What are the indications for referring a patient with angioedema to a specialist?

Referral to a specialist, such as a dermatologist or immunologist, for a patient with angioedema is indicated in several situations:

• Suspected Hereditary or Acquired Angio-oedema: If hereditary or acquired angio-oedema is suspected ¹.
• Persistent or Recurrent Symptoms After ACE Inhibitor Cessation: If symptoms persist or reoccur 3 months after stopping treatment with an ACE inhibitor ¹.
• Unidentifiable or Unavoidable Cause: When the cause of angio-oedema is not identifiable or cannot be avoided ¹.
• Following Suspected Anaphylaxis: After emergency treatment for suspected anaphylaxis, a referral to a specialist allergy service should be offered ².
• Severe Drug-Induced Angioedema: If a patient has had a suspected allergic reaction to a non-selective non-steroidal anti-inflammatory drug (NSAID) with severe angioedema, they should be referred to a specialist drug allergy service ³.

For people awaiting specialist review who are at risk of anaphylaxis, specialist advice should be sought regarding prescribing an adrenaline auto-injector device to be used before their hospital appointment ¹. People at risk of anaphylaxis include those with co-existing asthma, chronic obstructive pulmonary disease, or heart disease, those who have experienced angio-oedema with trace amounts of an allergen/trigger, and those who cannot easily avoid an allergen ¹. If an adrenaline auto-injector device is indicated in a person taking a beta-blocker, consider discontinuing the beta-blocker if possible, as it can interfere with the action of adrenaline ¹.