title: Guidance for diagnosis and treatment of acute angioedema in the emergency department: consensus statement by a panel of Italian experts.
abstract: Angioedema attacks, characterized by the transient swelling of the skin and mucosae, are a frequent cause of visits to the emergency department. Swellings of the oral cavity, tongue, or larynx can result in life-threatening airway obstruction, while abdominal attacks can cause severe pain and often lead to unnecessary surgery. The underlying pathophysiologic process resulting in increased vascular permeability and plasma extravasation is mediated by vasoactive molecules, most commonly histamine and bradykinin. Based on the mediator involved, distinct angioedema forms can be recognized, calling for distinct therapeutic approaches. Prompt recognition is challenging for the emergency physician. The low awareness among physicians of the existence of rare forms of angioedema with different aetiologies and pathogenesis, considerably adds to the problem. Also poorly appreciated by emergency personnel may be the recently introduced bradykinin-targeted treatments. The main objective of this consensus statement is to provide guidance for the management of acute angioedema in the emergency department, from presentation to discharge or hospital admission, with a focus on identifying patients in whom new treatments may prevent invasive intervention.
authors.affiliation: Medicina Interna, Ospedale Luigi Sacco, Università degli Studi di Milano, Milan, Italy, minni_sm@libero.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Cicardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bellis
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bertazzoni
authors.forename: Mauro
authors.initials: M
authors.lastname: Cancian
authors.forename: Maurizio
authors.initials: M
authors.lastname: Chiesa
authors.forename: Paolo
authors.initials: P
authors.lastname: Cremonesi
authors.forename: Pietro
authors.initials: P
authors.lastname: Marino
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
authors.forename: Claudia
authors.initials: C
authors.lastname: Morselli
authors.forename: Francesco
authors.initials: F
authors.lastname: Ottaviani
authors.forename: Roberto
authors.initials: R
authors.lastname: Perricone
authors.forename: Massimo
authors.initials: M
authors.lastname: Triggiani
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanichelli
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D000799:Angioedema / Q000175:diagnosis* / Q000628:therapy*; D004636:Emergency Service, Hospital; D006801:Humans; D007558:Italy