What Is the First-Line Treatment for Angioedema?
Angioedema presents with swelling of deeper dermal, subcutaneous, or submucosal tissues, commonly accompanied by urticarial skin lesions and pruritus. Prompt pharmacological management aims to relieve symptoms and limit the extent and duration of the episode.
Treatment Approach
H1 antihistamines are the cornerstone of therapy. Both first-generation and second-generation H1 antagonists are available options, with the choice between them guided by clinical context. An alternative agent with antihistamine properties may be considered when standard antihistamine therapy is not appropriate.
Full agent selection, sequencing, and dosing in the complete protocol below.
Clinical Goals
Relief of pruritus, and reduction in the number, size, and duration of urticarial skin lesions.
References
- H1-blocking antihistamines are the cornerstone of therapy in patients with acute urticaria and angioedema.
- First-generation H1 antihistamines such as diphenhydramine and hydroxyzine are effective; however, sedation is a significant side effect.
- Second-generation H1 antagonists (loratadine, cetirizine, desloratadine, fexofenadine) are considered the agents of choice for outpatient therapy.
- Doxepin hydrochloride, a tricyclic antidepressant with potent H1 and H2 antagonist properties, is recommended as an alternative to treatment with antihistamines.
- Administer an H1 antagonist to patients with acute urticaria and angioedema.
- In addition to relieving pruritus, these agents reduce the number, size, and duration of lesions.
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