Should all patients with acute angioedema that responds to treatment be admitted for observation?

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 that has responded to treatment] is [admission for short-term observation] better than [immediate discharge] at [reducing mortality from relapse]?

Clinical Scenario

A young caucasian male who presented with a first episode of severe angioedema requiring steroids and adrenaline has had a complete resolution of his symptoms after 4 hours and is keen to go home.

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. OR hereditary angioedema.mp.) AND (exp Patient Admission/ OR admission.mp. OR admit$.mp.) AND (exp Hospitalization/ OR hospitalisation.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Admission)

Search Outcome

MEDLINE - 13 papers, 0 relevant
Embase - 28 papers, 0 relevant
CINAHL - 8 papers, 0 relevant

Comment(s)

There is a 30% mortality for patients with laryngeal angioedema and acute attacks of angioedema can follow a relapsing remitting time course.

Clinical Bottom Line

Admission for observation may prevent deaths from relapsing angioedema but discharge may be suitable for those with a known form of angioedema when judged suitable on clinical grounds with specific instructions on what to do in case of a relapse. This area would benefit from more research into relapse rates from angioedema.