Angioedema (>18 years)
Airway compromise?
Consider allergist consult
Signs of severe disease?
Reassess clinical status
Resolution of any airway signs/symptoms?
Epinephrine injection
Famotidine injection
Dexamethasone injection
Diphenhydramine injection
- Identify potential triggering allergen
- Discharge home with
- Epinephrine auto-injector
- H1 blocker
- Prednisone taper
Admit for observation (stepdown/ ICU)
Bradykinin Mediated Angioedema
- Supportive care (analgesics, antiemetics, etc. as needed)
- In refractory cases or with airway involvement, FFP 2 units IV
- May give targeted therapy with allergist consultation
Fresh Frozen Plasma (FFP)
Inclusion Criteria
- Clinical suspicion for angioedema
Exclusion Criteria
- None
- Proceed to intubation or laryngoscopy
- Ketamine @ 1- 1.5mg/kg IV preferred agent
- Backup cricothyrotomy kit must be at bedside and ready
- BiPaP may help as a temporizing measure
- If there is time obtain ENT and Anesthesia consultation; do not delay airway intervention for these consultations
Ketamine injection
Signs of acute airway compromise in angioedema
- Stridor
- Voice change
- Dyspnea
- Tongue/throat swelling
- Drooling
Determine angioedema type
Histamine | Non-histamine |
Urticaria | No rash |
Wheezing | HAE/ACE-I history |
Sudden onset | Gradual Onset |
Shock | Abdominal pain |
Signs of severe disease
- Airway involvement
- Wheezing
- Shock
- Multisystem compromise