Isolated oedema of the uvula induced by intense snoring and ACE inhibitor

Rasmussen, Eva Rye; Mey, Kristianna; Bygum, Anette

doi:10.1136/bcr-2014-205585

Cited by 11 publications

(13 citation statements)

References 14 publications

(13 reference statements)

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“…As shown in Fig. 2a , described treatment strategies consisted of icatibant (42 patients in ten articles including one RCT) [ 5 , 6 , 21 , 24 , 26 , 27 , 31 , 33 , 36 , 37 ], C1INH (14 patients in five articles) [ 22 , 25 , 28 , 38 , 39 ], FFP (13 patients in six articles) [ 23 , 29 , 30 , 32 , 35 , 40 ], and kanokad (concentrate of vitamin K-dependent coagulation factor anti-vitamin K antagonist in one patient using anti-vitamin K medication concomitantly) [ 34 ]. In the 21 included studies for icatibant, C1INH, and FFP, the (median) time to initial response ranged from a few minutes up to 150 min, with one outlier up to 48 h [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Treatment of Non-hereditary Angioedema

Elzen

Knulst

et al. 2016

Clinic Rev Allerg Immunol

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Non-hereditary angioedema (AE) with normal C1 esterase inhibitor (C1INH) can be presumably bradykinin- or mast cell-mediated, or of unknown cause. In this systematic review, we searched PubMed, EMBASE, and Scopus to provide an overview of the efficacy of different treatment options for the abovementioned subtypes of refractory non-hereditary AE with or without wheals and with normal C1INH. After study selection and risk of bias assessment, 61 articles were included for data extraction and analysis. Therapies were described for angiotensin-converting enzyme inhibitor-induced AE (ACEi-AE), for idiopathic AE, and for AE with wheals. Described treatments consisted of ecallantide, icatibant, C1INH, fresh frozen plasma (FFP), tranexamic acid (TA), and omalizumab. Additionally, individual studies for anti-vitamin K, progestin, and methotrexate were found. Safety information was available in 26 articles. Most therapies were used off-label and in few patients. There is a need for additional studies with a high level of evidence. In conclusion, in acute attacks of ACEi-AE and idiopathic AE, treatment with icatibant, C1INH, TA, and FFP often leads to symptom relief within 2 h, with limited side effects. For prophylactic treatment of idiopathic AE and AE with wheals, omalizumab, TA, and C1INH were effective and safe in the majority of patients.

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Section: Resultsmentioning

confidence: 99%

Efficacy of Treatment of Non-hereditary Angioedema

Elzen

Knulst

et al. 2016

Clinic Rev Allerg Immunol

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“…Only a handful cases with Quincke's disease have been reported and hence an exact epidemiology of the condition is not yet known. Underlying etiologies explored and reported in literature untill now include food allergies such as nut or prawn [1] infections, mechanical pressure/ trauma regional [2] or general anesthesia [9], herbal agents (2020) 36:44 [3], drugs such as ACE inhibitors [4], or ARB [5]. However, idiopathic etiology is rarely reported [6].…”

Section: Discussionmentioning

confidence: 99%

“…Being a rare condition, epidemiology of Quincke's disease has not been documented in literature; however, multiple etiologies have been explored and defined over the last 2 decades [1][2][3][4][5][6]. The etiology of isolated angioedema of the uvula is usually an immediate type I hypersensitivity reaction by trauma, thermal injury, infections or drugs, and even idiopathic in some cases [7].…”

Section: Introductionmentioning

confidence: 99%

Quincke’s disease: a case report

Kamath

Juthika

2020

Egypt J Otolaryngol

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Background Isolated angioneurotic edema of the uvula is termed Quincke’s disease. It is a rare clinical disorder of acute onset with few known causes. It may be encountered in any emergency setup and must be dealt with rapidly and with utmost vigilance for prevention of progression and complications. Case presentation A young adult, 3 months post Frey’s procedure for chronic pancreatitis, presented with acute onset throat discomfort and gagging progressive over 8 h. Examination showed isolated edematous hyperemic uvula with normal oropharyngeal structures and adequate airway. Prompt antihistaminic and corticosteroid therapy caused relief of symptoms over 2 h with no recurrences. Conclusion Any symptom suggesting orofacial edema must not be trivialized. Awareness about this rare but acute condition, even in the background of unknown etiology, in all medical personnel is essential. Early diagnosis with appropriate management can prevent life-threatening airway obstruction and hypoxemia.

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“…It is also important to discuss the diagnosis of patients with isolated edema of the uvula. Acute AE that affects only the uvula is often snoring induced but can also be triggered by drugs or an allergic reaction [32,33]. In these cases, the diagnosis is challenging and cannot be definitively proven.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of angioedema induced by renin-angiotensin-aldosterone system inhibition: a retrospective analysis of 84 patients

Pfaue

Schuler

Mayer

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background and objectives: Bradykinin-mediated angioedema (AE) induced by antihypertensive drugs primarily affect the head and neck region and may occur even after several years of uneventful treatment. Many facts about the clinical course remain unknown. Diagnosis is not easy, as the clinical appearance resembles allergic AE. No specific diagnostic markers are known and no officially approved treatment is currently available. Methods: All patients who presented to the ORL department between 2010 and 2016 with acute AE were included. Those with a history of renin-angiotensin-aldosterone system (RAAS) blocker intake were defined as RAE and their pathophysiological characteristics and clinical course of the disease were analyzed. Results: A total of 84 patients (median age of 71 years) with RAE was identified. The majority (80%) was on ACE inhibition. The oral cavity was most often affected. Nearly 60% were medicated for more than 1 year before AE occurred. RAE occurred more often during the morning hours. The necessity for emergency intubation and/or tracheostomy was nine times higher in patients with acute RAE compared to patients with AE due to other reasons. Conclusions: Event-free, long-term therapy with an RAAS blocker before the first development of edema does not exclude RAE. RAE is associated with an increased risk for emergency airway management.

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Isolated oedema of the uvula induced by intense snoring and ACE inhibitor

Cited by 11 publications

References 14 publications

Efficacy of Treatment of Non-hereditary Angioedema

Efficacy of Treatment of Non-hereditary Angioedema

Quincke’s disease: a case report

Clinical features of angioedema induced by renin-angiotensin-aldosterone system inhibition: a retrospective analysis of 84 patients

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