Bradykinin-induced angioedema in the emergency department
Abstract 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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-022-00408-6 |
| _version_ | 1811272261485723648 |
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| author | Jacques Hébert Jean-Nicolas Boursiquot Hugo Chapdelaine Benoit Laramée Marylin Desjardins Rémi Gagnon Nancy Payette Oleksandra Lepeshkina Matthieu Vincent |
| author_facet | Jacques Hébert Jean-Nicolas Boursiquot Hugo Chapdelaine Benoit Laramée Marylin Desjardins Rémi Gagnon Nancy Payette Oleksandra Lepeshkina Matthieu Vincent |
| author_sort | Jacques Hébert |
| collection | DOAJ |
| description | Abstract 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 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 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 Diagnostic algorithms of bradykinin-induced angioedema should be followed in the ED, with early use of approved therapies to improve patient outcomes. |
| first_indexed | 2024-04-12T22:37:12Z |
| format | Article |
| id | doaj.art-50361bd81f294bf68d902ab930aaa272 |
| institution | Directory Open Access Journal |
| issn | 1865-1372 1865-1380 |
| language | English |
| last_indexed | 2024-04-12T22:37:12Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-50361bd81f294bf68d902ab930aaa2722022-12-22T03:13:49ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802022-03-0115111010.1186/s12245-022-00408-6Bradykinin-induced angioedema in the emergency departmentJacques Hébert0Jean-Nicolas Boursiquot1Hugo Chapdelaine2Benoit Laramée3Marylin Desjardins4Rémi Gagnon5Nancy Payette6Oleksandra Lepeshkina7Matthieu Vincent8CHU de Québec, Université LavalCHU de Québec, Université LavalCHU de Montréal, Université de MontréalPolyclinique Médicale Pierre-Le GardeurMcGill UniversityCHU de Québec, Université LavalCHU de Québec, Université LavalCHU de Québec, Université LavalMcGill UniversityAbstract 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 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 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 Diagnostic algorithms of bradykinin-induced angioedema should be followed in the ED, with early use of approved therapies to improve patient outcomes.https://doi.org/10.1186/s12245-022-00408-6BradykininHistamineAngioedemaEmergency |
| spellingShingle | Jacques Hébert Jean-Nicolas Boursiquot Hugo Chapdelaine Benoit Laramée Marylin Desjardins Rémi Gagnon Nancy Payette Oleksandra Lepeshkina Matthieu Vincent Bradykinin-induced angioedema in the emergency department International Journal of Emergency Medicine Bradykinin Histamine Angioedema Emergency |
| title | Bradykinin-induced angioedema in the emergency department |
| title_full | Bradykinin-induced angioedema in the emergency department |
| title_fullStr | Bradykinin-induced angioedema in the emergency department |
| title_full_unstemmed | Bradykinin-induced angioedema in the emergency department |
| title_short | Bradykinin-induced angioedema in the emergency department |
| title_sort | bradykinin induced angioedema in the emergency department |
| topic | Bradykinin Histamine Angioedema Emergency |
| url | https://doi.org/10.1186/s12245-022-00408-6 |
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