Angioedema

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Angioedema

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Definition

Extravasation of fluid into interstitial tissues due to loss of vascular integrity

References

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References

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References

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References

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Mechanisms
  • Mast Cell-Mediated
    • Associated with urticaria +/or pruritus in 90%
    • Can develop acutely after exposure or chronically without clear precipitant
    • Major Causes:
      • Food, drugs, insects, contact allergies (IgE mediated)
      • Agents causing direct mast cell release (opiates, iv contrast)
      • Serum sickness, transfusion reactions (immune complex mediated)
      • Aspirin (ASA), Nonsteriodal anti-inflammatory drugs (NSAIDs) (altered arachadonic acid metabolism)
  • Bradykinin/Complement-Mediated
    • Not associated with urticaria, pruritus, erythema, or hx allergies
    • Major Causes
      • ACE inhibitors (reduced degradation of bradykinin)
        • Usually occurs days to weeks after prescription started
        • Can occur after several years of prescription
      • Hereditary angioedema (C1 inhibitor deficiency)
      • Acquired C1 inhibitor deficiency
        • Malignancy-associated (excessive complement activation)
        • Autoimmune (ABs against C1 inhibitor)
References

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References

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References

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References

Diagnosis

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References

== History and Symptoms == Associate Editor-In-Chief: Contact at [ @ ]; Phone:

  • Rapid onset (minutes to hours)
  • Asymmetric distribution
  • Non-dependent distribution
  • May involve lips, larynx, bowel
  • May be associated with anaphylaxis
    • (Features not found with edema caused by oncotic/hydrostatic forces)
  • Acute urticarial or anaphylactic episode:
    • External triggers
  • Chronic or recurrent urticarial episodes:
    • Recurrent exposures
    • Drug history
    • Signs/symptoms autoimmune diathesis
  • Non-urticarial episodes
    • Family history
    • Age at onset, worsening in adolescence
    • Drug history (NSAIDs, ACE inhibitors)
References

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Appearance of the Patient

Eyes

Ear Nose and Throat

Heart

Lungs

Abdomen

Extremities

Neurologic

Other

References

Laboratory Findings

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  • Mast cell-mediated
    • Likely unnecessary
  • Kinin/complement-mediated
    • C4, C2, C1q levels
    • C1-inhibitor antigenic and functional assays
References

=== Electrocardiogram === Associate Editor-In-Chief: Contact at [ @ ]; Phone:


References

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References

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References

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References

Other Imaging Findings

References

Other Diagnostic Studies

References

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References

Treatment

Pharmacotherapy

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References

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References

Surgery and Device Based Therapy

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References

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References

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References

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References

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References

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References

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References

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References

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References

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Acknowledgements

The content on this page was first contributed by: Dr. Steve Wiviott

List of contributors:


Suggested Reading and Key General References

Suggested Links and Web Resources

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