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Pediatric angioedema: ten years' experience
1Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, 19104-4399, USA. shah@email.chop.edu
Objective:
To clarify the cause, clinical course, and management of children with angioedema.
Design:
Retrospective review.
Setting:
Urban tertiary care hospital for children.
Patients:
Consecutive sample of all children hospitalized from January 1, 1987, to December 31, 1997, with the diagnosis of angioedema. Complete records permitting analysis were available for 10 patients.
Main Outcome Measures:
Sex, age, site, symptoms at initial examination, cause, therapeutic management, and clinical outcome.
Results:
Seven boys and 3 girls, a mean age of 7.7 years, had angioedema of the head or neck, most often facial (8/10 [80%]). Manifesting symptoms, in addition to swelling, were tenderness or pain in 4 children (40%), dyspnea in 3 (30%), dysphagia (including drooling and spitting) in 3 (30%), and hoarseness in 1 (10%). Angioedema was due to food in 4 children (40%), insect bites in 3 (30%), infection in 2 (20%), and an antibiotic in 1 (10%). Treatment was pharmacological in all cases. No child required intubation or tracheotomy. Care in the intensive care unit was necessary for 1 child (10%).
Conclusions:
Pediatric angioedema exhibits a different cause and clinical manifestations than does adult angioedema. Prompt diagnosis and early treatment with an intravenous corticosteroid, an antihistamine, and/or epinephrine lead to rapid resolution and may, in appropriately staffed settings, avoid the need for care in the intensive care unit or airway intervention. Management algorithms based on adult experience must be modified to account for the milder pediatric manifestations of this immunologic disease.