Dawaa Reference

chronic

Acute allergic angioedema

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Resuscitation Council UK Anaphylaxis Guideline 2021 · Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph)

Verified against3 documents
  • Resuscitation Council UK Anaphylaxis Guideline 2021
  • Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph)
  • Acute allergic angioedema - disease-level clinical article (angioedema-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • Histaminergic angioedema can involve skin swelling, redness, and itching, breathing symptoms like bronchospasm, and abdominal pain with vomiting [abdominal pain · itching · redness · vomiting]
  • Histaminergic swelling starts within an hour of exposure and can last one to two days
  • Bradykinin-mediated swelling is not accompanied by hives, and lasts longer and is more severe than histaminergic swelling, with abdominal symptoms
  • ACE-inhibitor-related angioedema presents without hives or itching
  • NSAID-induced angioedema can present with hives and facial swelling [facial swelling · urticaria]
  • Hereditary angioedema starts in childhood or young adulthood and worsens at puberty, with recurrent swelling or abdominal pain [abdominal pain]
  • A serpiginous, non-itchy rash called erythema marginatum can be a warning sign before a hereditary angioedema attack [rash · redness]
  • A hereditary angioedema attack peaks over about a day and settles within two to three days

Signs — what you find (1)

  • A full exam should check vital signs, mental status, and the skin, head, neck, airway, and abdomen

Tests (6)

  • C4 and tryptase blood tests, drawn during an acute attack, screen for hereditary angioedema and anaphylaxis-related angioedema respectively
  • Tryptase stays normal in hereditary angioedema types 1 and 2 but rises with anaphylaxis or other mast-cell disorders
  • Flexible fiberoptic laryngoscopy can check tongue and larynx involvement when there are upper-airway symptoms
  • Hereditary angioedema type 1 shows low C1-inhibitor function, low C1-inhibitor level, and low C4
  • Hereditary angioedema type 2 shows low C1-inhibitor function and low C4 but a normal or high C1-inhibitor level
  • Acquired C1-inhibitor deficiency shows low C1-inhibitor antigen and function along with low C1q

If not this — what else fits (12)

  • Acute contact dermatitis is a differential to rule out
  • Drug rash with eosinophilia and systemic symptoms, or DRESS, can mimic it
  • Dermatomyositis belongs on the differential
  • Morbus Morbihan, chronic facial swelling linked to rosacea, is a differential
  • Superior vena cava syndrome can cause facial swelling mistaken for angioedema
  • Hypothyroidism-related myxedema is on the differential
  • Subcutaneous emphysema is a differential for swelling
  • Orofacial granulomatosis is a differential to consider
  • Hypocomplementemic urticarial vasculitis syndrome is on the differential
  • Clarkson's disease, or systemic capillary leak syndrome, is a differential
  • Gleich's syndrome, episodic angioedema with eosinophilia, is a differential
  • Hereditary angioedema can be mistaken for familial Mediterranean fever

SourceStatPearls "Angioedema" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Cetirizine + Hydrocortisone

1

ADRENALINE

1st line

Strength1 mg

Forminjection

Adult dose and duration

0.5 mg IM (0.5 mL of 1:1000 / 1 mg/mL) into anterolateral mid-thigh; repeat after 5 minutes if airway involvement or hypotension persists - single dose

Paediatric dose

Child: 0.01 mg/kg (0.01 mL/kg of 1:1000) IM into outer thigh (child <6y: 0.15 mg; 6-12y: 0.3 mg; >12y: 0.5 mg)

Dose source

Resuscitation Council UK Anaphylaxis Guideline 2021

Why

First-line life-saving treatment for acute allergic angioedema with airway compromise or anaphylaxis

Cautions
  • MUST be given intramuscularly (IM) into mid-outer thigh, NOT intravenously (IV injection carries fatal cardiac arrhythmia risk).
  • Call emergency services immediately for hospital transport.
  • Transient pallor, tremor, palpitations, and anxiety are expected pharmacological effects.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP.MEMPHIS10.00 EGP
ADRENAMAX 1 MG/1ML 10 AMPS.CHEMIPHARM75.00 EGP
EPINEPHRINE-MISR 1 MG/ML 100 AMP.MISR750.00 EGP
ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP.CID850.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Angioedema - disease-level clinical article (angioedema-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Laryngeal/airway involvement makes angioedema life-threatening. Airway compromise needs urgent airway management and hospital referral (intubation or surgical airway), not simply a repeat adrenaline dose at 5 minutes.
  • RED FLAG - If the episode does not respond to epinephrine, an antihistamine and a corticosteroid, that itself is a red flag for bradykinin-mediated angioedema (e.g. ACE-inhibitor-induced or hereditary), which needs a different approach: stop the ACE inhibitor and never rechallenge, and refer for bradykinin-targeted therapy.
3

CETIRIZINE

Regimen: angioedema-adjuncts

1 of 2 - GIVE ALL TOGETHER

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily oral (or chlorphenamine 10 mg slow IV/IM in emergency setting) x 3-5 days

Paediatric dose

(Child 2-5 years: 2.5 mg twice daily; 6-11 years: 5 mg twice daily; >=12 years: 10 mg once daily)

Dose by age
2 to under 6 years:2.5 mg twice daily
6 to under 12 years:5 mg twice daily
12 years and over:10 mg once daily
Dose source

Egyptian National Drug Formulary - Respiratory System 2026 (cetirizine monograph)

Why

Secondary adjunctive therapy after adrenaline

Cautions
  • Antihistamines DO NOT treat or prevent laryngeal edema or anaphylactic shock; adrenaline must be given first.
Egyptian brands
Egyptian brandManufacturerIndicative price
EPIRIZINE 10 MG 10 TABS.EIPICO15.50 EGP (1.55/unit)
CETRITIN 10MG 20 TAB.EL NILE.42.00 EGP (2.10/unit)
TOMAZINE 10MG 30 F.C. TABS.ALFACURE PHARMACEUTICALS63.00 EGP (2.10/unit)
CETRAK 10 MG 20 TABS.PHARCO68.00 EGP (3.40/unit)
HISTAZINE-1 10 MG 20 TABS.AMRIYA68.00 EGP (3.40/unit)
ZYRTEC 10 MG 20 TAB.GLAXO SMITHKLINE100.00 EGP (5.00/unit)
CETRICHEW 10MG 20 CHEWABLE F.C. TABS.AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.15.00 EGP
HISTA CHEW 10 MG 20 CHEWABLE TAB.ARAB CAPS > ADVOCURE15.00 EGP
LERGFREE 5MG/5ML SYRUP 120ML? strength differs? different route - not oral solidDEBEIKY9.00 EGP
EPIRIZINE 5MG/ML SYRUP 60 ML? strength differs? different route - not oral solidEIPICO19.00 EGP
4

HYDROCORTISONE

Regimen: angioedema-adjuncts

2 of 2 - GIVE ALL TOGETHER

Strength100 mg

Forminjection

Adult dose and duration

200 mg slow IV or IM (or Prednisolone 40-50 mg orally) - single dose

Paediatric dose

Child: 2-4 mg/kg IV/IM (max 100 mg for <6 yrs, 200 mg for >=6 yrs)

Dose source

Resuscitation Council UK Anaphylaxis Guideline 2021

Why

Adjunctive therapy to prevent biphasic late-phase allergic reaction

Cautions
  • Delayed onset of action (4-6 hours); never rely on corticosteroids for immediate airway relief.
Egyptian brands
Egyptian brandManufacturerIndicative price
SOLU-CORTEF 100MG/2ML VIALEIPICO > PFIZER16.00 EGP
HYDROCORTISONE SODIUM SUCCINATE 100MG I.V./I.M.VIALEIPICO26.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.