1/
Angioedema❗️
I recently encountered a patient with a history of severe angioedema. I was familiar with its association with ACE inhibitors...
However, I realized that I didn’t know that much about it. Here are the cliff notes 🤓
Angioedema❗️
I recently encountered a patient with a history of severe angioedema. I was familiar with its association with ACE inhibitors...
However, I realized that I didn’t know that much about it. Here are the cliff notes 🤓
2/
Angioedema is localized swelling of the skin or mucosal tissues. It is divided into two main types, histamine-mediated and bradykinin-mediated.
It’s important to identify the type, as the treatment strategy is completely different.
Angioedema is localized swelling of the skin or mucosal tissues. It is divided into two main types, histamine-mediated and bradykinin-mediated.
It’s important to identify the type, as the treatment strategy is completely different.
3/
Histamine-mediated angioedema develops quickly (minutes), involves pruritis/urticaria, and is associated with an allergic reaction.
Look for exposure to foods, drugs, insect stings, and other allergens.
Histamine-mediated angioedema develops quickly (minutes), involves pruritis/urticaria, and is associated with an allergic reaction.
Look for exposure to foods, drugs, insect stings, and other allergens.
4/
Bradykinin-mediated angioedema develops much slower (hours), and does not involve urticaria/pruritis. Interestingly, it may cause bowel edema in addition to facial edema.
Look for causative medications, abdominal pain, and nausea/vomiting/diarrhea.
Bradykinin-mediated angioedema develops much slower (hours), and does not involve urticaria/pruritis. Interestingly, it may cause bowel edema in addition to facial edema.
Look for causative medications, abdominal pain, and nausea/vomiting/diarrhea.
5/
Treatment of histamine-mediated angioedema is basically identical to that of anaphylaxis, as the pathophysiology is very similar.
- Corticosteroid (methylprednisolone)
- H1 antagonist (diphenhydramine)
- H2 antagonist (famotidine)
- Epinephrine if airway compromise
Treatment of histamine-mediated angioedema is basically identical to that of anaphylaxis, as the pathophysiology is very similar.
- Corticosteroid (methylprednisolone)
- H1 antagonist (diphenhydramine)
- H2 antagonist (famotidine)
- Epinephrine if airway compromise
6/
Moving on to bradykinin-induced angioedema.. It is further divided into two subclasses.
1. Medication-induced - Commonly ACEi, ARB, sacubitril/valsartan (Entresto®), and DPP4-inhibitors.
2. C1 inhibitor deficiency - Can be acquired or hereditary.
Moving on to bradykinin-induced angioedema.. It is further divided into two subclasses.
1. Medication-induced - Commonly ACEi, ARB, sacubitril/valsartan (Entresto®), and DPP4-inhibitors.
2. C1 inhibitor deficiency - Can be acquired or hereditary.
7/
The pathophysiology of bradykinin-mediated angioedema is much more complex. Ever heard of the kininogen pathway?
.... me neither.
The pathophysiology of bradykinin-mediated angioedema is much more complex. Ever heard of the kininogen pathway?
.... me neither.
8/
The bigest take away from the pathway is that antihistamines, epinephrine, and glucocorticoids are INEFFECTIVE for bradykinin-induced angioedema.
The bigest take away from the pathway is that antihistamines, epinephrine, and glucocorticoids are INEFFECTIVE for bradykinin-induced angioedema.
9/
Treatment of bradykinin-induced angioedema is very controversial. Possible drug therapies are listed below.
- FFP (contains ACE)
- TXA (halts activation of kininogen pathway)
- Others including C1-inhibitor concentrate, icatibant, or ecallantide
Treatment of bradykinin-induced angioedema is very controversial. Possible drug therapies are listed below.
- FFP (contains ACE)
- TXA (halts activation of kininogen pathway)
- Others including C1-inhibitor concentrate, icatibant, or ecallantide
10/
Summary
Angioedema can be a medical emergency, and it’s important to understand the underlying pathophysiology when using drug therapies.
Bonus: The risk of ACEi-induced angioedema is up to 5 times higher in African Americans
#TwitterRx
#FOAMed
Summary
Angioedema can be a medical emergency, and it’s important to understand the underlying pathophysiology when using drug therapies.
Bonus: The risk of ACEi-induced angioedema is up to 5 times higher in African Americans
#TwitterRx
#FOAMed
• • •
Missing some Tweet in this thread? You can try to
force a refresh
