Bradykinin-induced angioedema in the emergency department.
Angioedema
Bradykinin
Emergency
Histamine
Journal
International journal of emergency medicine
ISSN: 1865-1372
Titre abrégé: Int J Emerg Med
Pays: England
ID NLM: 101469435
Informations de publication
Date de publication:
26 Mar 2022
26 Mar 2022
Historique:
received:
01
11
2021
accepted:
26
11
2021
entrez:
30
3
2022
pubmed:
31
3
2022
medline:
31
3
2022
Statut:
epublish
Résumé
Acute airway angioedema commonly occurs through two distinct mechanisms: histamine- and bradykinin-dependent. Although they respond to distinct treatments, these two potentially life-threatening states present similarly. Poor recognition of the bradykinin-dependent pathway leads to treatment errors in the emergency department (ED), despite the availability of multiple pharmacologic options for hereditary angioedema (HAE) and other forms of bradykinin-induced angioedema. Here, we consider the pathophysiology and clinical features of bradykinin-induced angioedema, and we present a systematic literature review exploring the effectiveness of the available therapies for managing such cases. PubMed searches using 'emergency', 'bradykinin' and various therapeutic product names identified studies reporting the efficacy of treatments for bradykinin-induced angioedema in the ED setting. In all, 22 studies met prespecified criteria and are analysed here. Whereas histamine-induced angioedema has a faster onset and often presents with urticaria, bradykinin-induced angioedema is slower in onset, with greater incidence of abdominal symptoms. Acute airway angioedema in the ED should initially be treated with anaphylactic protocols, focusing on airway management and treatment with epinephrine, antihistamine and systemic steroids. Bradykinin-induced angioedema should be considered if this standard treatment is not effective, despite proper dosing and regard of beta-adrenergic blockade. Therapeutics currently approved for HAE appear as promising options for this and other forms of bradykinin-induced angioedema encountered in the ED. Diagnostic algorithms of bradykinin-induced angioedema should be followed in the ED, with early use of approved therapies to improve patient outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Acute airway angioedema commonly occurs through two distinct mechanisms: histamine- and bradykinin-dependent. Although they respond to distinct treatments, these two potentially life-threatening states present similarly. Poor recognition of the bradykinin-dependent pathway leads to treatment errors in the emergency department (ED), despite the availability of multiple pharmacologic options for hereditary angioedema (HAE) and other forms of bradykinin-induced angioedema. Here, we consider the pathophysiology and clinical features of bradykinin-induced angioedema, and we present a systematic literature review exploring the effectiveness of the available therapies for managing such cases.
METHODS
METHODS
PubMed searches using 'emergency', 'bradykinin' and various therapeutic product names identified studies reporting the efficacy of treatments for bradykinin-induced angioedema in the ED setting. In all, 22 studies met prespecified criteria and are analysed here.
FINDINGS
RESULTS
Whereas histamine-induced angioedema has a faster onset and often presents with urticaria, bradykinin-induced angioedema is slower in onset, with greater incidence of abdominal symptoms. Acute airway angioedema in the ED should initially be treated with anaphylactic protocols, focusing on airway management and treatment with epinephrine, antihistamine and systemic steroids. Bradykinin-induced angioedema should be considered if this standard treatment is not effective, despite proper dosing and regard of beta-adrenergic blockade. Therapeutics currently approved for HAE appear as promising options for this and other forms of bradykinin-induced angioedema encountered in the ED.
CONCLUSION
CONCLUSIONS
Diagnostic algorithms of bradykinin-induced angioedema should be followed in the ED, with early use of approved therapies to improve patient outcomes.
Identifiants
pubmed: 35350995
doi: 10.1186/s12245-022-00408-6
pii: 10.1186/s12245-022-00408-6
pmc: PMC8966254
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
15Informations de copyright
© 2022. The Author(s).
Références
West J Emerg Med. 2019 Jul;20(4):587-600
pubmed: 31316698
Am Fam Physician. 2003 Oct 1;68(7):1325-32
pubmed: 14567487
P T. 2015 Feb;40(2):109-14
pubmed: 25673959
J Allergy Clin Immunol Pract. 2017 Nov - Dec;5(6):1671-1678.e2
pubmed: 28601641
Eur J Emerg Med. 2013 Feb;20(1):10-7
pubmed: 22976464
N Engl J Med. 2020 Mar 19;382(12):1136-1148
pubmed: 32187470
P T. 2009 Jun;34(6):293-328
pubmed: 19572047
Int J Emerg Med. 2017 Dec;10(1):15
pubmed: 28405953
Medicine (Baltimore). 2015 Nov;94(45):e1939
pubmed: 26559262
J Allergy Clin Immunol. 2002 Feb;109(2):195-209
pubmed: 11842287
Am J Emerg Med. 2017 Jun;35(6):942.e5-942.e6
pubmed: 28159372
J Allergy Clin Immunol. 2017 Jul;140(1):242-248.e2
pubmed: 27913306
Ann Allergy Asthma Immunol. 2015 Mar;114(3):245-9
pubmed: 25601538
Front Med (Lausanne). 2018 Sep 19;5:257
pubmed: 30283782
Laryngoscope. 2015 Jun;125(6):E198-202
pubmed: 25583256
Niger J Clin Pract. 2018 Apr;21(4):531-533
pubmed: 29607870
J Emerg Med. 2013 Apr;44(4):764-72
pubmed: 23114109
J Pharm Pract. 2017 Dec;30(6):668-671
pubmed: 27837046
Arch Intern Med. 2001 Mar 12;161(5):714-8
pubmed: 11231704
N Engl J Med. 2015 Jan 29;372(5):418-25
pubmed: 25629740
Ann Emerg Med. 2015 Feb;65(2):204-13
pubmed: 25182544
Intern Emerg Med. 2015 Apr;10(3):345-50
pubmed: 25666515
J Clin Pharm Ther. 2019 Oct;44(5):685-692
pubmed: 31290163
Immunol Rev. 2011 Jul;242(1):128-43
pubmed: 21682742
Ann Allergy Asthma Immunol. 2007 Apr;98(4):383-8
pubmed: 17458436
Case Rep Crit Care. 2014;2014:864815
pubmed: 25328718
Int J Emerg Med. 2012 Nov 06;5(1):39
pubmed: 23131076
J Clin Immunol. 2010 Nov;30(6):823-9
pubmed: 20635155
World Allergy Organ J. 2019 Oct 12;12(9):100049
pubmed: 31641402
J Allergy Clin Immunol. 2007 Aug;120(2):416-22
pubmed: 17559913
J Emerg Med. 2007 Aug;33(2):137-9
pubmed: 17692764
Allergy Asthma Clin Immunol. 2019 Nov 25;15:72
pubmed: 31788005
BMJ Case Rep. 2013 Oct 04;2013:
pubmed: 24096073
Am J Emerg Med. 2015 Mar;33(3):479.e1-3
pubmed: 25241359
Nat Rev Immunol. 2008 Mar;8(3):205-17
pubmed: 18301424
J Allergy Clin Immunol Pract. 2017 Sep - Oct;5(5):1402-1409.e3
pubmed: 28552382
J Allergy Clin Immunol. 2009 Oct;124(4):801-8
pubmed: 19767078
Allergy Rhinol (Providence). 2016 Jan 1;7(3):168-171
pubmed: 27502825
Intern Med J. 2015 Aug;45(8):821-7
pubmed: 25944565
Acad Emerg Med. 2014 Apr;21(4):469-84
pubmed: 24730413
Ann Emerg Med. 2010 Sep;56(3):278-82
pubmed: 20447725