Episode 212: Angioedema

Angioedema – Recognition and Management in the ED

Hosts:
Maria Mulligan-Buckmiller, MD
Brian Gilberti, MD

Definition & Pathophysiology

Angioedema = localized swelling of mucous membranes and subcutaneous tissues due to increased vascular permeability.

Triggers increased vascular permeability → fluid shifts into tissues.

Etiologies

• Histamine-mediated (anaphylaxis)
  • Associated with urticaria/hives, pruritus, and redness.
  • Triggered by allergens (foods, insect stings, medications).
  • Rapid onset (minutes to hours).
• Bradykinin-mediated
  • Hereditary angioedema (HAE): C1 esterase inhibitor deficiency (autosomal dominant).
  • Acquired angioedema: Associated with B-cell lymphoma, autoimmune disease, MGUS.
  • Medication-induced: Most commonly ACE inhibitors; rarely ARBs.
  • Typically lacks urticaria and itching.
  • Gradual onset, can last days if untreated.
• Idiopathic angioedema
  • Unknown cause; diagnosis of exclusion.

Clinical Presentations

• Swelling
  • Asymmetric, non-pitting, usually non-painful.
  • May involve lips, tongue, face, extremities, GI tract.
• Respiratory compromise
  • Upper airway swelling → stridor, dyspnea, sensation of throat closure.
  • Airway obstruction is the most feared complication.
• Abdominal manifestations