The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine

Abstract

<p><strong>Objective. </strong>Angioedema (AE) is a potentially life-threatening event. We investigated the etiology of AE, with the emphasis on bradykinininduced angioedema treatment in emergency medicine.</p><p><strong>Methods. </strong>The retrospective study included 237 patients with AE, who were examined and treated in two hospitals (group A and B) in Croatia from 2009 to 2016. The location and duration of AE, data about chronic diseases and treatment, potential causative agents (food, drugs, insect bites and chemicals), physical examination data and the subsequent treatment were analyzed.</p><p><strong>Results. </strong>There was no statistical difference regarding age or comorbidities but there was a statistically significant difference in etiology between the groups (Chi-square, P=0.03). Renin-angiotensin-aldosterone system (RAAS) blocker induced AE was the main cause of emergency attendance in group A (37.5%) and among the leading causes in group B (18.8%). Bradykinin-induced AE (hereditary angioedema (HAE) and RAAS-AE) were the leading causes in a total of 75 (31.5%) patients. RAAS-AE was treated with glucocorticoids and antihistamines. HAE attacks in both groups (2/7 patients, 1.5/6%) were treated with specific therapy. Other causes of AE in groups A/B were insect bites (15/23 patients, 13.5/20%), use of antibiotics/analgetics (11/17 patients, 9/15%), gastroesophageal reflux disease (10/11 patients, 8/9%), neoplasms (5/6 patients, 4/5%) and idiopatic (32/31 patients, 26.5/26%). 21% of patients were hospitalized.</p><p><strong>Conclusion. </strong>Bradykinin-mediated AE was the main cause of emergency attendance associated with AE. Advances in the treatment of HAE, with case reports of patients with RAAS-AE treated with C1 esterase inhibitor concentrate or bradykinin receptor antagonist, may prove to be a new, reliable and efficacious therapy option.</p>

Can’t Intubate, Can’t Oxygenate: A Rare Case of a Difficult Airway due to Nonhereditary Angioedema

“…[7][8][9] Angioedema may be primarily manifested by recurrent episodes of Quincke's edema (as in our patient), but also by edema of subcutaneous tissue, edema of the mucous membranes of the upper respiratory tract and the gastrointestinal tract, with great variability in occurrence, usually without urticaria, rash or itching. 10,11 in our first study in Croatia we analyzed the frequency and treatment of bradykinin-induced angioedema as a cause for emergency treatment. bradykinin-induced Ae was the leading cause in the investigated group (31.5%).…”

“…bradykinin-induced Ae was the leading cause in the investigated group (31.5%). 11 Angioedema resulting from bradykinin-induced Ae (AAe and hAe) was the Sažetak RiJedAK SluČAJ oteŽAnog diŠnog PutA Zbog SteČenog AngioedemA -beZ moguĆnoSti intubACiJe i oKSigenACiJe Đ. Delalić, V. Borčić i I. Prkačin…”

“…( 7 - 9 ) Angioedema may be primarily manifested by recurrent episodes of Quincke’s edema (as in our patient), but also by edema of subcutaneous tissue, edema of the mucous membranes of the upper respiratory tract and the gastrointestinal tract, with great variability in occurrence, usually without urticaria, rash or itching. ( 10 , 11 )…”

“…Advances in the treatment of hAe and case reports of patients with ACei-Ae treated with C1-inh concentrate or bradykinin receptor antagonist show that they may be a safe and efficacious therapeutic option. 11 in conclusion, emergency physicians should be adequately educated on when to suspect nonhereditary angioedema, and how to manage the rapid onset of airway obstruction it causes it in the most severe cases. emergency departments should also be equipped with the medications used in its management.…”

Update on bradykinin-mediated angioedema in 2020

“…The most common form of drug-induced BK-AE is associated with ACEi [28,29]. ACE converts angiotensin 1 to angiotensin 2, leading to an increased systemic blood pressure, therefore ACEi are indicated for the treatment of essential hypertension, heart failure, recent post-myocardial infarction and proteinuric nephropathy of diabetes.…”