Angioedema - Our Experience Focused On Socio-Demographic, Etiological and Clinical Characteristics of the Condition and Its Management
BACKGROUND: Angioedema (AE) is acute oedema of the skin and mucous surfaces, involving the respiratory and gastrointestinal tracts. AE could be a life-threatening medical condition. Regardless of its growing clinical importance, many aspects of its aetiology and pathogenesis remain poorly understood. Its incidence, demographic characteristics, diagnosis and therapy, need further investigation.
AIM: This study reports our experience with angioedema concerning its social and demographic characteristics, aetiology, clinical features, diagnosis and treatment outcomes. Study design: Eighty-eight patients with AE were enrolled. The study is a retrospective analysis of patients treated in our Clinics.
METHODS: All participants were asked on a voluntary basis to fill out a specially designed questionnaire on the day of their discharge. Other important data sources included: patientsâ€™ history and notes during the hospital stay, information from previous admissions, etc. Parametric and non-parametric statistical methods were used for data processing. Data analysis was performed using SPSS (SPSS Inc., IBM SPSS Statistica) version 20.0
RESULTS: Based on our results, AE affects more frequently patients over 50 years of age, regardless of their sex. Urban residents prevail, among them - more commonly working women. Non-steroidal anti-inflammatory drugs (NSAIDs), hormones and antibiotics were among the most common triggers â€“ in 8%, 4.5% and 11.4% of the cases respectively. In 9.09% of the patients, food-induced AE was seen, the most common foods reported, were â€“ nuts, eggs and egg products. The common sites of involvement were periorbital area and lips. In only 9.1% of the patients, oedema progressed to spread to the upper respiratory tract. Cardiac conditions were the most frequent underlying disorders â€“ 33%, of the patients, auto-immune thyroiditis was the second most common-14.8%, followed by musculo- skeletal disorders (10.2%) and diabetes (4.5%) Family history of allergy was seen in 8.4% of the patients, the most frequent allergic disorder, reported, was asthma. In patients with HAE, family history was present in 2.9% of the patients.
CONCLUSIONS: All patients received therapy with steroids and antihistamines, resulting in resolution of symptoms and no invasive procedures were necessary. Based on our results, the diagnosis of AE is often difficult and delayed and requires specialist evaluation. If recognised on time and adequately treated, the outcomes are favourable.
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Quincke H. Uber akutes unschriebenes H autodem. [About an acute described skin edrema]. Monatshe Prakt Dermatol. 1882; 1:129â€“131.
Donati M. De medica historia mirabili. Mantuae, per Fr. Osanam, 1586.
Milton JL. On giant urticaria. Edinburgh Medical Journal. 1876; 22(6):513.
Osler W. Landmark publication from The American Journal of the Medical Sciences: Hereditary angio-neurotic oedema. The American journal of the medical sciences. 2010; 339(2):175-8. https://doi.org/10.1097/MAJ.0b013e3181b2803f PMid:20145434
Landerman NS. Hereditary angioneurotic edema: I. Case reports and review of the literature. Journal of Allergy. 1962; 33(4):316-29. https://doi.org/10.1016/0021-8707(62)90031-X
Donaldson VH, Evans RR. A biochemical abnormality in hereditary angioneurotic edema: absence of serum inhibitor of Câ€² 1-esterase. The American journal of medicine. 1963; 35(1):37-44. https://doi.org/10.1016/0002-9343(63)90162-1
Evans TC, Roberge RJ. Quincke's disease of the uvula. Am J Emerg Med. 1987; 5:211-16. https://doi.org/10.1016/0735-6757(87)90323-8
Bozkov B, Baleva M, Nikolov et al. Hereditary AE â€“ results from previous studies and perspectives. 3 rd National Congress of Allergy. 1994; 4-6.
Cicardi M, Aberer W, Banerji A, Bas M, Bernstein JA, Bork K, Caballero T, Farkas H, Grumach A, Kaplan AP, Riedl MA. Classification, diagnosis, and approach to treatment for angioedema: consensus report from the H ereditary A ngioedema I nternational W orking G roup. Allergy. 2014; 69(5):602-16. https://doi.org/10.1111/all.12380 PMid:24673465
Cicardi M, Bergamaschini L, Zingale LC, Gioffre D, Agostoni A. Idiopathic nonhistaminergic angioedema. Am J Med. 1999; 106:650â€“654. https://doi.org/10.1016/S0002-9343(99)00123-0
Chiu AG, Burningham AR, Newkirk KA, Krowiak EJ, Davidson BJ, Deeb ZE. Angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter review and an algorithm for airway management. Annals of Otology, Rhinology & Laryngology. 2001; 110(9):834-40. https://doi.org/10.1177/000348940111000906 PMid:11558759
Cebrail AKYÃœZ, Mustafa Suphi ELBÄ°STANLI. Incarceration by Rope: A Rare Cause of Uvula Edema, Tr J Emerg Med. 2013; 13(2):96-97
Bork K, Staubach P, Eckardt AJ, Hardt J. Symptoms, course, and complications of abdominal attacks in hereditary angioedema due to C1 inhibitor deficiency. Am J Gastroenterol. 2006; 101:619â€“627. https://doi.org/10.1111/j.1572-0241.2006.00492.x PMid:16464219
Bork K, Gul D, Hardt J, Dewald G. Hereditary angioedema with normal C1 inhibitor: clinical symptoms and course. Am J Med. 2007; 120:987â€“992. https://doi.org/10.1016/j.amjmed.2007.08.021 PMid:17976427
Cohen EG, Soliman AM. Changing trends in angioedema. The Annals of Otology, Rhinology and Laryngology. 2001; 110(8):701â€“706. https://doi.org/10.1177/000348940111000801 PMid:11510724
Rees RS, Bergman J, Ramirez-Alexander R. Angioedema associated with lisinopril. The American journal of emergency medicine. 1992; 10(4):321-2. https://doi.org/10.1016/0735-6757(92)90010-U
Zotter Z, Csuka D, SzabÃ³ E, Czaller I, NÃ©benfÃ¼hrer Z, TemesszentandrÃ¡si G, FustË† G, Varga L, Farkas H. The influence of trigger factors on hereditary angioedema due to C1-inhibitor deficiency. Orphanet journal of rare diseases. 2014; 9(1):1. https://doi.org/10.1186/1750-1172-9-44 PMid:24678771 PMCid:PMC3977696
Lewis JH. Idiopathic gastric acid hypersecretion: treatment implications for refractory acid/peptic disorders. Alimentary pharmacology & therapeutics. 1991; 5:15-24. https://doi.org/10.1111/j.1365-2036.1991.tb00745.x
Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, Mirakian R, Walker SM, Huber PA, Nasser SM. BSACI guidelines for the management of chronic urticaria and angioâ€oedema. Clinical & Experimental Allergy. 2007; 37(5):631-50. https://doi.org/10.1111/j.1365-2222.2007.02678.x PMid:17456211
Powell R, Leech SC, Till S, Huber PA, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clinical & Experimental Allergy. 2015; 45(3):547-65. https://doi.org/10.1111/cea.12494 PMid:25711134
Zingale L, Beltrami L, Zanichelli A, Maggioni L, Pappalardo E, Cicardi B, Cicardi M. Angioedema without urticaria: a large clinical survey. CMAJ. 2006; 175(9):1065-70. https://doi.org/10.1503/cmaj.060535 PMid:17060655 PMCid:PMC1609157
Zuberbier T, Aberer W, Asero R, Bindslevâ€Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, GimÃ©nezâ€Arnau A, Godse K, GonÃ§alo M. The EAACI/GA 2 LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69(7):868-87. https://doi.org/10.1111/all.12313 PMid:24785199
Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative crossâ€sectional population survey. Clinical and Experimental Dermatology: Clinical dermatology. 2010; 35(8):869-73. https://doi.org/10.1111/j.1365-2230.2010.03840.x PMid:20456386
Brickman CM, Tsokos GC, Below JE, Lawley TJ, Santaella M, Hammer CH, Frank MM. Immunoregulatory disorders associated with hereditary angioedema: I. Clinical manifestations of autoimmune disease. Journal of allergy and clinical immunology. 1986; 77(5):749-57. https://doi.org/10.1016/0091-6749(86)90424-0
Roche O, Blanch A, Caballero T, Sastre N, Callejo D, LÃ³pez-Trascasa M. Hereditary angioedema due to C1 inhibitor deficiency: patient registry and approach to the prevalence in Spain. Annals of Allergy, Asthma & Immunology. 2005; 94(4):498-503. https://doi.org/10.1016/S1081-1206(10)61121-0
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