Bradykinin-Mediated Angioedema View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2014

AUTHORS

Bernard Floccard , Jullien Crozon , Brigitte Coppere , Laurence Bouillet , Bernard Allaouchiche

ABSTRACT

Bradykinin-mediated angioedema (AE) is a clinical syndrome characterised by episodes of subcutaneous or mucosal oedema (extremities, throat, respiratory and digestive tracts) referred to as attacks. Any ICU physician could encounter patient during an attack. The diagnosis of AE must be evoked in cases of transient and recurrent oedema and/or abdominal pain. All attacks localised over the shoulders (face, neck, throat and respiratory tract) and all abdominal attacks with pain rated >5 on the VAS must be considered severe. Severe ENT attacks may be life-threatening. In the absence of specific treatment, the mortality rate reaches 25–30 % due to asphyxia. In emergency situations, a step-by-step approach is necessary to establish a diagnosis and evaluate the severity. This is not an allergic reaction. Antihistamines are not effective because bradykinin is the key mediator. There are hereditary and acquired forms, notably associated with the use of ACE inhibitors. All severe attacks should benefit from early specific treatment. The availability of these treatments varies by country and there is currently no consensus as to the correct choice of a specific treatment. Even in the absence of previous attack, short-term prophylaxis is necessary during the perioperatory period. The rarity of this disease and the characteristics of the specific drugs (i.e., their retention periods, modes of delivery, prices and methods for reimbursement) should encourage hospitals to make strategic choices regarding the creation of an emergency supply of drugs or an institute-wide protocol for the rapid transfer of patients to specialised centres for treatment. More... »

PAGES

175-190

References to SciGraph publications

Book

TITLE

Uncommon Diseases in the ICU

ISBN

978-3-319-04575-7
978-3-319-04576-4

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-04576-4_16

DOI

http://dx.doi.org/10.1007/978-3-319-04576-4_16

DIMENSIONS

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41 schema:description Bradykinin-mediated angioedema (AE) is a clinical syndrome characterised by episodes of subcutaneous or mucosal oedema (extremities, throat, respiratory and digestive tracts) referred to as attacks. Any ICU physician could encounter patient during an attack. The diagnosis of AE must be evoked in cases of transient and recurrent oedema and/or abdominal pain. All attacks localised over the shoulders (face, neck, throat and respiratory tract) and all abdominal attacks with pain rated >5 on the VAS must be considered severe. Severe ENT attacks may be life-threatening. In the absence of specific treatment, the mortality rate reaches 25–30 % due to asphyxia. In emergency situations, a step-by-step approach is necessary to establish a diagnosis and evaluate the severity. This is not an allergic reaction. Antihistamines are not effective because bradykinin is the key mediator. There are hereditary and acquired forms, notably associated with the use of ACE inhibitors. All severe attacks should benefit from early specific treatment. The availability of these treatments varies by country and there is currently no consensus as to the correct choice of a specific treatment. Even in the absence of previous attack, short-term prophylaxis is necessary during the perioperatory period. The rarity of this disease and the characteristics of the specific drugs (i.e., their retention periods, modes of delivery, prices and methods for reimbursement) should encourage hospitals to make strategic choices regarding the creation of an emergency supply of drugs or an institute-wide protocol for the rapid transfer of patients to specialised centres for treatment.
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