Pediatric angioedema - Ten years' experience

Objective: To clarify the cause, clinical course, and management of childre n with angioedema. Design: Retrospective review. Setting: Urban tertiary care hospital for children. Patients: Consecutive sample of all children hospitalized from January 1, 1 987, to December 31, 1997, with the diagnosis of angioedema. Complete recor ds permitting analysis were available for 10 patients. Main Outcome Measures: Sex, age, site, symptoms at initial examination, cau se, 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 ho arseness 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%). Treat ment was pharmacological in all cases. No child required intubation or trac heotomy. Care in the intensive care unit was necessary for 1 child (10%). Conclusions: Pediatric angioedema exhibits a different cause and clinical m anifestations than does adult angioedema. Prompt diagnosis and early treatm ent with an intravenous corticosteroid, an antihistamine, and/or epinephrin e lead to rapid resolution and may, in appropriately staffed settings, avoi d the need for care in the intensive care unit or airway intervention. Mana gement algorithms based on adult experience must be modified to account for the milder pediatric manifestations of this immunologic disease.