Angioedema

Question 0

What is the overall incidence of angioedema in the US

Answer 0

15%

Note: Peaks in the 3rd decade of life, female > male

Question 1

What are some inheritance trait patterns for angioedema

Answer 1

Autosomal

Sex linked

dominant

recessive

Question 2

Pathophysiology of angioedema

Answer 2

Vasoactive mediators (histamine, serotonin, kinins) produce Heart arteriolar dilation, venular inflammation, vascular leakage.

Same as urticaria (However, urticaria is in the dermis, angioedema is below the dermis)

Question 3

What are some classifications of angioedema

Answer 3

Drug-related angioedema (90%)

allergic angioedema

hereditary angioedema

idiopathic angioedema

Question 4

In regards to drug-related angioedema what are some of the causes

Answer 4

Interference with bradykinin degradation (Ace inhibitors 0.2% patients)

Arachidonate acid metabolism (aspirin, NSAIDS)

Mast cell release (contrast, dextran, opiates)

Question 5

Allergic angioedema is ____

Answer 5

IgE mediated

I.E. foods, exposure to cold/heat, emotional stress, local trauma, animal allergens

Question 6

Inherited angioedema is due to what?

Answer 6

Primary C1 esterase inhibitor

Type 1 – deficiency (30% normal Concentration) 85%
Type 2 - dysfunction (normal concentration) 15%

Question 7

Acquired angioedema is due to what?

Answer 7

Secondary C1 Esterase inhibitor

Question 8

In regards to acquired angioedema, what is the difference between C1 esterase inhibitor deficiency and C1 esterase dysfunction

Answer 8

C1 Esterase inhibitor deficiency – destruction of the inhibitor Lymphoma, connective tissue, auto-antibodies)

C1 Esterase dysfunction – auto-antibodies altering the inhibitor molecule

Question 9

True & false. Angioedema only occurs on the face

Answer 9

False

Can occur in G.I. GU tracts & skin of hands, arms, legs, buttocks

Question 10

What are some possible Treatments for angioedema

Answer 10

Pretreat = anabolic steroids to increase production of C1 Estrace inhibitor

Pretreat or post-treat = FFP, contains C1 Esterase inhibitor protein (half-life of 65 hours)

Question 11

If you have a patient that has known cases of angioedema, how should you treat?

Answer 11

Anabolic steroids: 10 – 14 days prior to surgery

FFP: within 24 hours prior to surgery

use regional or local anesthesia if possible

if using general anesthesia - minimize airways instrumentation, avoid oral airway, and no esophageal stethoscope

Question 12

What would you do if you were in surgery and a patient had angioedema (No previous history)?

Answer 12

FFP infusion immediately

repeat FFP as needed

H1, H2-blockers

steroids supportive management (epinephrine)

observed for 24 hours after resolution