Classification and treatment of angioedema without wheals: A spanish delphi consensus

Abstract

Introduction Problems in the defnition and classifcation of angioedema, leading to difculties in its diagnosis and treatment, have been identifed; therefore, an improvement in the current classifcation of angioedema is required. Objective The aim of this study was to propose a practical classifcation of angioedema without wheals that helps to establish a diferential diagnosis and take appropriate therapeutic decisions. Methods An initial proposal of classifcation of angioedema without wheals was agreed by a scientifc committee of experts and was subsequently validated by a panel of experts by means of consensus based on the Delphi methodology. Forty-fve items on the classifcation, diagnosis, and treatment of angioedema without wheals were proposed for the survey. Results Most items (93.8%) were agreed after two rounds. All panelists agreed with the proposed classifcation, as well as with most of the clinical and treatment characteristics. The angioedema without wheals classifcation established three groups: histamine-mediated, bradykinin-mediated, and unknown mechanism angioedema. The clinical characteristics of the proposed types of angioedema were also agreed, except for the allergic histamine-mediated and unknown mechanism angioedema, which generated debate. Regarding treatments, although there was broad agreement with the proposed items, a lack of knowledge about some treatments in this pathology was observed. Conclusion The proposed classifcation of angioedema without wheals was accepted with a high degree of agreement; however, knowledge of available treatments needs to be increased and the defnition of angioedema of unknown mechanism needs to be improved.