Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement.

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.

[Hereditary angioedema: treatment and educational therapeutic program]. / Angioedèmes héréditaires: traitements et éducation thérapeutique.

Hereditary angioedema (HAE) is a chronic disease with unpredictable and severe acute attacks that are potentially life threatening. The treatment of HAE has two main objectives: treat acute attacks and limit their occurrence in the short term and long term. The acute treatment should be administered as soon as possible for better efficiency and patient safety. Self-administration should be encouraged for greater patient autonomy and safety (reducing delay to receive treatment injection). Long-term prophylaxis treatments should be set up to limit acute attacks occurrences and finally improve patients' quality of life and safety. Short-term prophylaxis treatments are required and should be thoroughly applied in case of exposure to known potential triggers (surgery, dental care…). CREAK protocols are available. The HAE National Educational Therapeutic Program "Educreak" is in place to allow the patient and his close family or partners to acquire skills for greater autonomy in day to day disease management.