Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
The purpose of the presentation is to review the clinical controversy of the treatment of drug-induced angioedema. Currently, there are not FDA approved medications approved for the treatment of drug-induced angioedema. Drug-induced angioedema is a typically associated with ACEi/ARBS, but has been seen with many other drugs including NSAIDS, amlodipine, and DPP4’s. ACEi/ARBs are the most well-known drugs that cause drug-induced angioedema with approximately 1 out of 3 emergency department angioedema presentations is because of them. The presentation will look at the value of off label usage of targeted therapies such as Icatibant versus FFP and other non-targeted therapies such as corticosteroids, antihistamines and epinephrine.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe the epidemiology and pathophysiology involving drug-induced angioedema.
• Discuss the presentation of drug-induced angioedema and current treatment strategies using non-specific pharmacologic therapies.
• Evaluate the current literature utilizing targeted pharmacologic therapies for drug-induced angioedema for safety, efficacy, and cost.

Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is 0481-0000-19-116-H04-P.

Suggested Additional Reading:

1. Aygören-Pürsün, E., Magerl, M., Maetzel, A., & Maurer, M. (2018). Epidemiology of Bradykinin-mediated angioedema: a systematic investigation of epidemiological studies. Orphanet journal of rare diseases, 13(1), 73.
2. Baş, M., Greve, J., Stelter, K., Havel, M., Strassen, U., Rotter, N., ... & Kojda, G. (2015). A randomized trial of icatibant in ACE-inhibitor–induced angioedema. New England Journal of Medicine, 372(5), 418-425.
3. Chaaya, G., Afridi, F., Faiz, A., Ashraf, A., Ali, M., & Castiglioni, A. (2017). When nothing else works: fresh frozen plasma in the treatment of progressive, refractory angiotensin-converting enzyme inhibitor–induced angioedema. Cureus, 9(1).
4. C1 esterase inhibitor (human). (2010). P & T : a peer-reviewed journal for formulary management, 35(7 Section 2), 2–3.
5. Kalambay, J., Ghazanfar, H., Pena, K. A. M., Munshi, R. A., Zhang, G., & Patel, J. Y. (2017). Pathogenesis of drug induced non-allergic angioedema: a review of unusual etiologies. Cureus, 9(8). Lawlor, C. M., Ananth, A., Barton, B. M., Flowers, T. C., & McCoul, E. D. (2018). Pharmacotherapy for Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema: A Systematic Review. Otolaryngology–Head and Neck Surgery, 158(2), 232-239.
6. Saeb, A., Hagglund, K. H., & Cigolle, C. T. (2016). Using fresh frozen plasma for acute airway angioedema to prevent intubation in the emergency department: a retrospective cohort study. Emergency medicine international, 2016.
7. Straka, B. T., Ramirez, C. E., Byrd, J. B., Stone, E., Woodard-Grice, A., Nian, H., ... & Brown, N. J. (2017). Effect of bradykinin receptor antagonism on ACE inhibitor-associated angioedema. Journal of Allergy and Clinical Immunology, 140(1), 242-248.
8. Sinert, R., Levy, P., Bernstein, J. A., Body, R., Sivilotti, M. L., Moellman, J., ... & CAMEO study group. (2017). Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor–Induced Upper Airway Angioedema. The Journal of Allergy and Clinical Immunology: In Practice, 5(5), 1402-1409.
9. Schwartz, S. R. (2019). Icatibant is not helpful for the treatment of ACE inhibitor-induced angioedema. Clinical Research in Practice: The Journal of Team Hippocrates, 5(1), 6.
10. Warrier, M. R., Copilevitz, C. A., Dykewicz, M. S., & Slavin, R. G. (2004). Fresh frozen plasma in the treatment of resistant angiotensin-converting enzyme inhibitor angioedema. Annals of allergy, asthma & immunology, 92(5), 573-575.