Current and future therapies for the treatment of histamine-induced angioedema

Abstract

Introduction Angioedema, a sudden, self-limited swelling of localized areas of any part of the body that may or may not be associated with urticaria, is thought to be the result of a mast-cell mediated process versus a bradykinin etiology. Understanding the mechanism is key in determining the proper treatment. Areas Covered Clinical presentation of varying angioedema types may be similar; however, the appropriate treatment algorithm is dependent upon clinicians’ knowledge of the underlying pathophysiology and classification of angioedema. Literature review of recent guidelines, available medications, and alternative therapies was completed to provide an overview of options. Conclusion There are no formal guidelines for treatment of acute or chronic histamine-mediated angioedema, and therefore, algorithms for the treatment of acute and chronic urticaria should be followed until such information becomes available. Differentiating histamine-mediated versus bradykinin mediated angioedema is essential, as treatments and treatment responses are quite different. Further research is needed to better understand idiopathic angioedema that is unresponsive to H1/H2 antagonists, LTMAs, or medications designed to treat bradykinin-mediated angioedema.

Omalizumab rapidly improves angioedema‐related quality of life in adult patients with chronic spontaneous urticaria: X‐ACT study data

“…Angioedema can be mediated by histamine or bradykinin. Hereditary angioedema (HAE) is bradykinin‐mediated and usually develops over the course of several hours, whereas in CSU, angioedema is histamine‐mediated and develops rapidly . For HAE patients, angioedema episodes can range from a minor inconvenience to life‐threatening episodes, with a mortality rate of approximately 30% in the case of laryngeal edema .…”

Can Leukotriene Modifiers and Mast Cell Stabilizers Decrease the Fatal Outcomes of Coronavirus?

“…Some of the immune cells (mast cells), which are located in the submucosa of the pulmonary tract, attack primarily to Coronavirus. [1][2][3][4] First, the virus activates mast cells and then certain chemical compounds are generated against the pathogen. Here, we develop a new idea that inflammation in patients with COVID-19 may be mitigated by both leukotriene modifiers and mast cell stabilizers.…”

“…2 Angiotensin-converting enzyme 2 (ACE-2) inhibitorinduced angioedema could be a mast cell/histaminemediated. 3 Human pathogenic coronaviruses attach to epithelial cells through ACE-2 increased angiotensin-converting enzyme two and expression of ACE-2 in the lung, intestine, kidney and blood vessels facilitates infection. Some of the drugs that stimulate the expression of ACE-2 increase the risk of fatal COVID-19.…”

Mast Hücre- Aracılı (Histaminerjik) Anjioödeme Yaklaşım: Klinik Spektrum ve Tanı

“…Ürtiker-anjioödem tablolarının %10-15'inde anjioödem yalnız başına bulunmaktadır. 2,14,17 Anjioödem erişkinlerde (40-50 yaş arası) ve kadınlarda daha sıktır. Fakat idiyopatik anjioödem (ürtikersiz) daha sık erkeklerde görülür.…”

“…Ciltte deskuamasyon ve lekelenme yoktur, fakat kaşımaya bağlı morluk olabilir. Özellikle, MHAAÖ kaşıntıve ürtikerle beraber görülebilir 2,[7][8][9][10][11][12][13][14].…”