Diagnosis and management of angioedema

Czech version

Authors: Gavorník P. ¹; Dukát A. ^1,2; Gašpar Ľ. ^1,3; Gubo G. ^1,4; Bežillová N. ^1,5; Kováčová M. ⁶; Gavorníková E. ^1,7; Petrášová A. ⁸; Gašparová I. ^1,9; Sabolová L. ^10,11; Kučera M. ^3,12; Kusendová K. ¹³; Uhrinová A. ^1,14; Bendžala M. ^1,15; Mesárošová D. ^3,11; Fialová V. ¹
Authors‘ workplace: Angiologická sekcia Slovenskej lekárskej komory, Slovenská republika 2 V. interná klinika LF UK a UN Bratislava, Slovenská republika 3 I. interná klinika LF UK a UN Bratislava, Slovenská republika 4 Homerton University Hospital Foundation Trust, Homerton ¹
Published in: Kardiol Rev Int Med 2018, 20(4): 286-293

Overview

Angioedema is defined as a vascular reaction of the deep dermis and/or subcutaneous/submucosal tissues with localised vasodilatation and increased permeability of blood vessels resulting in tissue swelling. Angioedema can be mediated by bradykinin or mast cell mediators, including histamine. Bradykinin-mediated angioedema can occur either on a hereditary (HAE) or acquired (AAE) basis, with or without a deficiency/defect of C1 inhibitor (C1-INH). Three forms of HAE have been defined: HAE due to C1-INH deficiency (type 1 HAE, HAE-1), characterised by low antigenic and functional C1-INH levels; HAE due to C1-INH dysfunction (type 2 HAE, HAE-2), characterised by normal (or elevated) antigenic but low functional C1-INH levels; and HAE with normal C1-INH antigenic and functional levels (HAE-3). Acquired C1-INH deficiency refers to patients with angioedema due to C1-INH deficiency on an acquired basis. There are several types of acquired angioedema not due to C1-INH deficiency, which can be bradykinin-mediated (e.g., angiotensin-converting enzyme inhibitor-induced angioedema) or mast-cell-mediator-histamine-mediated (e.g., anaphylactic angioedema and urticarial angioedema). In recent years there have been several changes in how we look at anaphylaxis. The spectrum of trigger factors and diagnostic and therapeutic algorithms has changed significantly. Anaphylaxis is defined as any sudden severe hypersensitive reaction which can potentially lead to death.

Key words:

angioedema – angiology/ vascular medicine – AS SMC’ guidelines – CEAP – clinical-etiology-anatomy-patophysiology diagnosis – prevention – therapy

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