Patient Care - Allergy & Immunology - October 2007 - (Page 17)

Angioedema I Drugs mentioned agement, with intubation or other ers such as cimetidine (Tagain this article techniques for securing the airway met), 300 mg, can also be added being of paramount importance. to the treatment regimen. A synAlbuterol (Proventil, Ventolin) Epinephrine, SC, 0.3 mg using 1:1000 ergistic effect between H1-and Aminocaproic acid (Amicar) dilution, or IV 0.1 mg using 1:10,000 , H2-blockers may exist, and this Cimetidine (Tagamet) dilution, is the primary medical treatappears to account for greater Danazol (Danocrine) ment for severe reactions.13 For cases efficacy when both agents are Diphenhydramine (Benadryl) of anaphylactic shock, continuous IV used with severe anaphylaxis.17 Enalapril (Vasotec) infusion of epinephrine, 1-10 mcg/ Corticosteroids such as methylEpinephrine (EpiPen) min, can be used. In patients with seprednisolone (Medrol), 125 mg IV immunoglobulin (IVIG) vere reactions who are currently taking IV, or prednisone, 60 mg po, Methylprednisolone (Medrol) beta-blocker agents, glucagon infusion may help resolve the acute Prednisone is a possible treatment option, allowing episode but are felt to be most Stanozolol (Winstrol) bypass of beta receptors for clinical effective in preventing recurrent effect.14 or rebound symptoms, despite a Additional critical treatments include IV fluids relative lack of specific evidence to support their utilizing normal saline or lactated Ringer’s solution. use.18 Nebulized beta-agonists such as albuterol Hypotension due to anaphylaxis will generally (Proventil, Ventolin) may help with bronchospasm respond to this treatment. Care should be used resistant to epinephrine.15 Avoidance of any known when administering epinephrine and large volumes triggers such as nuts or shellfish is key to preventof IV fluids to elderly patients, to those with cardiac ing future episodes, and prescribing self-injectable problems including coronary artery disease, and to epinephrine (EpiPen) is also wise in appropriate sitpatients with current chest pain. Epinephrine may uations.13,19 be lifesaving in these situations and should not be withheld in a life-threatening emergency, but the Angioedema associated with eosinophilia risks and benefits of individual clinical situations Angioedema-associated eosinophilia (Gleich’s synmust be evaluated.13,15,16 H1 antihistamine agents drome) is a rare form that is also associated with such as diphenhydramine (Benadryl), 25-50 mg, severe swelling of the face, lips, mouth, tongue, and are important and can be given IV or po. H2-blockextremities. Symptoms typically are intermittent, with severe exacerbations that usually respond to systemic corticosteroid treatment. Molecular mechanisms of this syndrome are unclear, but IV immunoglobulin (IVIG) has also been reported as a CLINICAL PEARL potential therapy for acute exacerbations.20 I With angioedema, swelling involves tissues deep to the dermis, while urticaria involves swelling of tissues superficial to the dermis. Drs Stoev and Bohrn disclose that they have no financial relationship with any manufacturer in this area of medicine. REFERENCES 1. Cicardi M, Agostini A. Hereditary angioedema. N Engl J Med. 1996;334:1666-1667. Continued on page 18 OCTOBER 2007 PATIENT CARE ALLERGY & IMMUNOLOGY 17

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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