Like so many things in critical care, angioedema is difficult to research since it is uncommon, heterogeneous, and emergent. As such, we have relatively little high-quality evidence regarding this disease (and the high-quality evidence that we do have is largely restricted to pharma-sponsored trials of new and insanely expensive pharmaceuticals). This chapter attempts to create rational treatment strategies, while acknowledging that definitive data doesn't exist.
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Thank you for a great post! How long would you wait for before calling antihistamine category treatment as a failure in bradykinin induced angioedema?
Great question. Would probably expect full-bore tx should cause some improvement in around an hour? I feel like IV epinephrine typically works much faster than that, so if no improvement from epi/histamine/steroid in about an hour then maybe switch gears.
Awesome. Thank you!
Hello, and thanks again for your writings here.
The algorithm (in your IBCC Angioedema chapter) “differentiation of BDK vs Hist etc states :
“trial of immediate and agressive therapy for histamine mediated angioedema.
steroid, anti-histamine +/_ epinephrine.
I’m puzzled since “immediate and agressive therapy fpr histamine angioedema is epi ± antihistaline and sgteroids.
Slip of the keyboard ?
I’m mistaken ?
Any specific reason ?
Thanks
This IBCC article is absolutely fantastic. The uptodate chapters on this topic are a mess. Excellent description of the pathophysiology with a clear treatment plan that is easy to comprehend and remember in an emergency.