Mediha Türktan, Ersel Güleç, Zehra Hatipoğlu, Çağatay Küçükbingöz, Mustafa Yılmaz, Yasemin Güneş
Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by reduced activity of the C1 esterase inhibitor. Clinically, angioedema most often involves the upper extremities, face, neck and larynx. The most common cause of death is asphyxia related to laryngeal oedema. Attacks are triggered by many factors such as trauma, stress, infections and hormonal fluctuations. C1 esterase inhibitor concentrates, fresh frozen plasma (FFP), androgen steroids, quinine pathway inhibitors and antifibrinolytics can be used as treatment...
August 2014: Turkish Journal of Anaesthesiology and Reanimation
William R Lumry, Henriette Farkas, Dumitru Moldovan, Elias Toubi, Jovanna Baptista, Timothy Craig, Marc Riedl
BACKGROUND: In randomized, controlled, double-blind, multicenter phase 3 studies, one icatibant injection was efficacious and generally well tolerated in patients with a single hereditary angioedema (HAE) attack. Here, the efficacy and safety of icatibant for multiple HAE attacks was evaluated across the controlled and open-label extension phases of the For Angioedema Subcutaneous Treatment (FAST)-3 study (NCT00912093). METHODS: In the controlled phase, adults with HAE type I or II were randomized (1:1) to receive a single subcutaneous injection of icatibant 30 mg or placebo within 6 h of an attack becoming mild (laryngeal) or moderate (cutaneous/abdominal)...
2015: International Archives of Allergy and Immunology
William Lumry, Daniel Soteres, Richard Gower, Kraig W Jacobson, H Henry Li, Hongzi Chen, Jennifer Schranz
BACKGROUND: Human plasma-derived nanofiltered C1 esterase inhibitor (C1 INH-nf) is used to treat acute angioedema attacks in patients with hereditary angioedema (HAE), but data regarding use in children are sparse. METHODS: Patients 2 to <12 years of age, body weight ≥10 kg, with a diagnosis of HAE type I or II, were recruited for a multicenter open-label trial. Patients were recruited into 2 weight categories (10-25 kg, >25 kg). Each weight category included 2 dosing levels: C1 INH-nf (500 units [U], 1000 U) and C1 INH-nf (1000 U, 1500 U), respectively...
November 2015: Pediatric Allergy and Immunology
Marc A Riedl, Anette Bygum, William Lumry, Markus Magerl, Jonathan A Bernstein, Paula Busse, Timothy Craig, Michael M Frank, Jonathan Edelman, Debora Williams-Herman, Henrike Feuersenger, Mikhail Rojavin
BACKGROUND: The plasma-derived, highly purified, nanofiltered C1-inhibitor concentrate (Berinert; "pnfC1-INH") is approved in the United States for treating hereditary angioedema (HAE) attacks and in many European countries for attack treatment and short-term prophylaxis. OBJECTIVE: The objective of this study was to describe safety and usage patterns of pnfC1-INH. METHODS: A multicenter, observational, registry was conducted between 2010 and 2014 at 30 United States and 7 European sites to obtain both prospective (occurring after enrollment) and retrospective (occurring before enrollment) safety and usage data on subjects receiving pnfC1-INH for any reason...
September 2016: Journal of Allergy and Clinical Immunology in Practice
Iman H Nasr, Ania L Manson, Humaid A Al Wahshi, Hilary J Longhurst
Hereditary angioedema (HAE) is a rare but serious and potentially life threatening autosomal dominant condition caused by low or dysfunctional C1 esterase inhibitor (C1-INH) or uncontrolled contact pathway activation. Symptoms are characterized by spontaneous, recurrent attacks of subcutaneous or submucosal swellings typically involving the face, tongue, larynx, extremities, genitalia or bowel. The prevalence of HAE is estimated to be 1:50,000 without known racial differences. It causes psychological stress as well as significant socioeconomic burden...
2016: Expert Review of Clinical Immunology
Bruce L Zuraw, Donna K Davis, Anthony J Castaldo, Sandra C Christiansen
BACKGROUND: Hereditary angioedema (HAE) is a genetic disorder clinically characterized by recurrent attacks of subcutaneous and mucosal swelling. 17-α-Alkylated androgens (AA) have been used prophylactically to reduce HAE severity, but there are many questions about the efficacy and tolerability of AA. OBJECTIVE: The objective of this study was to investigate the tolerability and effectiveness of AA therapy in a large cohort of patients with HAE. METHODS: We performed a retrospective cross-sectional study on 650 subjects with HAE utilizing a one time, anonymous, web-based survey...
September 2016: Journal of Allergy and Clinical Immunology in Practice
T González-Quevedo, J I Larco, C Marcos, M Guilarte, M L Baeza, S Cimbollek, M C López-Serrano, M Piñero-Saavedra, M Rubio, T Caballero
BACKGROUND AND OBJECTIVE: There is little information on pregnancy and delivery in patients with hereditary angioedema due to C1 inhibitor deficiency (C1INH-HAE). The aim of this study was to describe the effect of pregnancy and deliveries on symptoms of C1INH-HAE and review the need for and safety of treatments available during the study period. METHODS: Retrospective review using a purpose-designed questionnaire of 61 C1INH-HAE patients from 5 hospitals specialized in the management of HAE in Spain...
2016: Journal of Investigational Allergology & Clinical Immunology
Emel Aygören-Pürsün, Markus Magerl, Jochen Graff, Inmaculada Martinez-Saguer, Wolfhart Kreuz, Hilary Longhurst, Iman Nasr, Murat Bas, Ulrich Straßen, Lei Fang, Melanie Cornpropst, Sylvia Dobo, Phil Collis, William P Sheridan, Marcus Maurer
No abstract text is available yet for this article.
September 2016: Journal of Allergy and Clinical Immunology
Allen P Kaplan, Kusumam Joseph
Plasma of patients with types I and II hereditary angioedema is unstable if incubated in a plastic (i.e., inert) vessel at 37 °C manifested by progressively increasing formation of bradykinin. There is also a persistent low level of C4 in 95 % of patients even when they are symptomatic. These phenomena are due to the properties of the C1r subcomponent of C1, factor XII, and the bimolecular complex of prekallikrein with high molecular weight kininogen (HK). Purified C1r auto-activates in physiologic buffers, activates C1s, which in turn depletes C4...
October 2016: Clinical Reviews in Allergy & Immunology
Zonne L M Hofman, Anurag Relan, Sacha Zeerleder, Christian Drouet, Bruce Zuraw, C Erik Hack
Hereditary angioedema (HAE) caused by a deficiency of functional C1-inhibitor (C1INH) becomes clinically manifest as attacks of angioedema. C1INH is the main inhibitor of the contact system. Poor control of a local activation process of this system at the site of the attack is believed to lead to the formation of bradykinin (BK), which increases local vasopermeability and mediates angioedema on interaction with BK receptor 2 on the endothelium. However, several observations in patients with HAE are difficult to explain from a pathogenic model claiming a local activation process at the site of the angioedema attack...
August 2016: Journal of Allergy and Clinical Immunology
Konrad Bork
Hereditary angioedema (HAE) due to C1 esterase inhibitor (C1-INH) deficiency (HAE-C1-INH) is a rare but medically significant disease that can be associated with considerable morbidity and mortality. Research into the pathogenesis of HAE-C1-INH has expanded greatly in the last six decades and has led to new clinical trials with novel therapeutic agents and treatment strategies. Mechanisms of pharmacotherapy include (a) supplementing C1-INH, the missing serine-protease inhibitor in HAE; (b) inhibiting the activation of the contact system and the uncontrolled release of proteases in the kallikrein-kinin system, by blocking the production/function of its components; (c) inhibiting the fibrinolytic system by blocking the production/function of its components; and (d) inhibiting the function of bradykinin at the endothelial level...
October 2016: Clinical Reviews in Allergy & Immunology
Maria Paula Henao, Jennifer L Kraschnewski, Theodore Kelbel, Timothy J Craig
Hereditary angioedema (HAE) is a rare autosomal dominant disease that commonly manifests with episodes of cutaneous or submucosal angioedema and intense abdominal pain. The condition usually presents due to a deficiency of C1 esterase inhibitor (C1-INH) that leads to the overproduction of bradykinin, causing an abrupt increase in vascular permeability. A less-understood and less-common form of the disease presents with normal C1-INH levels. Symptoms of angioedema may be confused initially with mast cell-mediated angioedema, such as allergic reactions, and may perplex physicians when epinephrine, antihistamine, or glucocorticoid therapies do not provide relief...
2016: Therapeutics and Clinical Risk Management
Henriette Farkas, Nóra Veszeli, Erika Kajdácsi, László Cervenak, Lilian Varga
Angioedema, as a distinct disease entity, often becomes a clinical challenge for physicians, because it may cause a life-threatening condition, whereas prompt and accurate laboratory diagnostics may not be available. Although the bedside diagnosis needs to be established based on clinical symptoms and signs, family history, and the therapeutic response, later, laboratory tests are available. Currently, only for five out of the nine different types of angioedema can be diagnosed by laboratory testing, and these occur only in a minority of the patient population...
October 2016: Clinical Reviews in Allergy & Immunology
Steven de Maat, Jenny Björkqvist, Chiara Suffritti, Chantal P Wiesenekker, Willem Nagtegaal, Arnold Koekman, Sanne van Dooremalen, Gerard Pasterkamp, Philip G de Groot, Marco Cicardi, Thomas Renné, Coen Maas
BACKGROUND: Patients with angioedema experience unpredictable attacks of tissue swelling in which bradykinin is implicated. Several distinct mutations in Factor XII (FXII) are associated with hereditary angioedema (HAE) in the presence of normal C1 esterase inhibitor activity (FXII-HAE). The underlying disease mechanisms are unclear, which complicates diagnosis and treatment. OBJECTIVE: We sought to identify the natural trigger for FXII activation, which causes uncontrolled bradykinin production in patients with FXII-HAE...
November 2016: Journal of Allergy and Clinical Immunology
Jaison Jose, Jamie Zacharias, Timothy Craig
Hereditary angioedema (HAE) is a rare bradykinin-mediated disease that is characterized by recurrent attacks of subcutaneous or submucosal edema, which can be life threatening. HAE affects all ethnic groups equally and does not differentiate between age, sex, or race. However, the availability of therapies varies amongst countries resulting in a lack of uniformity of care. Not only is there a disparity of medication availability, but since HAE is a rare disease, it is frequently overlooked and the diagnosis is missed...
October 2016: Clinical Reviews in Allergy & Immunology
Henriette Farkas
INTRODUCTION: Hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) is a rare disease, characterized by recurrent, unpredictable episodes of cutaneous and/or mucosal edema. Bradykinin, released by the activation of the contact system, binds to bradykinin B2 receptors on the endothelial cell surface to enhance vascular permeaility, which leads to angioedema. AREAS COVERED: C1-INH-HAE therapy is aimed at the inhibition of bradykinin release, as well as at the blockage of its effects mediated by its receptor...
June 2016: Expert Review of Clinical Pharmacology
Thorbjørn Hermanrud, Nicolaj Duus, Anette Bygum, Eva Rye Rasmussen
Angioedema of the upper airways is a severe and potentially life-threatening condition. The incidence has been increasing in the past two decades, primarily due to pharmaceuticals influencing the generation or degradation of the vasoactive molecule bradykinin. Plasma-derived C1-esterase inhibitor concentrate is a well-established treatment option of hereditary and acquired complement C1-esterase inhibitor deficiency, which are also mediated by an increased level of bradykinin resulting in recurrent angioedema...
2016: Case Reports in Emergency Medicine
Anastasios E Germenis, Matthaios Speletas
Contemporary genetic research has provided evidences that angioedema represents a diverse family of disorders related to kinin metabolism, with a much greater genetic complexity than was initially considered. Convincing data have also recently been published indicating that the clinical heterogeneity of hereditary angioedema due to C1 inhibitor deficiency (classified as C1-INH-HAE) could be attributed at least in part, either to the type of SERPING1 mutations or to mutations in genes encoding for enzymes involved in the metabolism and function of bradykinin...
October 2016: Clinical Reviews in Allergy & Immunology
S Loffredo, M Bova, C Suffritti, F Borriello, A Zanichelli, A Petraroli, G Varricchi, M Triggiani, M Cicardi, G Marone
BACKGROUND: Hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) is a rare inherited genetic disease characterized by recurrent swelling episodes of the skin, gastrointestinal tract, and upper airways. Angioedema attacks result from increased vascular permeability due to the release of bradykinin from high molecular weight kininogen. Currently, there are no biomarkers predicting the frequency of angioedema attacks. Vascular permeability is modulated by several factors, including vascular endothelial growth factors (VEGFs) and angiopoietins (Angs)...
July 2016: Allergy
Tal D Berger, Ben-Zion Garty
Hereditary angioedema (HAE) may manifest with swelling of the face, extremities, and upper airways. Gastrointestinal symptoms are also common and may include abdominal pain, vomiting, and diarrhea. However, pancreatic involvement is rare and has been reported only in a few adults with previously diagnosed HAE. We describe a 6-year-old boy who presented with recurrent severe abdominal pain accompanied by an elevation in pancreatic enzyme levels, without subcutaneous or cutaneous angioedema. His symptoms had begun 18 months earlier, and he was hospitalized several times before the present admission with a diagnosis of acute pancreatitis...
February 2016: Pediatrics
2016-07-06 15:58:38
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