The Drug-Induced Respiratory Disease Website
See PMID 30075570. Review at PMID 28291095. Major risk is UAO, with consequent asphyxia. Can be followed by irreversible hypoxic brain damage/death. See also under VIIIg. May occur in isolation or accompany drug-induced anaphylaxis. Airway angioedema can be in the form of acute swelling of the lips, tongue, mouth floor, uvula, pharynx, larynx, glottis, subglottic area and/or upper trachea. This can cause acute upper airway obstruction (UAO) and asphyxia. May overlap with IVb. Expedient identification the airway by endoscopy and maintenance of airway patency are crucially important, as if the UAO progresses emergent risky tracheostomy can be required. Icatibant may alleviate all manifestations of drug-induced angioedema (PMID: 22936825). Rebound phenomenon can occur after an initial falsely reassuring period of improvement. NPPE (IIg) may occur as a secondary complication. Reviews and series at PMID 20447725, 20667117, 20922352, 22552531, 22936825, 22976464, 25059449. Angioedema can also involve the bowel wall in concomitance, causing abdominal pain or cramping or simulate an acute abdomen (PMID: 20376210, 21785085, 22867837)
Publications
Angioedema After Use of Recombinant Tissue-Type Plasminogen Activators in Stroke.
Stroke 2024 Aug;55;2193-2197 — 2024 Aug — 2193-2197
Angioedema Secondary to tPA Use in Acute Ischemic Stroke Patient with Hypertension: A Case Report.
Clinical practice and cases in emergency medicine 2021 May;5;159-162 — 2021 May — 159-162
Hemilingual Angioedema after Thrombolysis in a Patient on an Angiotensin II Receptor Blocker.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2019 May;28;e44-e45 — 2019 May — e44-e45
Angioedema after thrombolysis with tissue plasminogen activator: an airway emergency.
Oxford medical case reports 2019 Jan;2019;omy112 — 2019 Jan — omy112
Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents.
Critical care research and practice 2018;2018;9360918 — 2018 — 9360918
A Novel Approach to the Treatment of Orolingual Angioedema After Tissue Plasminogen Activator Administration.
Annals of emergency medicine 2016 09;68;345-8 — 2016 09 — 345-8
Orolingual angiodema associated with alteplase treatment of acute stroke: a reappraisal.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2015 Jan;24;31-40 — 2015 Jan — 31-40
Angioedema from recombinant TPA administration: case report and pathophysiology review.
American journal of therapeutics 2013 Nov-Dec;20;691-3 — 2013 Nov-Dec — 691-3
Lingual angioedema with macroglossia during the treatment of acute ischemic stroke with alteplase.
International journal of general medicine 2012;5;183-6 — 2012 — 183-6
Angioedema after tPA: what neurointensivists should know.
Neurocritical care 2012 Jun;16;440-3 — 2012 Jun — 440-3
[Orolingual angioedema under systemic thrombolysis with rt-PA: an underestimated side effect].
Der Nervenarzt 2009 Apr;80;459-63 — 2009 Apr — 459-63
Giménez-Muñoz A, Capablo-Liesa JL, Torné-Hernández L, Sagarra-Mur D, Sebastián-Torres B, Alarcia-Alejos R
[Orolingual angioedema secondary to alteplase treatment in cases of stroke].
Revista de neurologia 2008 Mar 16-31;46;382 — 2008 Mar 16-31 — 382
[Angioneurotic orolingual edema associated with the use of rt-PA following a stroke].
Der Anaesthesist 2007 Oct;56;1024-7 — 2007 Oct — 1024-7
Biochemical basis of angioedema associated with recombinant tissue plasminogen activator treatment: an in vitro experimental approach.
Stroke 2002 Jun;33;1712-6 — 2002 Jun — 1712-6
Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2000 May 02;162;1281-4 — 2000 May 02 — 1281-4