RT Journal Article
SR Electronic
T1 Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 101
OP 103
DO 10.7861/clinmedicine.15-1-101
VO 15
IS 1
A1 Sharif Ismail
A1 Leo Cheng
A1 Sofia Grigoriadou
A1 James Laffan
A1 Manoj Menon
YR 2015
UL http://www.rcpjournals.org/content/15/1/101.abstract
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.