Angioedema associated with nonsteroidal anti-inflammatory drugs

Abstract

The manuscript addresses the pathophysiology and pharmacogenetics of angioedema, reviews its classification and assesses the diagnosis and management of angioedemas exacerbated and induced by NSAIDs.

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis

“…Quincke first described HAE as a clinical entity in 1882 25 - 27 , and Osler established its hereditary nature in 1888 28 - 32 . The first biochemical change associated with the disease, C1 inhibitor (C1-INH) deficiency, was not identified until 75 years later.…”

“…Angioedema can be induced by the activation of mast cells and/or basophils, resulting in the release of histamine and other mediators (histaminergic angioedema), and by an excess of bradykinin (bradykinin-mediated or non-histaminergic angioedema), as seen in HAE, acquired angioedema with C1-INH deficiency (AAE) and angioedema induced by ACEi and other drugs involved in bradykinin metabolism 4 , 29 . A scheme in which angioedema is classified according to endotype has recently been proposed and may provide clinicians with insights into the etiology of the disease and/or the pathophysiological mechanism underlying the development of the different types of this clinical entity ( Figure 4 ) 25 , 27 , 33 - 35 .…”

“…Cyclosporine and omalizumab have also been used to treat affected patients, indicating that this group of patients is heterogeneous. We speculate that this classification may include patients with HAE with normal C1-INH levels and without a family history of the disease and patients with chronic spontaneous urticaria/angioedema resistant to antihistamines, given that up to 10% of these patients present with recurrent angioedema without urticaria 4 , 27 , 67 .…”

Cyclo‐oxygenase selectivity and chemical groups of nonsteroidal anti‐inflammatory drugs and the frequency of reporting hypersensitivity reactions: a case/noncase study in VigiBase

“…Nonsteroidal anti‐inflammatory drugs (NSAIDs) are the drugs most often reported to be associated with adverse drug reactions (ADRs) . This group of drugs may cause various types of hypersensitivity reactions (HSRs) and be classified into either allergic reactions or nonallergic reactions with similar symptoms, that is, pseudoallergic (anaphylactoid reactions) .…”

The Hereditary Angioedema Triggered by Estrogen: Systematic Review

“…In nineteenth century, a physician named Heinrich Quincke was the first to report the clinical occurrence of hereditary angioedema (HAE) [1][2][3]. After six years, the Canadian physician and researcher, Willian Osler, revealed the genetic association of the disease as autosomal dominant [4][5][6][7][8].…”