Angioedema treatment
Angioedema often clears without treatment, but antihistamines (eg fexofenadine, loratadine or cetirizine) or oral corticosteroids (usually prednisolone) may be appropriate for allergic or idiopathic oedema. Adrenaline should be considered for anaphylaxis. If itching is a problem, older antihistamine types causing drowsiness may improve sleep.8,10
People with heart failure who have developed angioedema after taking an ACE inhibitor should be offered a beta-blocker, mineralocorticoid receptor antagonist (MRA) eg spironolactone, and a sodium-glucose cotransporter-2 (SGLT2) inhibitor (gliflozins). An ARB can also be considered.30
Long-term medication may be necessary for hereditary angioedema, for example with danazol which increases C1-esterase inhibitor (C1-inh) protein levels, but side effects can be unpleasant. Other options are tranexamic acid, or icatibant injections.10
As a bradykinin receptor antagonist icatibant is indicated for hereditary angioedema, but it might also be considered (off-label) for ACEI-related angioedema.25