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Abstract
Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.
Acknowledgements
M.P., A.P.-G., and A.S.-C. contributed equally to the manuscript and are listed in alphabetical order.
Declaration of interest: Dr M. Pedrosa has received sponsorship for educational purposes and has taken part in clinical trials sponsored by Jerini AG/Shire, CSL-Behring, Pharming NV, and Viropharma.
Dr A. Prieto-García has received sponsorship for educational purposes, has been paid for consultancy services, and has taken part in clinical trials sponsored by Shire, CSL-Behring, and Viropharma.
Dr A. Sala-Cunill has received sponsorship for educational purposes, has been paid for consultancy services, and has taken part in clinical trials sponsored by Shire, CSL-Behring, Pharming NV, and Viropharma.
Notice of correction
In the original version of this article, published online ahead of print on 12 August 2014, one of the members of the SGBA was omitted from the contributor list. M. Piñero-Saavedra has now been added to the list in this version.