GuidelinesPrimary Care STG
Angioedema
Allergies
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ICD 10 code: T78.3 + (Y14.99/Y34/Y57.9)
DESCRIPTION
- Localised oedema of the subcutaneous tissue affecting particular parts of the face i.e. lips, eyes and tongue. May also affect the larynx, causing life threatening airway obstruction and anaphylaxis
- ACE-inhibitors are the most common cause in adults. Other causes include other medicines and allergies
GENERAL MEASURES
- Stop all suspected agents e.g. ACE-inhibitor
- In the case of airway obstruction, a definitive airway must be established if oedema is extensive or progressing
MEDICINE TREATMENT
If urticaria and/or itch present (no imminent airway compromise):
- Cetirizine, oral, 10 mg as a single dose
OR
- Promethazine, IM, 25–50 mg immediately
LoE:IVb
In severe cases where airway obstruction is present:
Adults
- Adrenaline (epinephrine), 1:1000 solution, 0.5 mL into the lateral thigh, administered immediately and repeated every 5 to 15 minutes as needed
Children
- Adrenaline (epinephrine), IM, 0.01 mL/kg of 1:1000 solution, administered immediately
- Maximum dose of 0.3 mL AND • Hydrocortisone, IV, 100 mg as a single dose
AND
- Hydrocortisone, IV, 100 mg as a single dose
Note:
Observe all cases until resolution.
REFERRAL
- Failure to respond
- No obvious cause found
- Severe ACE-inhibitor induced angioedema
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.10.2 Angioedema