In patients with acute angioedema not responding to steroids and adrenaline should blind treatment with C1 esterase inhibitor be given?

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 [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
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)

Search Outcome

MEDLINE - 324 papers, 0 relevant
Embase - 678 papers, 0 relevant
CINAHL - 19 papers, 0 relevant

Clinical 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.