- subdermal and submucosal oedema due to unapposed vasoactive mediators - does **NOT** need to have urticaria # Causes - allergic reaction - [[Anaphylaxis]] IgE mediated from food or drugs - hereeditary (HAE) - rare - does NOT have urticaria - acquired C1 esterase inhibitor def - lymphoma - SLE - ==drug induced== - [[ACE inhibitors]] (1/200 people will get sx within first few months of treatment, but can be delayed months to years - sometimes only get rxn with increase dose - swelling is NOT itchy or painful, usually aroudn face, tongue, and throat, and no urticaria - NOT caused by ARBs - [[TPA]] - uncommon - plasmin activation of bradykinin - Infection - idiopathic # Complications - dysphonia - dysphagia - airway obstruction # Clinical features - airwya obv - GIT involvement if angiooedema of intestine # Ix - C1 esterase - compliment levels - consider lateral neck radiology # Mgmt - IV access, upright patient - [[Adrenaline]] if anaphylaxis - consider 4mL of 1:1000 nebulised adrenaline - Steroids - dex 10mg IV or hydrocort 200mg IV note: antihistamines NOT recommended for angioedema or anaphylaxis ## Specific treatments ### HAE see [RCH C1 esterase inhibitor deficiency](https://www.rch.org.au/clinicalguide/guideline_index/C1_Esterase_Inhibitor_Deficiency/) **Hereditary angioedema (C1-esterase inhibitor deficiency)** - C1 esterase inhibitor concentrate (**Berinert**) - 20 IU/kg rounded to nearest 500 IU. symptoms usually stabilise in 30 min - Bradykinin B2 receptor antagonist [[Icatibant]] (**Cipla**) given by s/c injection . Second dose can be given *6 hours* after first dose - 12 - 25 kg → 10mg (1mL) - 26 - 40kg → 15mg (1.5mL) - 41 - 50kg → 20mg (2mL) - \>50kg → 30mg (3mL) - FFP can be used if not available, but less effective ## ACE angioedema [[Icatibant]] is [better](https://www.nejm.org/doi/full/10.1056/NEJMoa1312524) than steroids/antihistamines/adrenaline - give 30mg s/c Q6H if required #Allergy/angioedema