angioedema 2

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 Here are teaching points in question-and-answer format on angioedema:

1. What is angioedema?

  • Answer: Angioedema is a self-limited, localized swelling of the subcutaneous or submucosal tissues, resulting from fluid leakage into the interstitial tissue. It can occur alone, with urticaria, or as part of an anaphylactic reaction.

2. Which areas are commonly affected by angioedema?

  • Answer: Angioedema typically affects areas with loose connective tissue, such as the face, lips, mouth, throat, larynx, extremities, genitalia, and bowel wall.

3. How does angioedema differ from other types of edema?

  • Answer: Angioedema is distinguished by rapid onset (minutes to hours), asymmetric distribution, non-gravitational location, and its tendency to resolve spontaneously within hours to a few days.

4. What are the main types of angioedema based on mechanism?

  • Answer: Angioedema is classified as either mast cell-mediated (histaminergic), often associated with allergic reactions, or bradykinin-mediated, which does not involve urticaria or allergic symptoms and has a more prolonged course.

5. What are common triggers for mast cell-mediated angioedema?

  • Answer: Triggers for mast cell-mediated angioedema include food allergies, insect stings, and other allergens. It often presents with symptoms of histamine release, such as urticaria, flushing, bronchospasm, and throat tightness.

6. How is bradykinin-mediated angioedema different from mast cell-mediated angioedema?

  • Answer: Bradykinin-mediated angioedema is not associated with urticaria, bronchospasm, or other allergic symptoms. It develops over 24–36 hours and resolves within 2–4 days. ACE inhibitors and hereditary C1 inhibitor deficiency are common causes.

7. Which medications are commonly associated with angioedema?

  • Answer: ACE inhibitors are a well-known cause of bradykinin-mediated angioedema. Other medications, like NSAIDs and estrogen, can also induce angioedema in certain populations.

8. What are the key signs of life-threatening angioedema?

  • Answer: Life-threatening angioedema may involve the larynx, upper airway, or tongue, causing airway obstruction. Angioedema can also be a component of anaphylaxis, which requires immediate treatment with epinephrine.

9. How is angioedema diagnosed?

  • Answer: Diagnosis is typically clinical, based on the history of rapid-onset, localized, non-pitting swelling. Complement testing (e.g., C4 levels) may be useful in cases without a clear trigger or when hereditary angioedema is suspected.

10. What is the initial management for angioedema involving the airway?

  • Answer: Immediate airway assessment and protection are critical. Epinephrine, corticosteroids, and antihistamines are given for mast cell-mediated angioedema. In bradykinin-mediated angioedema, treatments include C1 inhibitor concentrate and icatibant.

11. How is acute allergic angioedema managed?

  • Answer: For mast cell-mediated angioedema without anaphylaxis, antihistamines and corticosteroids are the main treatments. Epinephrine is indicated for severe cases or if there is risk of airway compromise.

12. What should be done for ACE inhibitor-induced angioedema?

  • Answer: The ACE inhibitor should be immediately discontinued, and the patient should be monitored closely for airway swelling. Other medications may be used in severe cases if needed, although they are less effective in bradykinin-mediated cases.

13. How is hereditary angioedema (HAE) treated during an acute attack?

  • Answer: Treatments include C1 inhibitor concentrate, ecallantide, or icatibant. Fresh frozen plasma may be used if other treatments are unavailable, though it can sometimes worsen symptoms.

14. What options exist for long-term management of idiopathic angioedema?

  • Answer: High-dose, nonsedating antihistamines are often prescribed to prevent recurrent episodes. Montelukast may be added in cases resistant to antihistamines alone.

15. When should patients with angioedema be referred to a specialist?

  • Answer: Referral to an allergist or immunologist is recommended for patients with severe, recurrent, or idiopathic angioedema, particularly if the episodes are unresponsive to antihistamines.

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