What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-inhibitor?

Statement reviewed and approved by AAEM Board of Directors. (11/12/2020)

Recommendations:

  1. The primary focus of emergency treatment is airway evaluation and stabilization.
  2. A careful history and physical exam must be performed to differentiate ACE inhibitor-induced angioedema (ACE-I-AE) from acute allergic angioedema, idiopathic angioedema (IAE), or hereditary angioedema (HAE).
  3. There is insufficient data to support the routine use of epinephrine, antihistamines, and steroids in ACE-IAE.
  4. There is insufficient data to support the use of icatibant, ecallantide, C1-INH concentrate, tranexamic acid, or fresh frozen plasma (FFP) in ACE-I-AE.
  5. No laboratory tests confirm the diagnosis of ACE-I-AE.
  6. Patients with ACE-I-AE should be advised to stop the medication and that ACE-I-AE is a class effect, therefore, all types of ACE-Is should be avoided.
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