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

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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.

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Acknowledgments

The consensus conference was organized with the support of Shire.

Conflict of interest

None.

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Authors and Affiliations

  1. Medicina Interna, Ospedale Luigi Sacco, Università degli Studi di Milano, Milan, Italy

    Marco Cicardi

  2. Medicina d’Urgenza, P.O. S. Maria di Loreto Mare, ASL Napoli 1 Centro, Naples, Italy

    Paolo Bellis

  3. Dipartimento di Emergenza-Pronto Soccorso, Policlinico Umberto I°, Università La Sapienza, Rome, Italy

    Giuliano Bertazzoni

  4. Dipartimento di Medicina, Università di Padova, Padua, Italy

    Mauro Cancian

  5. Pronto Soccorso e Medicina d’Urgenza, Ospedale S. Antonio, ULSS 16, Padua, Italy

    Maurizio Chiesa

  6. Pronto Soccorso e Medicina D’Urgenza, Ente Ospedaliero Ospedali Galliera, Genoa, Italy

    Paolo Cremonesi

  7. Medicina d’Urgenza, A.O. Fatebenefratelli, Milan, Italy

    Pietro Marino

  8. Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, Ospedale Luigi Sacco, Università degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy

    Marco Cicardi, Nicola Montano & Andrea Zanichelli

  9. Medicina d’Urgenza, AUSL Imola, Imola, Italy

    Claudia Morselli

  10. Head of Division of Otorhinolaryngology, Department of Clinical Sciences and Community Health, Hospital “San Giuseppe”, University of Milan, Via San Vittore 12, Milan, Italy

    Francesco Ottaviani

  11. Reumatologia, Scuola di Specializzazione in Allergologia e Immunologia Clinica, Facoltà di Medicina e Chirurgia, Università Tor Vergata, Rome, Italy

    Roberto Perricone

  12. Università di Salerno, Salerno, Italy

    Massimo Triggiani

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  1. Marco Cicardi
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Correspondence to Marco Cicardi.

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Cicardi, M., Bellis, P., Bertazzoni, G. et al. Guidance for diagnosis and treatment of acute angioedema in the emergency department: consensus statement by a panel of Italian experts. Intern Emerg Med 9, 85–92 (2014). https://doi.org/10.1007/s11739-013-0993-z

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