title: Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement.
abstract: Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
authors.affiliation: aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon cEmergency Department, Louis Mourier University Hospital, Paris 7 University dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand gDepartment of Internal Medicine, Niort Hospital, Niort hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion jDepartment of Internal Medicine, Caen University Hospital, Caen kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Floccard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Javaud
authors.forename: Alban
authors.initials: A
authors.lastname: Deroux
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boccon-Gibod
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Amarger
authors.forename: Claire
authors.initials: C
authors.lastname: Blanchard-Delaunay
authors.forename: Pierre Y
authors.initials: PY
authors.lastname: Jeandel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Marmion
authors.forename: Yann
authors.initials: Y
authors.lastname: Ollivier
authors.forename: Pauline
authors.initials: P
authors.lastname: Pralong
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gayet
authors.forename: Aurélie
authors.initials: A
authors.lastname: Du-Thanh
authors.forename: Fabien
authors.initials: F
authors.lastname: Pelletier
authors.forename: Laurent
authors.initials: L
authors.lastname: Sailler
authors.forename: Philip
authors.initials: P
authors.lastname: Robinson
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Laurence
authors.initials: L
authors.lastname: Bouillet
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000799:Angioedema / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003697:Delphi Technique; D004636:Emergency Service, Hospital; D005602:France; D006801:Humans; D012720:Severity of Illness Index