Abstract
The aetiologies of recurrent angioedema (AE) comprise the frequent histaminergic AE and the rare bradykinin-mediated AE. Diagnosis must be done carefully because they do not have the same treatment. Diagnosis strategy is clinical. The most specific symptoms for bradykinin AE are: isolated AE without wheals, long duration of the attack, abdominal localisation. The unique useful biological tests for the diagnosis of bradykinin AE are C1Inh exploration which is altered in hereditary AE (HAE) types I and II. No other biological test is useful in clinical practice at present. In case of suspicion of bradykinin AE with normal C1Inh, physicians must think of drug-induced AE. Hereditary AE with normal C1Inh may be associated with a mutation on gene F12 in 20% of cases. For 80% of patients without mutation, the diagnosis must be done very carefully.
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References
Grattan C, Powell S, Humphreys F. Management and diagnostic guidelines for urticaria and angio-oedema. Br J Dermatol 2001; 144: 708–14.
Kaplan AP, Greavs MW. Angioedema. J Am Acad Dermatol 2005; 53: 373–88.
Zingale L, Beltrami L, Zanichelli A, et al. Angioedema without urticaria: a large clinical survey. CMAJ 2006; 175: 1065–70.
Kulthanan K, Jiamton S, Boochangkool K, Jongjarearnprasert K. Angioedema: Clinical and Etiological Aspects. Clin Dev Immunol 2007; 2007: 26438.
Bouillet L, Boccon-Gibod I, Massot C. Bradykinin mediated angioedema. Rev Med Intern 2011; 32: 225–31.
Boccon-Gibod I. Urticaire/angioedème histaminique ou bradykinique. Rev Fr Allergol 2012; 52: 327–32.
Longhurst H, Cicardi M. Hereditary angioedema. Lancet 2012; 379: 474–81.
Augey F, Nosbaum A, Berard F, Nicolas JF. Corticosteroids should not be used in urticaria because of the potential risk of steroid dependence and development of severe anti-H1-resistant urticaria. Eur J Dermatol. 2011; 21: 431.
Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA2LEN/EDF/WAO guideline: management of urticaria. Allergy 2009; 64: 1427–43.
Bork K, Meng G, Staubach P, Hardt J. Hereditary Angioedema: New Findings concerning Symptoms, Affected Organs, and Course. Am J Med 2006; 119: 267–74.
Agostoni A, Cicardi M. Drug-induced angioedema without urticaria. Drug Saf 2001; 24: 599–606.
Beltrami L, Zanichelli A, Zingale L, Vacchinib R, Carugo S, Cicardi M. Long-term follow-up of 111 patients with angiotensin converting enzyme inhibitor-related angioedema. J Hypertens 2011; 29: 2273–7.
Consensus HAS urticaire chronique 2003: http://www.hassante.fr/portail/upload/docs/application/pdf/urticaire_court.pdf
Cugno M, Nussberger J, Cicardi M, Agostini A. Bradykinin and the physiopathology of angioedema. Int Imunopharmacol 2003; 3: 311–7.
Vitrat-Hincky V, Gompel A, Dumestre-Perard C, et al. Type III hereditary angio-oedema: clinical and biological features in a French cohort. Allergy 2010; 65: 1331–6.
Bowen T, Cicardi M, Farkas H, et al. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol 2010; 6: 24–37.
Longhurst H, Cicardi M. Hereditary angio-oedema Lancet 2012; 379: 474–81.
Gordon EM, Ratnoff OD, Saito H, Donaldson VH, Pensky J, Jones PK. Rapid fibrinolysis, augmented Hageman factor (factor XII) titers, and decreased C1 esterase inhibitor titers in women taking oral contraceptives. J Lab Clin Med 1980; 96: 762–9.
Cohen A, Laskin C, Tarlo S. C1 esterase inhibitor in pregnancy. J Allergy Clin Immunol 1992; 90: 412–3.
Cugno M, Castelli R, Cicardi M. Angioedema due to acquired C1-inhibitor deficiency: A bridging condition between autoimmunity and lymphoproliferation. Autoimmun Rev 2008; 8: 156–9.
Simons FE, Ardusso LR, Bilò MB, et al. 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol 2012; 12: 389–99.
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Bouillet, L., Boccon-Gibod, I., Berard, F. et al. Recurrent angioedema: diagnosis strategy and biological aspects. Eur J Dermatol 24, 293–296 (2014). https://doi.org/10.1684/ejd.2014.2276
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DOI: https://doi.org/10.1684/ejd.2014.2276