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April 6, 2017

Drug therapy for allergic angioedema

Question

What is the good drug combination to treat allergic angioedema without urticaria in an adult patient?

Answers

By Doctor Jonathan A. Bernstein,

The approach to isolated angioedema should first determine whether it is histaminergic or non-histaminergic (i.e., responsive to H1 antagonists or not). After excluding hereditary and acquired forms (AAE, ACE induced…), the best approach to treatment would be to follow a step-care approach which first includes H1 with or without an H2 antagonist; not effective or only partially effective then one could start an LTMA and/or complex antihistamines like Doxepin. If not effective, then I usually start hydroxychloroquine due to relatively good safety profile and my positive experience treating urticaria. If this treatment is only partially effective or not effective I would either change or add sulfasalazine to the regimen due to safety and based on my personal experience. There are many other potential therapies that can be used that are outlined in published reviews on urticaria if these treatments prove ineffective (i.e., cyclosporine, colchicine, dapsone, mycofenolate…). However, unfortunately, very few studies have been conducted to determine whether these treatments will also be effective in angioedema. Therefore, clinical experience using algorithms similar for urticaria is the best approach currently.

Jonathan A. Bernstein, M.D.
Professor of Medicine
University of Cincinnati College of Medicine
Department of Internal Medicine
Division of Immunology/Allergy Section
Director of Clinical Research
Editor-in-Chief Journal of Asthma


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