icatibant and Urticaria

Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency physicians with a focused overview of the evaluation and management of angioedema. Two primary forms include histamine-mediated and bradykinin-mediated angioedema. Histamine-mediated forms present similarly to anaphylaxis, while bradykinin-mediated angioedema presents with greater face and oropharyngeal involvement and higher risk of progression. Initial evaluation and management should focus on evaluation of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes. Histamine-mediated angioedema should be treated with epinephrine intramuscularly, antihistaminergic medications, and steroids. These medications are not effective for bradykinin-mediated forms. Other medications include C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists. Evidence is controversial concerning the efficacy of these medications in an acute episode, and airway management is the most important intervention when indicated. Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy. Disposition is dependent on patient's airway and respiratory status, as well as the sites involved.

Topics: Airway Management; Algorithms; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Blood Coagulation Factors; Bradykinin; Bradykinin B2 Receptor Antagonists; Bronchodilator Agents; Emergency Service, Hospital; Epinephrine; Glucocorticoids; Histamine; Histamine Antagonists; Humans; Peptides; Plasma; Urticaria

The bradykinin B2 receptor antagonist icatibant is effective in angiotensin-converting enzyme inhibitor-induced angioedema. The drug is not approved officially for this indication and has to be administered in an emergency situation off-label. Corticosteroids or antihistamines do not seem to work in this condition. The effectiveness of C1-esterase-inhibitor in angiotensin-converting enzyme-induced angioedema must be verified in a double-blind study.

Topics: Angioedema; Bradykinin; Bradykinin B2 Receptor Antagonists; Diagnosis, Differential; Drug-Related Side Effects and Adverse Reactions; Emergency Medical Services; Epiglottis; Humans; Off-Label Use; Renin; Tongue; Urticaria

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Bradykinin; Female; Hereditary Angioedema Types I and II; Histamine; Humans; Recurrence; Skin Tests; Urticaria