Angioedema: The Daily PANCE Blueprint
A 58-year-old female with a history of hypertension (on lisinopril) presents with tongue swelling and a muffled voice that began 4 hours ago. She denies rash or itching. Exam shows marked tongue edema. What is the most appropriate initial step in management?
A. Administer IM epinephrine
B. Give IV diphenhydramine and corticosteroids
C. Discontinue lisinopril and observe
D. Assess and secure the airway
E. Administer C1-esterase inhibitor concentrate
Answer and topic summary
The answer is D. Assess and secure the airway
Angioedema is nonpitting swelling of the subcutaneous and submucosal tissues caused by increased vascular permeability (typically in the lips, eyes, or throat) It is classified by mediator type. Histaminergic (mast cell–mediated) angioedema is typically due to IgE-mediated allergic reactions (e.g., foods, drugs, insect stings) or NSAIDs, presents rapidly (minutes), and is usually associated with urticaria and pruritus. Bradykinin-mediated angioedema includes hereditary C1-esterase inhibitor deficiency (autosomal dominant) and ACE inhibitor–induced cases; it has a slower onset and occurs without urticaria or pruritus. Laryngeal involvement may cause life-threatening airway obstruction, so airway assessment and protection are the priority. Histaminergic angioedema is treated with H1 antihistamines, corticosteroids, and IM epinephrine if anaphylaxis is present.
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