Synopsis
Separate mast-cell-mediated angioedema from bradykinin-mediated and other swelling, secure the airway early, and investigate recurrent episodes without misusing allergy tests.
- Angioedema is deeper swelling of skin or mucosa; eyelids and lips are common, but tongue, larynx and bowel involvement determine danger.
- Wheals, itch, rapid onset and an obvious allergen support mast-cell disease; absence of wheals, slower onset and abdominal attacks support bradykinin disease.
- ACE-inhibitor angioedema may occur after years of treatment; stop the ACE inhibitor permanently and document it clearly.
Key red flags
Voice change, stridor, drooling, dysphagia, tongue swelling, respiratory distress, hypotension, rapid progression or previous difficult airway requires immediate hospital care.
Tongue, floor-of-mouth or laryngeal swelling, altered voice, drooling or stridor requires immediate airway expertise and repeated examination.
Investigation priorities
Detect progression before obstruction becomes physiologically obvious.
Management branches
Swelling affects tongue or airway, progresses rapidly, or accompanies breathing or circulation compromise.
- Call anaesthetic and resuscitation support, position according to physiology, provide high-flow oxygen and monitor continuously while planning a difficult airway.
- Give intramuscular adrenaline promptly when anaphylaxis is suspected and repeat after five minutes if ABC compromise persists.
Key medicines
Intramuscular adrenaline 1 mg/mL solutionFor adult anaphylaxis give 500 micrograms intramuscularly, equal to 0.5 mL of 1 mg/mL solution, into the anterolateral thigh; repeat after five minutes if ABC problems persist.
Cetirizine 10 mg tabletsAdults and adolescents aged 12 years and over take 10 mg orally once daily, adjusted for renal impairment according to product guidance.