Thank you for your recent inquiry.
Of course one can never say "never" in terms of whether or not an incident of any phenomenon has occurred or been reported. However, my experience is consistent with what you have been taught in that it would be very unusual for a patient with chronic idiopathic urticaria and angioedema or episodes of recurrent idiopathic angioedema to experience a fatal case of laryngeal or pharyngeal edema.
With a cursory review of the literature by searching PubMed, I was not able to find such a case. There are of course fatal cases of angioedema involving the airway, but the cases that I found were in association with the administration of a drug (particularly ACE inhibitors) or in a patient with the hereditary form of angioedema. I do not know how to search the question you asked in terms of whether or not patients could die from pharyngeal edema in the absence of laryngeal edema. However, I believe such could be the case.
Thus, based upon the above comments, in my opinion, prescriptions for an automatic epinephrine injector are not indicated in the vast majority of patients with recurrent idiopathic angioedema or with chronic idiopathic urticaria and angioedema. However, I believe you have in part answered your own inquiry in your last sentence. Certainly, a blanket statement should not be made regarding the need for automatic epinephrine injectors in patients with recurrent angioedema alone or idiopathic urticaria and angioedema. The ultimate decision in this regard is one based upon an interpretation of each individual case and the clinical judgment of the physician managing the patient.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.