Assessment and initial treatment of angioedema

Angioedema is typically characterised by acute oedema of subcutaneous tissue, as single or multiple lesions. Lesions are not itchy, and resolve over hours to several days. They can occur anywhere on the body, but often affect the face, periorbital region, lips, tongue, glottis, dorsa of feet and hands, and genitals.

Consider anaphylaxis if angioedema is associated with respiratory, gastrointestinal or cardiovascular symptoms. Angioedema involving the tongue, pharynx or larynx is potentially life-threatening—administer adrenaline and urgently refer to a hospital emergency department.

Patients can have angioedema alone, but angioedematous lesions are common in urticaria. Angioedema without urticaria usually has the same pathogenesis as angioedema with urticaria (ie mast cell activation with histamine release).

Treat angioedema with less-sedating antihistamines, as for urticaria; however, treatment is less likely to be effective. Daily antihistamine therapy may be more beneficial than antihistamine therapy used as required, especially for frequent episodes.

If higher doses of less-sedating antihistamines do not control symptoms, consider adding montelukast Akenroye, 2018 to the less-sedating antihistamine. Use:

If symptoms are severe (eg lip or eye swelling), persistent or distressing, consider using a short course of oral corticosteroid initially, in addition to the less-sedating antihistamine. Use:

The less-sedating antihistamine can be continued when the short course of oral corticosteroid is completed. Avoid long-term therapy with an oral corticosteroid.

If there is no response to therapy, consider whether the patient may have angioedema that is not related to mast cell activation (eg bradykinin-mediated angioedema)—refer the patient for specialist opinion. See also Bradykinin-mediated angioedema.