What are the criteria for airway intervention in patients with angioedema?
Explore this issue:March 2011
Background: Angioedema is painless edema of the mucosal and cutaneous surfaces. The more common type is hereditary and is caused by defects in C1 esterase inhibitor, accumulation of bradykinin and mast cell degranulation. The goals were to determine trends in presentation, management and factors associated with the need for admission and airway intervention.
Study design: Retrospective chart review, describing the inciting factors, presentation, and clinical course of patients. A bivariate analysis using a Fisher’s exact test was performed.
Setting: Three tertiary care hospitals in N.Y.
Synopsis: More than 360 episodes of angioedema were reviewed. There was a female preponderance (66 percent) with a mean age of 52 years, and the majority (62 percent) of patients were African-American. Almost half of all patients were on ACE inhibitors and most of these patients were African-American. Non-African-American angioedema cases were more likely to be idiopathic. Isolated type I angioedema involving the lips and oral cavity was found in more than 75% of patients. A multivariate analysis of factors associated with the need for hospital admission showed non-African-American race, allergies, alcohol, use of ACE inhibitors or angiotensin receptor blockers, multiple sites and age. Management review showed that more than 90 percent were treated with steroids and antihistamines and only 3 percent required airway intervention. Although this is one of the largest series to date evaluating angioedema in an urban tertiary care center, the patient demographics make some of their results fairly different from previous studies, where 10 percent to 34 percent required intubation or tracheostomy. Selection bias based on the extraction of charts from the database may have also contributed.
Bottom line: Although this is one of the largest series to date, it gives little new information on the management of angioedema. In addition, the low number of patients requiring airway intervention, whether by intubation or tracheostomy, does not correspond to other studies. As a general rule, airway risk may be predicted by anatomic site of presentation, allowing appropriate management with preparation for airway intervention where necessary.
Citation: Tai S, Mascaro M, Goldstein NA. Angioedema: a review of 367 episodes presenting to three tertiary care hospitals. Ann Otol Rhinol Laryngol. 2010;119(12): 836-841.
—Reviewed by Natasha Mirza, MD