Intubation Risk Factors in Angioedema

What are the risk factors for progression and airway intervention of angioedema after initial evaluation?

Background: Angioedema of the upper aerodigestive tract can lead to significant airway obstruction. There are many different patient presentations and many different possible progressions of the disease. To date, no articles have delineated risk factors for progression after initial evaluation.

Study design: Retrospective review of patients with angioedema at a single institution from 1999 to 2003.

Setting: Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center.

Synopsis: This study reviewed a total of 177 patients presenting to the emergency department diagnosed with upper aerodigestive tract angioedema. Initial treatment included dexamethaosone, famotidine, and diphenhydramine, along with fiberoptic laryngoscopy with notation of the primary location of the angioedema. Thirty-two (18%) patients required intubation, 25 (14%) on initial presentation and seven (4%) who progressed from having an initially stable airway to requiring intervention after reevaluation. For those who were intubated, a statistically significant variance was noted between those patients who initially presented with laryngeal or pharyngeal involvement and those who initially presented with involvement of only the lip and face. Also, older patients were noted to have a higher incidence of intubation.

Bottom line: In patients who present with angioedema, edema located further down the aerodigestive tract is associated with a higher rate of intubation.

Citation: Brook CD, Devaiah AK, Davis EM. Angioedema of the upper aerodigestive tract: risk factors associated with airway intervention and management algorithm. Int Forum Allergy Rhinol. 2014;4:239-245.