Laryngeal attack | Abdominal attack | Cutaneous attack | ||
Extremities, trunk | Face, neck | |||
C1-INH concentrate (plasma derived or recombinant) given intravenously | Yes | Yes | Yes, unless swelling is extremely mild and not causing disability | Yes |
Ecallantide (United States only) | Yes | Yes | Yes, unless extremely mild | Yes |
Icatibant | Yes | Yes | Yes, unless extremely mild | Yes |
Plasma (solvent/detergent treated or fresh frozen) | Yes, if first-line therapies are not available | Yes, if first-line therapies are not available | Yes, if severe and first-line therapies are not available | Yes |
Intubation*, transfer to ICU, rarely emergent tracheotomy | Yes (consider early intubation if above agents are not available) | Not applicable | Not applicable | May be necessary if attack spreads to involve upper airway |
Wait and see (spontaneous resolution) | Not sufficient | Not recommended unless symptoms are mild and first-line therapies are not available | Acceptable if mild | Not sufficient (because angioedema can spread to involve upper airway) |
C1-INH: C1 inhibitor; ICU: intensive care unit.
* Consider intubation early in setting of progressive laryngeal edema or if C1-INH preparations, ecallantide, or icatibant are not available.