Skip to main content
SpringerLink
Log in

Angioedema in the Emergency Department

  • Chapter
Allergy Frontiers: Diagnosis and Health Economics

Part of the book series: Allergy Frontiers ((ALLERGY,volume 4))

The molecular, and in hereditary forms, the genetic basis of angioedema is becoming better understood, leading to improved management including more focussed emergency room diagnosis and treatment.

It is now possible to distinguish in the laboratory the three subtypes of hereditary angioedema from each other and from acquired C′1 esterase inhibitor deficiency and this is important because of the impact on treatment.

C′1 inhibitor concentrate is established as a safe and effective emergency room treatment for hereditary C′1 inhibitor deficient angioedema, but in the acquired forms, because of increased consumption, it may have to be supplemented by tranexamic acid treatment. Icatibant, a bradykinin antagonist, has now been licensed in Europe for acute attacks of types 1 and 2 hereditary angioedema. Both Icatibant and the kallikrein inhibitor ecallantide are promising treatments for ACE inhibitor angioedema though not yet licensed for this indication.

In all cases of acute angioedema whatever the type or cause, the cornerstones of emergency treatment include securing the airway, establishing an intravenous line and parenteral adrenaline. Admission for 24h observation is also advisable for all but the mildest cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kaplan AP, Greaves MW. Angioedema. J Am Acad Dermatol. 2005; 53: 373–388.

    Article  PubMed  Google Scholar 

  2. Champion RH, Roberts SOB, Carpenter RG, Roger JH. Urticaria and angioedema: a review of 554 patients. Br J Dermatol. 1969; 81: 588–597.

    Article  PubMed  CAS  Google Scholar 

  3. Kaplan AP, Greaves MW. Angioedema. Current Allergy Clin Immunol. 2006; 19: 104–111.

    Google Scholar 

  4. Zuberbier T, Bindslev-Jensen C, Canonica W, et al. EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy. 2006; 61: 321–331.

    Article  PubMed  CAS  Google Scholar 

  5. Downing A, Jacobsen J, Sorenesen HT, et al. Risk of hospitalisation for angioedema among users of newer Cox – 2 selective inhibitors and other nonsteroid anti-inflammatory drugs. Br J Clin Pharmacol. 2006; 62: 496–501.

    Article  PubMed  CAS  Google Scholar 

  6. Wakelin SH, White IR. Latex allergy. Clin Exp Dermatol. 1999; 24: 245–248.

    Article  PubMed  CAS  Google Scholar 

  7. Sabroe RA, Seed PT, Francis DM, et al., Chronic idiopathic urticaria: comparison of clinical features of patients with or without anti-FceR1 or anti-IgE autoantibodies. J Am Acad Dermatol. 1999; 40: 443–450.

    Article  PubMed  CAS  Google Scholar 

  8. Kozel MA, Mekkes JR, Bossuyt PM, Bos JD. Natural course of physical and chronic urticaria and angioedema in 220 patients. J Am Acad Dermatol. 2001; 45: 387–391.

    Article  PubMed  CAS  Google Scholar 

  9. Hide M, Francis DM, Grattan C, et al. Autoantibodies against the high-affinity IgE receptor as a cause for histamine release in chronic urticaria. New Engl J Med. 1993; 328: 1599–1604.

    Article  PubMed  CAS  Google Scholar 

  10. Sabroe RA, Greaves MW. Chronic idiopathic urticaria with functional autoantibodies: 12 years on. Br J Dermatol. 2006; 154: 813–819.

    Article  PubMed  CAS  Google Scholar 

  11. Greaves MW. Chronic idiopathic urticaria. Curr Opin Allergy Clin Immunol. 2003; 3: 363–368.

    Article  PubMed  Google Scholar 

  12. Nimii N, Francis DM, Kermani F, et al. Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol. 1996; 106: 1001–1006.

    Article  Google Scholar 

  13. Wedi B, Novacovic V, Koerner M, et al. Chronic urticaria serum induces histamine release, leukotriene and basophil CD 63 surface expression-inhibitory effects of anti-inflammatory drugs. J Allergy Clin Immunol. 2000; 105: 552–560.

    Article  PubMed  CAS  Google Scholar 

  14. Confino-Cohen R, Aharoni D, Goldberg A, et al. Evidence for aberration of regulation of the p21 Ras pathway in PBMC's of patients with chronic idiopathic urticaria. J Allergy Clin Immunol. 2002; 109: 349–356.

    Article  PubMed  CAS  Google Scholar 

  15. Black AK. Physical urticaria and cholinergic urticaria. In Greaves MW, Kaplan AP, eds, Urticaria and Angioedema. New York: Marcel Dekker, 2004: 171–214.

    Google Scholar 

  16. Wisnieski JJ, Baer AN, Christensen J, et al. Hypocomplementaemic urticarial vasculitis syndrome. Clinical and serologic findings in 8 patients. Medicine (Baltimore) 1995; 74: 24–41.

    Article  CAS  Google Scholar 

  17. Osler W. Hereditary angioneurotic edema. Am J Med Sci. 1888; 95: 362–367.

    Article  Google Scholar 

  18. Nussberger J, Cugno M, Amstutz C, et al. Plasma bradykinin in angioedema. Lancet. 1998; 351: 1693–1697.

    Article  PubMed  CAS  Google Scholar 

  19. Visy B, Fust G, Varga L, et al. Sex hormones in hereditary angioneurotic oedema. Clin Endocrinol. (Oxf) 2004; 60: 508–515.

    Article  CAS  Google Scholar 

  20. Yip J, Cunliffe WJ. Hormonally exacerbated Hereditary angioedoema. Australas. J Dermatol. 1992; 33: 35–38.

    Article  PubMed  CAS  Google Scholar 

  21. Gompels MM, Lock RJ, Morgan JE, et al. A multicentre study of the diagnostic efficiency of serological investigations for C1 inhibitor deficiency. J Clin Pathol. 2002; 55: 145–147.

    Article  PubMed  CAS  Google Scholar 

  22. Tosi M. Molecular genetics of C'1 inhibitor. Immunobiology 1998; 119: 358–365.

    Google Scholar 

  23. Kramer J, Rosen F, Colten H, et al. Transinhibition of C'1 inhibitor synthesis in type I hereditary angioedema. J Clin Immunol. 1993; 91: 1258–1262.

    CAS  Google Scholar 

  24. Farkas H, Harmat G, Fust G, et al. Clinical management of hereditary angio-oedema in children. Pediatr Allergy Immunol 2002; 13: 153–161.

    Article  PubMed  Google Scholar 

  25. Frank MM, Gelfand JA, Atkinson JP. Hereditary angioedema: the clinical syndrome and its management. Ann Int Med. 1976; 84: 580–593.

    PubMed  CAS  Google Scholar 

  26. Farkas H, Harmat G, Fay A, et al. erythema marginatum preceding an acute oedematous attack of hereditary angio-neurotic oedema. Acta Derm Venereol. 2001; 81: 376–377.

    Article  PubMed  CAS  Google Scholar 

  27. Shah TJ, Knowles WO, Mc Geadt SJ. Hereditary angioedema with recurrent abdominal pain and ascites. J Allergy Clin Immunol. 1995; 96: 259–261.

    Article  PubMed  CAS  Google Scholar 

  28. Farkas H, Harmat G, Kaposi PN, et al. Ultrasonography in the diagnosis and monitoring of ascites in acute abdominal attacks of hereditary angioneurotic oedema. Eur J Gastroenterol Hepatol. 2001; 13: 1225–1230.

    Article  PubMed  CAS  Google Scholar 

  29. Bork K, Siedlecki K, Bosch S, Schopf RE, Kreuz, W. Asphyxiation due to laryngeal edema in patients with hereditary angioedema. Mayo Clin Proc. 2000; 75: 349–354.

    Article  PubMed  CAS  Google Scholar 

  30. Koide M, Shirahama S, Tokura Y, et al. Lupus erythematosus associated with C1 inhibitor deficiency. J Dermatol. 2002; 29: 503–507.

    PubMed  Google Scholar 

  31. Gompels, MM, Lock RJ, Unsworth GJ, et al. Misdiagnosis of hereditary angioedema type 1 and type 2. Br J Dermatol. 2003; 148: 719–723.

    Article  PubMed  CAS  Google Scholar 

  32. Zuraw BL, Sugimoto S, Curd JG. The value of rocket immunoelectrophoresis for C'4 activation in the evaluation of patients with angioedema or C1-inhibitor deficiency. J Allergy Clin Immunol. 1986; 78: 1115–1120.

    Article  PubMed  CAS  Google Scholar 

  33. Nielson EW, Johanson HT, Holt J, Mollines TE. C1 inhibitor and diagnosis of HAE in new-borns. Paediatr Res. 1994; 35: 184–187.

    Google Scholar 

  34. Warin RP, Cunliffe WJ, Greaves MW, Wallington TB. Recurrent angioedema: familial and oestrogen-induced. Br J Dermatol. 1986; 115: 731–734.

    Article  PubMed  CAS  Google Scholar 

  35. Bork K, Barnstedt SE, Koch P, Traupe H. Hereditary angioedema with normal C1-inhibitor activity in women. Lancet. 2000; 356: 213–217.

    Article  PubMed  CAS  Google Scholar 

  36. Martin L, Degenne D, Toutain A, Ponard D, Watier H. Hereditary angioedema type 111: an additional French pedigree with autosomal dominant transmission. J Allergy Clin Immunol. 2001; 107: 747–748.

    Article  PubMed  CAS  Google Scholar 

  37. Binkley KE, Davis AE. Estrogen-dependent inherited angioedema. Transfus Apheresis Sci. 2003; 29: 215–219.

    Article  Google Scholar 

  38. Dewald G, Bork K. Missense mutations in the coaulation factor XII (Hageman factor) genein hereditary angioedema with normal C′ 1 inhibitor. Biochem. Biophys. Res. Commun. 2006; 343: 1286–1289.

    Article  PubMed  CAS  Google Scholar 

  39. Schreiber A, Zweiman B, Atkins P, et al. Acquired angioedema with lymphoproliferative disorder: association of C′1 inhibitor deficiency with cellular abnormality. Blood. 1976; 48: 567–580.

    PubMed  CAS  Google Scholar 

  40. Geha R, Quinti I, Austen KF, et al. Acquired C′1 inhibitor deficiency associated with anti-idiotypic antibody to monoclonal immunoglobulins. N Engl J Med. 1985; 312: 534–540.

    PubMed  CAS  Google Scholar 

  41. Donaldson V, Hess E, McAdams A. Lupus erythematosus-like disease in three unrelated women with hereditary angioneurotic edema. Ann Int Med. 1977; 86: 312–313.

    PubMed  CAS  Google Scholar 

  42. Jackson J, Sim R, Whelan A, et al. An IgG autoantibody which inactivates C1-inhibitor. Nature. 1986; 323: 722–724.

    Article  PubMed  CAS  Google Scholar 

  43. Alsenz, J, Bork K, Loos M. Autoantibody-mediated acquired deficiency of C1 Inhibitor. N Engl J Med. 1987; 316: 1360–1366.

    PubMed  CAS  Google Scholar 

  44. Chevailler A, Arlaud G, Ponard D, et al. C1-inhibitor binding monoclonal immunoglobulins in three patients with acquired angioneurotic oedema. J Allergy Clin Immunol. 1996; 97: 998–1008.

    Article  PubMed  CAS  Google Scholar 

  45. Agah R, Bandi V, Gunturpalli KK. Angioedema: the role ofACE inhibitors and factors associated with poor outcome. Intensive Care Med. 1999; 23: 793–796.

    Article  Google Scholar 

  46. Hedner T, Samuelsson O, Lunde H et al. Angioedema in relation to treatment with angiotensin converting enzyme inhibitors. Brit Med. J. 1992; 304: 941–946.

    Article  PubMed  CAS  Google Scholar 

  47. Lin RY, Shah SN, Karandish K. Increasing Hospitalisations due to angioedema in the united States. J Allergy Clin Immunol. 2008; Suppl. 1; 121: S99 (abs).

    Article  Google Scholar 

  48. Pigman EC, Scott JL. Angioedema in the emergency department: the impact of angiotensin converting enzyme inhibitors. Am J Emerg Med. 1993; 11: 350–354.

    Article  PubMed  CAS  Google Scholar 

  49. Schiller PI, Langauer MS, Haefeli WE, et al. Angiotensin-converting enzyme inhibitor induced angioedema: late onset, irregular course and potential role of triggers. Allergy. 1997; 52: 432–435.

    Article  PubMed  CAS  Google Scholar 

  50. Brown NJ, Snowden M, Griffin MR. Recurrent angiotensin convertase enzyme inhibitor-associated angioedema. J Am Med Assoc. 1997; 278: 232–233.

    Article  CAS  Google Scholar 

  51. Greaves MW, Shuster S. Responses of skin blood vessels to bradykinin, histamine and 5-hydroxytryptamine. J Physiol. 1967; 193: 255–267.

    PubMed  CAS  Google Scholar 

  52. Nussberger J, Cugno M, Amstutz C, et al. Plasma bradykinin in angioedema. Lancet 1998; 351: 1693–1697.

    Article  PubMed  CAS  Google Scholar 

  53. Mathews KP, Pan M, Gardner MJ, Hugli T. Familial carboxypeptidase N deficiency. Ann Int Med. 1980; 93: 443–445.

    PubMed  CAS  Google Scholar 

  54. Sabroe RA, Black AK. Angiotensin converting enzyme (ACE) inhibitors and angioedema. Br J Dermatol. 1997; 136: 153–158.

    Article  PubMed  CAS  Google Scholar 

  55. Irons BK, Kumar A. Valsartan-induced angioedema. Ann Pharmacother. 2003; 37: 1024–1027.

    Article  PubMed  Google Scholar 

  56. Abdi R, Dong VM, Lee CJ, Ntoso KA. Angiotensin 11 receptor blocker-associated angioedema: on the heels of ACE inhibitor angioedema. Pharmacotherapy. 2002; 22: 1173–1175.

    Article  PubMed  Google Scholar 

  57. Tan Y, Hutchinson FN, Jaffa AA. Mechanisms of angiotensin 11-induced expression of B2 kinin receptors. Am J Physiol Heart Circ Physiol. 2004; 286: H926–932.

    Article  PubMed  CAS  Google Scholar 

  58. Coats AJ. Omipatrilat — the story of Overture and Octave. Int J Cardiol. 2002; 86: 1–4.

    Article  PubMed  Google Scholar 

  59. Pickering RJ, Kelly JR, Good RA, Gerwuz H. Replacement therapy in hereditary angioedema: successful treatment of two patients with fresh frozen plasma. Lancet. 1969; 1: 326–330.

    Article  PubMed  CAS  Google Scholar 

  60. Gompels MM, Lock RJ. C1 inhibitor deficiency: management. Clin Exp Dermatol. 2005; 30: 737–740.

    Article  PubMed  CAS  Google Scholar 

  61. Waytes TA, Rosen FS, Frank MM. Treatment of hereditary angioedema with a vapor-heated C′1 inhibitor concentrate. N Engl J Med. 1996; 334: 1630–1634.

    Article  PubMed  CAS  Google Scholar 

  62. Bowen T, Cicardi M, Farkas H, et al. Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema. J Allergy Clin Immunol. 2004; 114: 629–646.

    Article  PubMed  Google Scholar 

  63. Bork K, Yasothan U, Kirkpatrick P. Icatibant. Nat Rev Drug Disc 2008; 7: 801–802.

    Article  CAS  Google Scholar 

  64. Cugno M, Cicardi M, Agostoni A. Activation of the contact system and fibrinolysis in autoimmune acquired angioedema: a rationale for prophylactic use of tranexamic acid. J Allergy Clin Immunol. 1994; 93: 870–876.

    Article  PubMed  CAS  Google Scholar 

  65. Oike Y, Ogata Y, Higashi D, et al. Fatal angioedema associated with enalapril. Int Med. 1993; 32: 308–310.

    Article  CAS  Google Scholar 

  66. Thompson T, Frable M. Drug-induced life-threatening angioedema revisited. Laryngoscope. 1993; 103: 10–12.

    Article  PubMed  CAS  Google Scholar 

  67. Orfan, N, Patterson R, Dykewicz M. Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema. JAMA. 1990; 264: 1287–1289.

    Article  PubMed  CAS  Google Scholar 

  68. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med. 2002; 346: 175–179.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. London Allergy Clinic, 66, New Cavendish St London W1 and Institute of Dermatology, St Thomas' Hospital, London, SE1, UK

    Malcolm W. Greaves

  2. Guy's Kings and St Thomas' Schools of Medicine and Dentistry, University of London, London, UK

    Malcolm W. Greaves

  3. National Allergy and Urticaria Centres of Charleston, Charleston, South Carolina, USA

    Allen P. Kaplan

Authors
  1. Malcolm W. Greaves
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allen P. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. UMKC School of Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer

About this chapter

Cite this chapter

Greaves, M.W., Kaplan, A.P. (2009). Angioedema in the Emergency Department. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_19

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-98349-1_19

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-98293-7

  • Online ISBN: 978-4-431-98349-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation