mare, ASL Napoli 1 CentroNaplesItaly
  3. 3.Dipartimento di Emergenza-Pronto SoccorsoPoliclinico Umberto I°, Università La SapienzaRomeItaly
  4. 4.Dipartimento di MedicinaUniversità di PadovaPaduaItaly
  5. 5.Pronto Soccorso e Medicina d’UrgenzaOspedale S. Antonio, ULSS 16PaduaItaly
  6. 6.Pronto Soccorso e Medicina D’UrgenzaEnte Ospedaliero Ospedali GallieraGenoaItaly
  7. 7.Medicina d’UrgenzaA.O. FatebenefratelliMilanItaly
  8. 8.Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, Ospedale Luigi SaccoUniversità degli Studi di MilanoMilanItaly
  9. 9.Medicina d’UrgenzaAUSL ImolaImolaItaly
  10. 10.Head of Division of Otorhinolaryngology, Department of Clinical Sciences and Community Health, Hospital “San Giuseppe”University of MilanMilanItaly
  11. 11.Reumatologia, Scuola di Specializzazione in Allergologia e Immunologia Clinica, Facoltà di Medicina e ChirurgiaUniversità Tor VergataRomeItaly
  12. 12.Università di SalernoSalernoItaly

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