eMedicine Specialties > Allergy and Immunology > Urticaria and Angioedema

Angioedema: Follow-up

Author: Maurice Reid, MD, Staff Physician, Department of Emergency Medicine, University of Maryland Medical System
Coauthor(s): Brian Euerle, MD, FACEP, Associate Professor, Department of Emergency Medicine, Director of Emergency Ultrasound Program, University of Maryland School of Medicine; Mary Elizabeth Bollinger, DO, Associate Professor, Department of Pediatrics, Interim Chief, Division of Pediatric Pulmonology and Allergy, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Oct 20, 2008

Follow-up

Further Inpatient Care

  • Patients with oropharyngeal involvement should be admitted to either an intensive care unit or an intermediate care unit, depending on the severity of the angioedema (ie, lip vs tongue and soft palate involvement).
  • If available, an in-house ear, nose, and throat specialist should be notified of the patient's condition and the possibility that a surgical airway or use of equipment for direct laryngoscopy may be needed. In this regard, an anesthesiologist should also be notified of the potential for airway compromise.
  • All hospitalized patients should be monitored continuously with pulse oximetry.
  • Continued analgesia and fluid resuscitation are also concerns in patients with HAE or AAE.

Further Outpatient Care

  • Patients with HAE or AAE should follow up with an allergist and an immunologist as soon as possible.

Inpatient & Outpatient Medications

  • Long-term prophylaxis with androgens is needed for patients with monthly attacks or a history of airway compromise.
  • In children, long-term prophylaxis with aminocaproic acid reduces attacks by 80%.
  • Prophylaxis is needed before any dental or oropharyngeal procedure (ie, 5-10 d preoperatively and 3 d postoperatively). Shortly before the intervention, FFP should be administered.
  • Before emergent procedures, purified C1-INH may be administered. In addition, women who are pregnant may receive C1-INH before delivery. This has no effect on C1-INH levels in the newborn because C1-INH does not cross the placenta.

Complications

  • The most dreaded complication of angioedema is complete airway obstruction caused by laryngeal edema. This type of airway swelling is usually less severe than that associated with anaphylaxis. Patients with upper airway involvement present with hoarseness and dysphagia, which may gradually progress to upper airway obstruction over a period of hours.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis, especially in patients with the classic triad of abdominal pain, peripheral edema, and laryngeal edema
  • Failure to intervene early by securing the airway in patients with oropharyngeal involvement
  • Failure to instruct patients who have had ACE inhibitor–related angioedema that they have a lifelong prohibition from taking the drug again as well as any others in the class is a pitfall. This information must also be communicated to the patient's primary care provider.
 


More on Angioedema

Overview: Angioedema
Differential Diagnoses & Workup: Angioedema
Treatment & Medication: Angioedema
Follow-up: Angioedema
Multimedia: Angioedema
References
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References

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Further Reading

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Keywords

angioneurotic edema, oedema, laryngeal edema, hereditary angioedema, HAE, acquired angioedema, AAE, allergic reactions, hereditary angioneurotic edema, airway obstruction, swelling

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Contributor Information and Disclosures

Author

Maurice Reid, MD, Staff Physician, Department of Emergency Medicine, University of Maryland Medical System
Maurice Reid, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Brian Euerle, MD, FACEP, Associate Professor, Department of Emergency Medicine, Director of Emergency Ultrasound Program, University of Maryland School of Medicine
Brian Euerle, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Mary Elizabeth Bollinger, DO, Associate Professor, Department of Pediatrics, Interim Chief, Division of Pediatric Pulmonology and Allergy, University of Maryland School of Medicine
Mary Elizabeth Bollinger, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, and American College of Allergy, Asthma and Immunology
Disclosure: Merck Honoraria Speaking and teaching; Merck Consulting fee Consulting; Novartis Honoraria Speaking and teaching

Medical Editor

Stephen C Dreskin, MD, PhD, Director of Allergy, Asthma, and Immunology Practice, Professor of Medicine, Departments of Internal Medicine and Immunology, University of Colorado Health Sciences Center
Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American Association of Neuropathologists, American Association of Ophthalmic Pathologists, American Association of Oral and Maxillofacial Surgeons, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology
Disclosure: Genentech Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel R Marney, Jr, MD, Director, Associate Professor, Department of Internal Medicine, Division of Allergy and Immunology, Vanderbilt University School of Medicine
Samuel R Marney, Jr, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, and Tennessee Medical Association
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD, Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians
Disclosure: Abbott Consulting fee Consulting; Alcon Consulting fee Consulting; Glaxo Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering Consulting fee Consulting; Teva  Consulting; Meda Honoraria Speaking and teaching

 
 
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