Histamine-meditated Angioedema
Histamine-induced AE, which may occur through multiple mechanisms, is important to differentiate from other forms of AE, as the treatment approach and prognosis for this condition is quite different - Christine James and Jonathan A. Bernstein
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image by: Maimonides Emergency Medicine
HWN Suggests
Angioedema
History is SUPER important! The onset of bradykinin-mediated angioedema is on the scale of hours; histamine-mediated is more on the scale of minutes. Urticaria more frequently associated with histamine mediated. Think about bradykinin-mediated if there is no improvement to antihistamines or steroids!
For histamine-mediated, the treatment is similar to how you may treat any allergic reaction of various severities. Diphenhydramine 50 mg IV, famotidine 20 mg IV, IV methylprednisolone 125 mg, IM 0.5 epinephrine.
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Anaphylaxis & Angioedema: Practical Approach to Diagnosis and Management in Emergency Department
Do Not rely on the presence of hypotension or shock for diagnosis of anaphylaxis. As implicated by diagnostic criterion 1 and 2; hypotension is not required for diagnosis of anaphylaxis accordingly.
Articles of Interest
Current and future therapies for the treatment of histamine-induced angioedema
Histamine-induced AE, which may occur through multiple mechanisms, is important to differentiate from other forms of AE, as the treatment approach and prognosis for this condition is quite different. The current management strongly relies on guidelines developed for chronic urticaria, as there is a paucity of literature investigating allergic AE as a distinct clinical entity.
Histamine-Mediated Emergencies
The wheel and flare of urticaria is the pathognomonic feature of histamine-mediated cutaneous lesions.
Idiopathic Angioedema: Current Challenges
Mast-cell induced AE (MC‐AE) is the most frequent form, seen in 96% of consultations.1 MC‐AE can last from only a few hours up to several days and is often associated with hives, concomitant with or at some distance in time from the AE episode. So, searching for episodes of hives in the patient’s medical history is the first step in this challenging diagnosis.
Idiopathic histaminergic acquired angioedema
Idiopathic histaminergic acquired angioedema (IH-AAE) is a common cause of recurrent angioedema without wheals. It is a mast cell-mediated disease thought to belong to the same clinical entity as chronic urticaria (CU).
