• Samer Al-Khudari, Michael J Loochtan, Edward Peterson, and Kathleen L Yaremchuk.
• Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan 48202, USA. sameralkhudari@gmail.com
• Laryngoscope. 2011 Nov 1;121(11):2327-34.

Objectives/HypothesisTo develop and validate a clinical algorithm for management of patients with angiotensin-converting enzyme inhibitor-induced angioedema (AIIA).Study DesignProspective cohort observational study.MethodsOver 1 year, 40 patients with AIIA were evaluated by otolaryngology, underwent laryngoscopy, and were followed until disease resolution. The need for airway intervention, disposition for appropriate level of care, and other parameters were analyzed.ResultsTreatment started within 61.5 minutes of presentation to the emergency department (ED). Mean duration until resolution of edema was 29 hours. Twenty (50%) patients required intensive care unit (ICU) admission, and six (15%) required intubation. Seventeen (42.5%) were monitored and discharged from the ED. Floor-of-mouth edema was present in 19 (47.5%), and massive tongue edema was found in four (10%) patients. The aryepiglottic fold was involved in 20 (50%) patients on laryngoscopy. Older patients (P = .048) with subjective dyspnea (P = .003) and dysphonia (P = .001) were most likely to require ICU admission. Upper lip swelling had a negative correlation with airway edema identifiable on laryngoscopy alone (P = .008). Dysphonia (n = 16) predicted airway edema upon laryngoscopy (P = .001). All 40 patients were triaged successfully without the need for readmission or escalation of level of care.ConclusionsThe management protocol was successful in 40 consecutive patients to the appropriate level of care. History and physical examination may predict airway findings identified on laryngoscopy and help guide management when treatment by otolaryngology is not immediately available. A subset of patients will require acute airway intervention and can be identified at initial presentation.Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

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