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Recognition and differential diagnosis of hereditary angioedema in the emergency department

The Journal of Emergency Medicine Nov 20, 2020

Pines JM, Poarch K, Hughes S, et al. - Via this review, researchers aimed at describing the pathophysiology and clinical features of Angioedema (AE) as well as reported on the diagnosis and treatment of AE in the emergency department (ED). No response of Bradykinin-mediated AE to antihistamines and corticosteroids has been observed. By contrast, there are several targeted, effective therapies, including C1-inhibitor (C1-INH) concentrates, which replace the missing protein activity underlying some bradykinin-mediated AE, and treatments that directly reduces bradykinin activity (eg, ecallantide and icatibant). In bradykinin-mediated AE, generally urticaria is not evident which serves as a primary differentiating factor in the clinical diagnosis. C1-INH levels, C1-INH function, and C4 complement are the relevant laboratory assessments. When presenting to the ED, patients with HAE or a family member can communicate concerning their known diagnosis, and may even bring their own medication(s) with them. Based on findings, they emphasize referring patients newly diagnosed with HAE in the ED for specialized outpatient care upon ED discharge. They highlight a great necessity for ED clinicians to be informed concerning HAE, its differential diagnosis, and appropriate treatment to ensure that patients receive optimal and timely treatment. 

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