PT  - JOURNAL ARTICLE
AU  - Sharif Ismail
AU  - Leo Cheng
AU  - Sofia Grigoriadou
AU  - James Laffan
AU  - Manoj Menon
TI  - Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks
AID  - 10.7861/clinmedicine.15-1-101
DP  - 2015 Feb 01
TA  - Clinical Medicine
PG  - 101--103
VI  - 15
IP  - 1
4099  - http://www.rcpjournals.org/content/15/1/101.short
4100  - http://www.rcpjournals.org/content/15/1/101.full
SO  - Clin Med2015 Feb 01; 15
AB  - Acute angioedema attacks are conventionally treated with antihistamines and steroids, in line with a presumed mechanism of disease involving overwhelming mast-cell degranulation. This approach overlooks a small but important minority of cases in which attacks are bradykinin driven and exhibit poor responsiveness to steroid or anti-histamine therapy. These patients may have a family history of angioedema (hereditary angioedema), or a past medical history including B-cell lymphoproliferative disorders or autoimmune disease (acquired angioedema). Rather than steroid therapy, they respond to administration of a bradykinin inhibitor, or more commonly, a C1 esterase inhibitor substitute, to control acute symptoms and reduce the probability of invasive airway insertion. In the long-term, they require C1 esterase inhibitor sparing therapy and a treat-the-cause approach to reduce the risk of recurrent attacks. We present here a case of a middle-aged woman who presented with recurrent angioedema of initially uncertain aetiology.