Let’s Learn About:
Angioedema
It will be swell…
Physiology - Pathophysiology - Pharmacology
Most common causes of Angioedema
Anaphylaxis - mast cell mediated response to an allergen
Medication Related - ACE Inhibitors and NSAIDs
HAE - Hereditary Angioedema
Knowledge Check
● What hormone causes vasodilation, capillary permeability, and is the
main cause of swelling and redness in anaphylaxis?
A. Cytokines
B. Histamine
C. Bradykinin
D. Spaghetti-Os
What would this patient look like?
Let’s watch a clip that shows how quickly angioedema can develop and how that
patient may present.
**Guilford County does not recommend any treatment modalities pictured in this
video.
Death on a leaf….
What happened in this video?
Our patient (Hitch) was exposed to an allergen (Coquilles St. Jacques aka. Death on a leaf)
Symptoms: itching around his ear and itching in throat
Angioedema (facial swelling of lips, face ears) began on his right side and worsened in a short
period of time
Pt. attempted to “self-administer” Benadryl to treat symptoms
**(Benadryl chugging not recommended by GCEMS)
Medication Related AE - ACE Inhibitors
Excess
Bradykinin
Beta-2
Receptors
Knowledge Check
● What is the common root ending for a drug to clue you in they are on
ACE Inhibitors?
A. -lol
B. -pine
C. -pril
D. -amab
Medication Related AE - NSAIDs
Mast Cell-Mediated
Treatment
This treatment is effective for anaphylaxis
and angioedema that we see caused by
normal cell-mediated responses to
allergens and medications
Knowledge Check
● We should treat anaphylaxis with angioedema with what drugs?
A. None, it will resolve on its own.
B. Benadryl 50mg IV only
C. Epi 1:1,000 0.3mg IM only
D. According to our protocols based on severity (Moderate or
Severe, normally)
Hereditary Angioedema - HAE
Let’s read the fine print...
PEARLS
But it looks the same...
Knowledge Check
HAE reactions are exactly the same as typical anaphylaxis reactions?
True OR
False
But it’s not the same...
Hereditary AE (HAE) = deficiency of functional C1 inhibitor -> allows plasma
kallikrein activation -> overproduction of bradykinin
HAE has 3 broad subtypes: deficiency of C1E, decreased function of C1E, estrogen induced failure
of C1E
Taming the SRU: http://www.tamingthesru.com/blog/clinical-treatments/angioedema
How it
happens
How do we treat it?
1. Follow our Allergic Reaction protocol based on the severity of
symptoms the patient is experiencing
2. Assist the patient or administer the patient’s medications
prescribed for this emergent condition according to package
instructions
What types of medications would I find?
Icatibant - B2 Bradykinin Receptor Antagonist
Ecallantide - Kallikrein Enzyme Inhibitor
Lanadelumab - Also targets Kallikrein
*These three medication are generally administered subcutaneously
Knowledge Check
● What is a medication that a patient may be prescribed for HAE?
A. Epi-Pen
B. Glucagon
C. Icatibant
D. Solucortef
Summary
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Common causes of angioedema
Pathophysiology of angioedema
Examples of angioedema patients and their presentation
Treatment of angioedema based on cause
Treatment based on GCEMS Protocols
Questions?
If you have questions regarding angioedema, treatment, assessment or anything else covered in this
presentation please feel free to reach out!
Jenna Tuttle
jtuttle1@guilford-es.com
Cell: 336-451-5080 call or text