Should all patients presenting with acute undiagnosed angioedema be treated with steroids and adrenaline?

Report By: Katherine Palmer - Medical Student
Search checked by Katherine Palmer - Medical Student
Institution: Manchester Royal Infirmary
Date Submitted: 12th July 2010
Last Modified: 13th July 2010
Status: Blue (submitted but not checked)

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

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)

Search Outcome

MEDLINE 121 papers, 0 relevant
Embase 689 papers, 0 relevant
CINAHL 24 papers, 0 relevant

Clinical 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.