Should all patients presenting with acute undiagnosed angioedema be treated with steroids and adrenaline?
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 [acutely unwell patients with undiagnosed angioedema] is [generic treatment with adrenaline and steroids] better than [focused treatment] at [reducing mortality]?
Clinical Scenario:
A 20 year old female patient presents to the ED of a busy acute hospital with swelling of face and lips and difficulty breathing. She has no previous history and has become suddenly unwell over the last hour.
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 database using the EBSCOhost on the world wide web on 12/7/2010
CINAHL database 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 Epinephrine/OR epinephrine.mp. OR adrenaline.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Epinephrine)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Epinephrine)
Outcome:
MEDLINE 121 papers, 0 relevant
Embase 689 papers, 0 relevant
CINAHL 24 papers, 0 relevant
Embase 689 papers, 0 relevant
CINAHL 24 papers, 0 relevant
Bottom Line:
More research needs to be done in this area. However when a patient presents with undiagnosed angioedema treatment with steroids and adrenaline may prove life saving when focused treatment is difficult in the face of an unknown pathophysiology and when there is a need to treat quickly.