Fig. 2

ED response to localised airway angioedema, consistent with published algorithms [1, 3, 4]. When a patient presents at the ED with localised angioedema, airway management should be performed and intubation, tracheotomy or cricothyrotomy procedures should be prepared for worsening symptoms. Unless the patient is known to have HAE or reports prior experience of ACEi- or similar drug-induced angioedema, it is usually difficult to differentiate between histamine- or bradykinin-induced angioedema by clinical presentation alone. Because histamine-induced angioedema is more common, the patient should receive standard treatment (epinephrine, antihistamine and/or corticosteroids). If the symptoms subside, this helps confirm the aetiology as histamine-induced angioedema. Conversely, if symptoms do not resolve or begin to worsen, and beta-adrenergic blockade has been excluded, bradykinin-induced angioedema becomes more likely. Although approved treatments are currently for HAE, some studies have reported that patients with suspected bradykinin-induced angioedema in the ED respond well to these treatments. However, more studies are required to establish their efficacy and use in emergency situations. The patient’s primary care physician should be notified, and the patient should be referred to a specialist if appropriate for long-term management