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Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department

a French consensus statement

Floccard, Bernarda; Javaud, Nicolasc; Deroux, Albane; Boccon-Gibod, Isabellee; Fain, Olivierd; Amarger, Stéphanief; Blanchard-Delaunay, Claireg; Jeandel, Pierre Y.h; Marmion, Nicolasi; Ollivier, Yannj; Pralong, Paulinek; Gayet, Stéphanel; Du-Thanh, Auréliem; Pelletier, Fabienn; Sailler, Laurento; Robinson, Philipb; Launay, Davidp; Bouillet, Laurencee on behalf of the French Reference Centre for Angioedema (CREAK)

European Journal of Emergency Medicine: October 2017 - Volume 24 - Issue 5 - p 318–325
doi: 10.1097/MEJ.0000000000000446
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Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.

aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital

bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon

cEmergency Department, Louis Mourier University Hospital, Paris 7 University

dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris

eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble

fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand

gDepartment of Internal Medicine, Niort Hospital, Niort

hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice

iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion

jDepartment of Internal Medicine, Caen University Hospital, Caen

kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble

lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille

mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier

nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon

oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse

pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France

Correspondence to Bernard Floccard, MD, Département d’Anesthésie Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, CHU de Lyon, 69437 Lyon Cedex 03, France Tel: +33 472 116 350; fax: +33 472 116 349; e-mail: bernard.floccard@chu-lyon.fr

Received July 5, 2016

Accepted December 12, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.