In patients with acute angioedema not responding to steroids and adrenaline should blind treatment with C1 esterase inhibitor be given?
Date First Published:
July 12, 2010
Last Updated:
July 13, 2010
Report by:
Katherine Palmer, Medical Student (Manchester Royal Infirmary)
Search checked by:
Katherine Palmer, Manchester Royal Infirmary
Three-Part Question:
In [patients with angioedema not responding to adrenaline and steroids] is [treatment with C1 esterase inhibitor] better than [conservative management] at [reducing mortality]?
Clinical Scenario:
A 19 year old Afro-Caribbean male has received IM adrenaline and IV hydrocortisone for acute swelling of his tongue and face. He has shown no improvement after one hour and has begun to develop a hoarse voice.
Search Strategy:
MEDLINE 1950 to 2010 June Week 5 and Embase 1980 to 2010 Week 27 using the OVID interface on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
Search Details:
MEDLINE and Embase - (exp Hereditary Angioedema Type III/ OR exp Angioedema/ OR exp "Hereditary Angioedema Types I and II"/ OR angioedema.mp.) AND (exp Complement C1 Inhibitor Protein/ OR c1 esterase inhibitor.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (C1 esterase inhibitor)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (C1 esterase inhibitor)
Outcome:
MEDLINE - 324 papers, 0 relevant
Embase - 678 papers, 0 relevant
CINAHL - 19 papers, 0 relevant
Embase - 678 papers, 0 relevant
CINAHL - 19 papers, 0 relevant
Bottom Line:
More research needs to be conducted in this area before a conclusion as to how to treat poorly responding undiagnosed angioedema can be given.