Perioperative Management of Tooth Extractions for a Patient With Hereditary Angioedema

Self‐administration of icatibant in acute attacks of Type I hereditary angioedema: A case report and review of hereditary angioedema

“…A good dental care and influenza vaccines are suggested, particularly in children, respectively to reduce dental extractions and airway infections (Jurado-Palomo et al, 2013;Sanuki, Watanabe, Kurata, & Ayuse, 2014). Current therapy for acute HAE attacks (on-demand treatment) and short-or long-term prophylaxis which are well established for HAE Types I and II, are also used in the other types of HAE, although their mechanism is not so clear (Depetri et al, 2019;Maurer et al, 2018).…”

“…In the management of HAE, apart from medical therapy, general measures are recommended to avoid triggering factors, like mechanical trauma, medical and surgical procedures, estrogen‐containing contraceptives, ACE‐inhibitors, psychological stress, fatigue, strenuous physical activities (Farkas et al, ; Ghazi & Andrew Grant, ). A good dental care and influenza vaccines are suggested, particularly in children, respectively to reduce dental extractions and airway infections (Jurado‐Palomo et al, ; Sanuki, Watanabe, Kurata, & Ayuse, ). Current therapy for acute HAE attacks (on‐demand treatment) and short‐ or long‐term prophylaxis which are well established for HAE Types I and II, are also used in the other types of HAE, although their mechanism is not so clear (Depetri et al, ; Maurer et al, ).…”

“…Short‐term prophylaxis is recommended before procedures like dental treatments, surgical trauma, endotracheal intubation, and endoscopy, which may induce local trauma and life‐threatening swellings within 4–48 hours (Longhurst & Cicardi, ; Sanuki et al, ). C1‐INH concentrate should be used just before the procedure in a dose of 1,000 units or a 20 units/kg in adults, as well as children, breast‐feeding, and pregnant women, namely before amniocentesis, surgical abortion, cesarean section, complicated labor and delivery (Caballero et al, ; Maurer et al, ).…”

Hereditary angioedema: death after a dental extraction

“…There are many recent references in the literature to dental treatment as a trigger for HAE [14][15][16] . It is important to the dentist to be aware of HAE, because there is a possibility of lifethreatening laryngeal swelling leading to airway obstruction or asphyxia after routine dental care 15 . This may occur hours or even days after the trigger treatment, by which time the dental appointment will be long over [17][18][19] .…”

“…Sanuki 15 states that HAE attacks can be triggered by physical or psychological stress, and points out that dental appointments abound with such potential triggers. It is also a possibility that the local anaesthetic used in the present case may have contributed to the outcome.…”