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2017 ; 114
(29-30
): 489-496
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Angioedema
#MMPMID28818177
Hahn J
; Hoffmann TK
; Bock B
; Nordmann-Kleiner M
; Trainotti S
; Greve J
Dtsch Arztebl Int
2017[Jul]; 114
(29-30
): 489-496
PMID28818177
show ga
BACKGROUND: Acute angioedema of the upper airways can be life-threatening. An
important distinction is drawn between mast-cell-mediated angioedema and
bradykinin-mediated angioedema; the treatment of these two entities is
fundamentally different. METHODS: This review is based on pertinent articles
retrieved by a selective search in PubMed and on guidelines concerning the
treatment of angioedema. The authors draw on their own clinical experience in
their assessment of the literature. RESULTS: In the emergency clinical situation,
the most important information comes from accompanying manifestations such as
itching and urticaria and from the patient's drug history and family history.
When angioedema affects the head and neck, securing the upper airways is the
highest priority. Angioedema is most commonly caused by mast-cell mediators, such
as histamine. This type of angioedema is sometimes accompanied by urticaria and
can be effectively treated with antihistamines or glucocorticoids. In case of a
severe allergic reaction or anaphylaxis, epinephrine is given intramuscularly in
a dose that is adapted to the patient's weight (150 ?g for body weight >10 kg,
300 ?g for body weight >30 kg). Bradykinin-mediated angioedema may arise as
either a hereditary or an acquired tendency. Acquired angioedema can be caused by
angiotensin converting enzyme (ACE) inhibitors and by angiotensin II receptor
blockers. Bradykinin-mediated angioedema should be treated specifically with
C1-esterase inhibitor concentrates or bradykinin-2 receptor antagonists.
CONCLUSION: Angioedema of the upper airways requires a well-coordinated
diagnostic and therapeutic approach. Steroids and antihistamines are very
effective against mast-cell-mediated angioedema, but nearly useless against
bradykinin-mediated angioedema. For angioedema induced by ACE inhibitors, no
causally directed treatment has yet been approved.
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