• Bernard Floccard, Nicolas Javaud, Alban Deroux, Isabelle Boccon-Gibod, Olivier Fain, Stéphanie Amarger, Claire Blanchard-Delaunay, Pierre Y Jeandel, Nicolas Marmion, Yann Ollivier, Pauline Pralong, Stéphane Gayet, Aurélie Du-Thanh, Fabien Pelletier, Laurent Sailler, Philip Robinson, David Launay, Laurence Bouillet, and French Reference Centre for Angioedema (CREAK).
• aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon cEmergency Department, Louis Mourier University Hospital, Paris 7 University dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand gDepartment of Internal Medicine, Niort Hospital, Niort hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion jDepartment of Internal Medicine, Caen University Hospital, Caen kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France.
• Eur J Emerg Med. 2017 Oct 1; 24 (5): 318-325.

AbstractAngio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.

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