Evidence-Based Management of Angioedema in Urgent Care (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: May 2024 (Volume 3, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 05/01/2027.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional requirements.

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Peer Reviewers

Abstract

Patients experiencing angioedema commonly self-direct to urgent care centers. While acute presentations are often transient and localized, angioedema is a potentially life-threatening event that can rapidly progress to acute airway compromise, anaphylaxis, or both. Urgent care clinicians must quickly recognize the clinical presentations that indicate the need for emergency intervention. This article reviews the etiology and pathophysiology of angioedema, including the distinct mechanisms of the primary forms of angioedema, and presents evidence-based recommendations for the evaluation, treatment, and disposition of patients with angioedema in the urgent care setting.

Case Presentations

A 52-year-old man presents to the urgent care clinic with a complaint of itching on his mouth and lips 20 minutes after biting into a doughnut at a local bakery...

• The symptoms started approximately 3 hours prior to his arrival at the clinic. He did not use his epinephrine autoinjector.
• He denies any shortness of breath.
• He states that he has a peanut allergy and has had similar reactions when he has eaten peanuts in the past, but he is certain there were no peanuts in or on his doughnut.
• Due to the risk of anaphylaxis associated with peanut allergies, the patient is prioritized for evaluation immediately after triage.
• He denies any new medications, chemical exposures, fevers, or exposure to animals or plants. He has not taken any NSAIDs and is not on an ACE inhibitor.
• His vital signs are: temperature, 36.4°C; heart rate, 76 beats/min; blood pressure, 123/84 mm Hg; respiratory rate, 14 breaths/min; and oxygen saturation, 98% on room air.
• On examination, his airway is patent. Mild symmetric swelling to the lips is noted. The oropharynx is unremarkable, and the uvula is midline and without swelling. There is a faint expiratory wheeze throughout lung fields. There is no visible rash, but dermographia is noted with a scratch test.
• You wonder how you should manage this patient...

A 48-year-old woman presents to the urgent care clinic with lip swelling...

• She states her lips felt “heavy” when she woke up around 8 hours ago. She says her lips are significantly swollen, but the swelling has neither worsened nor improved.
• She denies shortness of breath, voice change, rash, itching, or prior history of similar occurrences, as well as fever or infection, any known allergies, or significant family history. She said she has had no recent exposures, travel, or trauma.
• The patient’s past medical history includes hypertension, diabetes mellitus type 2, and hyperlipidemia. She reports that she currently takes lisinopril, metformin, and atorvastatin.
• Her vital signs are: temperature, 37°C; heart rate, 82 beats/min; blood pressure, 138/78 mm Hg; respiratory rate, 16 breaths/min; and oxygen saturation, 100% on room air.
• On examination, the patient is in no distress, but she has significant upper and lower lip swelling, with no oropharyngeal involvement. The rest of her examination is unremarkable.
• You wonder if you should administer an antihistamine...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.