Angioedema
Description General measures Medicine treatment ICD-10 code: T78.3 + Y57.9 Contact the 24/7 South African Angioedema Hotline at: 082 091 5684 if you require assistance with acute management, investigation or follow up. DESCRIPTION Two major groups of angioedema should be differentiated: allergic angioedema forming part of a systemic reaction to an allergen, and non-allergic angioedema caused by b
ICD-10 code: T78.3 + Y57.9
| Contact the 24/7 South African Angioedema Hotline at: 082 091 5684 if you require assistance with acute management, investigation or follow up. |
DESCRIPTION
Two major groups of angioedema should be differentiated: allergic angioedema forming part of a systemic reaction to an allergen, and non-allergic angioedema caused by bradykinin excess.
In allergic angioedema, features of allergy or anaphylaxis will often be present, including urticaria, bronchospasm, hypotension or gastrointestinal upset.
Anaphylaxis should be treated urgently. See: Anaphylaxis/anaphylactic shock.
Non-allergic angioedema is most commonly caused by ACE-inhibitors in susceptible individuals. It may also be caused by hereditary angioedema or acquired C1 esterase deficiency. Associated features of allergy are absent.
Symptoms
Swelling usually occurs around eyes and lips but may occur elsewhere. Life-threatening airway obstruction can occur with angioedema of upper airways.
GENERAL MEASURES
Stop all suspected agents, e.g. ACE-inhibitor.
In case of angioedema with airway obstruction, early airway management is essential. If oedema is extensive or progressive, establish a definitive airway. The most skilled person available must handle airway interventions.
Avoid re-exposure to the offending agent and provide an alert bracelet.
MEDICINE TREATMENT
In severe cases of hypersensitivity where airway obstruction may be imminent:
Note:
A definitive airway may be required before patient responds to medical treatment. Low threshold to surgical airway tracheostomy.
In cases where angioedema is part of anaphylaxis, treat as anaphylaxis. See: Anaphylaxis/Anaphylactic shock.
If urticaria and/or itch present (no imminent airway compromise):
- Promethazine, IM/IV, 25–50 mg as a single dose.
AND
- Hydrocortisone, IV, 100 mg as a single dose.
Severe ACE-inhibitor induced angioedema with threatened airway:
Note:
A definitive airway may be required before patient responds to medical treatment. Low threshold to surgical airway tracheostomy.
- Lyophilised plasma, IV, 2 units.
If lyophilised plasma is unavailable:
- FFP, IV, 2 units.
Observe all cases until resolution.
Click here for the Supporting NEMLC report and reviews_(2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_June 2024
Chapter 20: Emergencies and Injuries