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Grumach AS, Gadir N, Kessel A, Yegin A, Martinez-Saguer I, Bernstein JA. Current challenges and future opportunities in patient-focused management of hereditary angioedema: A narrative review. Clin Transl Allergy 2023; 13:e12243. [PMID: 37227422 DOI: 10.1002/clt2.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023] Open
Abstract
Patients with hereditary angioedema (HAE) experience a high burden of disease due to unpredictable, painful, disfiguring, and potentially life-threatening HAE attacks. Multiple HAE-specific medications for the on-demand treatment, short-term and long-term prophylaxis of HAE attacks have entered the market in recent years; however, the availability and access to these medications may vary between different countries. For this review, PubMed and EMBASE databases were searched for guidelines, consensus statements, and other publications on HAE management as well as publications on quality of life in patients with HAE. The current guidelines and recent literature on HAE management in specific countries are summarized with the aim to highlight the similarities and differences between guideline recommendations and the country-specific clinical practice. Improvement in quality of life, which is a key goal in HAE management, is also discussed and the country-specific trends are highlighted. Finally, the ways to achieve a more patient-centric approach to HAE management within the framework set by the clinical management guidelines are examined.
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Affiliation(s)
- Anete S Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario Faculdade de Medicina ABC (FMABC), Santo Andre, Brazil
| | - Noga Gadir
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Centre, Technion Faculty of Medicine, Haifa, Israel
| | - Ashley Yegin
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | | | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
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Evcen R, Çölkesen F, Saygın DA, Aykan FS, Kılınç M, Ergün ÜY, Akkuş FA, Önalan T, Yıldız E, Arslan Ş. High digit ratio (2D:4D) is associated with attack frequency and severity in hereditary angioedema patients. Early Hum Dev 2023; 177-178:105724. [PMID: 36827749 DOI: 10.1016/j.earlhumdev.2023.105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) caused by a deficiency or dysfunction of the plasma protease C1-inhibitor is a rare autosomal-dominant disorder. We explored a possible correlation between the ratio of the second and fourth finger lengths (2D:4D) and the frequency of HEA attacks, and whether the ratio might predict laryngeal attack. METHOD We evaluated 35 HEA patients aged 19 to 66 years; 3 were subsequently excluded. The 2D:4D ratio was calculated by dividing the length of the second finger by that of the fourth finger of both hands. A structured clinical questionnaire exploring HAE course and treatment over the prior year was administered. RESULTS Of the 32 participants, 56.25 % (n = 18) were female. Of them, those with high 2D:4D ratios suffered significantly more laryngeal attacks than others; 93.3% of patients with high 2D:4D ratios experienced ≥5 attacks annually, significantly more than those with low ratios. Among type 2 HEA patients, 75 % of those experiencing ≥5 attacks annually had high 2D:4D ratios; all patients with low 2D:4D ratios reported <5 attacks annually. These significant effects were found for right-hand 2D:4D ratios and not left-hand 2D:4D ratios. CONCLUSION The data suggest that intrauterine sex hormone exposure, which affects the 2D:4D ratio, is significantly associated with HEA attack frequency and severity, and laryngeal edema.
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Affiliation(s)
- Recep Evcen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey.
| | - Fatih Çölkesen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Duygu Akın Saygın
- Department of Anatomy, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Filiz Sadi Aykan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Mehmet Kılınç
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Ümmügülsüm Yılmaz Ergün
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Fatma Arzu Akkuş
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Tuğba Önalan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Eray Yıldız
- Necip Fazıl City Hospital, Division of Clinical Immunology and Allergy, Kahramanmaraş, Turkey
| | - Şevket Arslan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
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Chong-Neto HJ. A narrative review of recent literature of the quality of life in hereditary angioedema patients. World Allergy Organ J 2023; 16:100758. [PMID: 36994443 PMCID: PMC10040818 DOI: 10.1016/j.waojou.2023.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/30/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare disorder that causes unpredictable and debilitating cutaneous and submucosal edema and can lead to death. HAE can impair patients' ability to perform daily activities, proportional to pain severity, with patients reporting lower productivity, missed time from work or school and potentially resulting in missed career and educational opportunities. Many patients with HAE experience a significant psychological burden, including anxiety and depression. Available treatment aims to prevent and/or treat HAE attacks as they occur, to reduce morbidity and mortality and, finally, to improve health-related quality of life. Two different validated specific angioedema instruments are available to assess patients' quality of life. The Angioedema Quality of Life Questionnaire (AE-QoL) examines diagnosed patients' quality of life but is not specific for HAE. The disease-specific questionnaire is the Hereditary Angioedema Quality of Life (HAE-QoL), and the first used for hereditary angioedema with C1 inhibitors (C1-INH) deficiency. These quality-of-life instruments are helpful to the HAE patients' assessment and to the development of better therapeutic strategies as clinical tools, as defined by international guidelines. Considering this context, this review was conducted to compare the effects of acute vs. long-term prophylaxis on HAE patients' health-related quality of life. In addition, the prevalence of anxiety and depression among these individuals was also reviewed.
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Jones D, Zafra H, Anderson J. Managing Diagnosis, Treatment, and Burden of Disease in Hereditary Angioedema Patients with Normal C1-Esterase Inhibitor. J Asthma Allergy 2023; 16:447-460. [PMID: 37124440 PMCID: PMC10132308 DOI: 10.2147/jaa.s398333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 05/02/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare, chronic, and debilitating genetic disorder characterized by recurrent and unpredictable swelling episodes that primarily affect the subcutaneous and/or submucosal tissues of the extremities, larynx, face, abdomen, and genitals. Most cases of HAE are caused by mutations in the serpin family G member 1 gene (SERPING1), which encodes C1-esterase inhibitor (C1-INH) protein. Mutations in SERPING1 lead to deficient (type I HAE-C1-INH) or dysfunctional (type II HAE-C1-INH) C1-INH protein and subsequent dysregulation of the kallikrein-bradykinin cascade. However, some patients present with a third type of HAE (HAE-nI-C1-INH), which was first described in the year 2000 and is characterized by an absence of mutations in SERPING1. Although mutations in the coagulation factor XII, angiopoietin-1, plasminogen, kininogen-1, myoferlin, and heparan sulfate-glucosamine 3-O-sulfotransferase-6 genes have been identified in some patients with HAE-nI-C1-INH, genetic cause is still unknown in many cases, hindering full elucidation of the pathology of this HAE subtype. Diagnosis of HAE-nI-C1-INH is also further complicated by the fact that patients typically demonstrate normal plasma levels of C1-INH and complement component 4 protein and normal C1-INH functionality during laboratory analysis. Therefore, we review the challenges associated with diagnosing, treating, and living with HAE-nI-C1-INH. We conclude that raising awareness of the presenting features of HAE-nI-C1-INH within the clinical setting and among the general public is critical to aid earlier suspicion and diagnosis of the disease. Furthermore, adopting an individualized approach to HAE-nI-C1-INH treatment is essential to help address the current and significant unmet needs in this patient population.
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Affiliation(s)
- Douglas Jones
- Rocky Mountain Allergy, Tanner Clinic, Layton, UT, USA
- Correspondence: Douglas Jones, Rocky Mountain Allergy, Tanner Clinic, 2121 North 1700 West, Layton, UT, 84041, USA, Tel +1 801 773 4840, Fax +1 801 525 8179, Email
| | - Heidi Zafra
- Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee, WI, USA
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Kesh S, Bernstein JA. Isolated Angioedema: A Review of Classification and Update on Management. Ann Allergy Asthma Immunol 2022; 129:692-702. [PMID: 35988876 DOI: 10.1016/j.anai.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this article is to review the various types of angioedema including diagnosis and treatment. DATA SOURCES PubMed search of articles in the English language various types of angioedema STUDY SELECTION: Articles on the subject matter were selected and reviewed. RESULTS Herein, a case based approach is presented for discussing the major types of angioedema including: hereditary angioedema (HAE) TypesI/II and normal complement, acquired angioedema, Angiotensin converting enzyme (ACE) induced angioedema, as well as histaminergic and non-histaminergic angioedema. Emerging treatments of HAE including targets of pre-kalikrein, DNA vector technology replacing C1INH protein, and CRIPSR technology targeting PKK among many others are explored. In addition, other causes as well as mimickers of angioedema are briefly reviewed. Finally, a novel algorithm is proposed to help guide the treating physician through the work up and management of patients with suspected idiopathic angioedema unresponsive to conventional therapy with antihistamines. CONCLUSION Over the years, many strides have been made in both understanding the pathophysiology of various types of angioedema as well as expansion of treatment options. It is important for clinicians to be aware of current and emerging treatment options. We provide a novel practical algorithm to guide clinicians in challenging cases of idiopathic angioedema refractory to antihistamines.
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Affiliation(s)
- Susamita Kesh
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Immunology and Allergy
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section; Bernstein Allergy Group.
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Minafra FG, Cunha LAO, Mariano RGDS, Goebel GA, de Lima LS, Pinto JA. Investigation of Mortality of Hereditary Angioedema in a Reference Center in Brazil. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1805-1812. [PMID: 35526778 DOI: 10.1016/j.jaip.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/05/2022] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) is known for mortality when it is not treated properly. Many advances have occurred over the past decades that affected patients' lives. However, not all patient populations have access to the same diagnosis and treatment resources. OBJECTIVE To evaluate mortality from HAE in a large cohort in a reference center in Brazil. Furthermore, the research intended to describe patients' life span, the asphyxia evolution, and factors related to the fatal outcome. METHODS A cohort of 433 patients from 46 families was evaluated in this prospective and retrospective study. Families were organized in clusters and were given a verbal autopsy to arrange data collection for the deaths and analyze symptoms during life. Causes of death were classified as deaths from laryngeal edema (LE) or other causes. RESULTS Of 433 patients evaluated, 254 were not given the diagnosis of HAE. A total of 75 fatal events were evaluated. Only 10 of 75 patients were given the diagnosis of HAE before death, and the HAE diagnosis was made after death in 65 of 75 patients using verbal autopsy. The final cause of death after the investigation was asphyxiation owing to LE in 39 of 75 (52%) and deaths owing to other causes in 36 of 75 (48%). Ten deaths had occurred in the past decade. Time from onset of symptoms to seeking medical assistance was a median of 4 hours, and the time to death was a median of 8 hours. Three patients received fresh-frozen plasma and none received medications specific to HAE attacks. Throat pain or discomfort was the most common symptom, experienced by 71.8% of patients. The most common mistaken diagnosis at the original death certificate was allergy or anaphylaxis. The life span of patients who died of LE was reduced by 20 years compared with those who died of other causes. CONCLUSIONS Hereditary angioedema remains a threat to life in the studied population. The large number of patients who do not receive a diagnosis makes the situation even more severe and is responsible for most deaths. Death analyses add knowledge to an understanding of the diseases and their impact on patients' lives, improving the targeting of public health efforts.
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Affiliation(s)
- Fernanda Gontijo Minafra
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Luciana Araújo Oliveira Cunha
- Allergy and Immunology Outpatient Clinic, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rhaianny Gomes de Souza Mariano
- Allergy and Immunology Outpatient Clinic, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriela Assunção Goebel
- Allergy and Immunology Outpatient Clinic, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laís Sezini de Lima
- Allergy and Immunology Outpatient Clinic, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jorge Andrade Pinto
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Gabriel N, Marcelino F, Ferriani MPL, Arruda LK, Campos RA, Gonçalves RF, Chong-Neto H, Rosario Filho N, Valle SOR, Pesquero JB, Grumach AS. Pregnancy in Patients With Hereditary Angioedema and Normal C1 Inhibitor. FRONTIERS IN ALLERGY 2022; 3:846968. [PMID: 35386641 PMCID: PMC8974819 DOI: 10.3389/falgy.2022.846968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background HAE with normal C1 inhibitor (HAE-nC1-INH) has been identified as a bradykinin mediated angioedema. Estrogens are one of the main trigger factors. Pregnancy in HAE with C1 inhibitor deficiency showed variable course, however, few reports are available for HAE-nC1-INH. We evaluated the course of pregnancies in women diagnosed with HAE-nC1-INH. Methods Women with diagnosis of HAE-nC1-INH according to the following criteria: clinical manifestations similar to HAE-C1-INH, normal biochemical evaluation and family history were included. A questionnaire about pregnancies was applied after consent. Genetic evaluation for known mutations was performed in all patients. Results A total of 45 pregnancies occurring in 26 HAE-nC1-INH patients were evaluated (7/26 patients with F12 variant). Spontaneous abortion was reported in 8/45 (17.8%) pregnancies. Onset of attacks started before the pregnancy in 18/26 patients; during the pregnancy in 2/26; and after the pregnancy in 6/26. HAE attacks occurred in 24/37 pregnancies (64,7%): during the 1st trimester in 41.7%; 2nd trimester in 12.5%; 3rd trimester in 20.8%; 1st and 3rd trimesters in 4.2% and during the whole pregnancy in 20.8%. Among 15/18 patients who had attacks before pregnancy, symptoms persisted with worsening in 9/15; improvement in 4/15; no change in 1/15, and no response in 1/15. Conclusions The occurrence of abortion in HAE-nC1-INH was similar to the expected for not affected women. The 1st trimester of the pregnancy was more symptomatic for HAE-nC1-INH women. Considering the strong relevance of estrogens in HAE-nC1-INH, pregnancy could worsen the course of disease.
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Affiliation(s)
- Natalia Gabriel
- Clinical Immunology, Faculdade de Medicina, Centro Universitario FMABC, Santo André, Brazil
| | | | | | - L. Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Regis A. Campos
- Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | | | | | | | - Solange O. R. Valle
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil
| | - Joao B. Pesquero
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Anete S. Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario FMABC, Santo André, Brazil
- *Correspondence: Anete S. Grumach
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Giavina-Bianchi P, Aun MV, Garcia JFB, Gomes LS, Ribeiro AJ, Takejima P, Agondi RC, Kalil J, Motta AA. Clinical features of hereditary angioedema and warning signs (H4AE) for its identification. Clinics (Sao Paulo) 2022; 77:100023. [PMID: 35318167 PMCID: PMC8943246 DOI: 10.1016/j.clinsp.2022.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The study describes a case series of hereditary angioedema with C1 Inhibitor Deficiency (C1INH-HAE) in order to corroborate six clinical warning signs "HAAAAE (H4AE)" to enable early identification of this disease. METHODS The authors analyzed the C1INH-HAE cohort to analyze the clinical aspects of the present study's patients and corroborate the six clinical warning signs of the Hereditary Angioedema Brazilian Guidelines. Data regarding demographics, the onset of disease, time to diagnosis, frequency of attacks per year, organs involved, triggers, crisis duration and their outcomes, and disease treatment were collected. Then the authors developed an acronym, H4AE, to help healthcare professionals remember the warning signs. RESULTS The authors included 98 patients in the study, with a mean age of 38.1 years, 67.3% being female, and 75.3% with a family history of HAE. HAE diagnosis was delayed, on average, 13.7 years after its initial manifestation. Exploratory laparotomy was reported by 26.9%, and orotracheal intubation by 21.3% of the present study's patients; 61.3% and 30.3% of them were admitted at least once in the hospital and in the intensive care unit, respectively. The authors constructed an acronym "H4AE" with the six warning signs of HAE: Hereditary, recurrent Angioedema, Abdominal pain, Absence of urticaria, Absence of response to antihistamines, Estrogen association. CONCLUSION C1INH-HAE is still underdiagnosed and associated with high morbidity. The study showed clinical features of this disease, corroborating the warning signs, which may be useful in raising awareness and improving the diagnosis of C1INH-HAE. The authors suggest the acronym "H4AE" to remind the warning signs.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcelo Vivolo Aun
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Fóes Bianchini Garcia
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Laís Souza Gomes
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Júlia Ribeiro
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Priscila Takejima
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Câmara Agondi
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge Kalil
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio Abilio Motta
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
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Minafra FG, Gonçalves TR, Alves TM, Pinto JA. The Mortality from Hereditary Angioedema Worldwide: a Review of the Real-World Data Literature. Clin Rev Allergy Immunol 2021; 62:232-239. [PMID: 34687444 DOI: 10.1007/s12016-021-08897-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
This study aims to review the global mortality secondary to laryngeal edema in patients diagnosed with hereditary angioedema and their relatives over the years, as well as to describe epidemiological and clinical findings associated with this outcome. An extensive search of the literature was made in PubMed, Scopus, and Embase to identify mortality rates secondary to laryngeal edema in patients with hereditary angioedema. The search was carried out in September of 2020 and in April of 2021, and keywords based on the MeSH terms were searched in three databases. The filter of language was used for finding only articles in English, and there was no limit to the year of publication. A total of twenty-three articles fulfilled the inclusion criteria for review and data extraction. The analyzed studies included 3292 patients and 411 deaths from asphyxia due to laryngeal edema. One hundred and three deaths in close relatives were described as secondary to the same cause. The main findings were summarized in tables: year and place of publication, the number of patients and deaths from laryngeal edema, patients previously diagnosed, and death age. Death rates from laryngeal edema had an average of one death for every 20 patients. Eight studies reported deaths in relatives. For every 7.4 patients in these studies, one relative died. The percentage among deaths in general associated with laryngeal edema was evaluated in three studies (32.7%, 44.4%, and 56%). The high frequency of this outcome suggests that deaths still occur, and improvement of hereditary angioedema treatment still needs to be met.
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Affiliation(s)
- Fernanda Gontijo Minafra
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Av. Professor Alfredo Balena, 190/267, Minas Gerais, Brazil.
| | | | - Thaís Martins Alves
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jorge Andrade Pinto
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Av. Professor Alfredo Balena, 190/267, Minas Gerais, Brazil
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Nunes FL, Ferriani MPL, Moreno AS, Langer SS, Maia LSM, Ferraro MF, Sarti W, Bessa Junior JD, Cunha D, Suffritti C, Dias MM, Januário YC, daSilva LLP, Aragon DC, Caballero T, Arruda LK. Decreasing Attacks and Improving Quality of Life through a Systematic Management Program for Patients with Hereditary Angioedema. Int Arch Allergy Immunol 2021; 182:697-708. [PMID: 33657571 DOI: 10.1159/000513896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Prevention of attacks is a major goal in management of patients with hereditary angioedema (HAE). We aimed to investigate the effects of a systematic intervention for HAE patients. METHODS Thirty-three patients with HAE with C1-inhibitor deficiency, belonging to a single family, participated in a management program coordinated by an allergist/immunologist. Angioedema attacks before intervention were ascertained by interviews and emergency room charts and recorded prospectively by patients or caregivers after enrollment. Mean number of attacks/month was compared at 12 months preintervention and 8 and 14 months within intervention. Patient-reported outcome instruments were used to assess quality of life, including HAE Quality of Life (HAE-QoL) questionnaire, psychological conditions, and work impairment, at baseline and 8 and 14 months within intervention. Data were stored in REDCap platform and analyzed by adjusted Bayesian models of double Poisson regression. RESULTS Mean number of attacks/month significantly decreased (95% credible interval [CrI] excluding 0) from 1.15 preintervention to 0.25 and 0.23, 8 and 14 months within intervention, with mean decreases of -0.89 (95% CrI: -1.21 to -0.58) and -0.92 (95% CrI: -1.22 to -0.60), respectively. HAE-QoL scores showed mean total increases of 15.2 (95% CrI: 1.23-29.77) and 26 (95% CrI: 14.56-39.02) at 8 and 14 months within the study, as compared to baseline, revealing marked improvement in quality of life. Significant increase in role-emotional and reduction of depression, stress, and anxiety were observed at 14 months. CONCLUSION A systematic approach integrating HAE-specific care with effective handling of psychological issues decreased the number of attacks and improved quality of life, targets for best practice in HAE.
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Affiliation(s)
- Fernanda Leonel Nunes
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariana P L Ferriani
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Adriana S Moreno
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sarah S Langer
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luana S M Maia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Maria Fernanda Ferraro
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Willy Sarti
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José de Bessa Junior
- Department of Surgery, State University of Feira de Santana, Feira de Santana, Brazil
| | - Deborah Cunha
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Chiara Suffritti
- Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università di Milano, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | - Marina M Dias
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Yunan C Januário
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luis L P daSilva
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi Casale Aragon
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Teresa Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - L Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil,
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11
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Proper SP, Lavery WJ, Bernstein JA. Definition and classification of hereditary angioedema. Allergy Asthma Proc 2020; 41:S03-S07. [PMID: 33109317 DOI: 10.2500/aap.2020.41.200040] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hereditary angioedema (HAE) is defined as a rare genetic disease with recurrent episodes of localized bradykinin-mediated swelling of the deep tissues of the skin, respiratory, and gastrointestinal tracts that can be life threatening. Classification of HAE has evolved over time with our further understanding of clinical phenotypes, underlying causes, and available testing. In most cases, HAE is caused by a deficiency of C1-esterase inhibitor (C1-INH) on the Serpin Family G Member 1 (SERPING1) gene, either through decreased amounts of C1-INH protein (C1-INH-HAE, type 1) or decreased function of C1-INH (C1-INH-HAE, type 2). HAE with normal C1-INH levels and function are divided into unknown cause or into non-C1-INH-HAE forms, which include known mutational defects in factor XII (called FXII-HAE in the Hereditary Angioedema International Working Group consensus), angiopoietin-1, plasminogen, and kininogen 1 genes. It is possible that, after an initial workup, a patient without a family history of HAE could be classified with an acquired form of angioedema (nonhereditary) that may later prove to be HAE due to a de-novo SERPING1 mutation. Because there are forms of nonhistaminergic (H1-antihistamine unresponsive) angioedema that appear clinically very similar to HAE, it is essential that the patient undergoes a thorough clinical history and diagnostic evaluation to ensure that he or she is properly diagnosed and classified.
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Affiliation(s)
- Steven P. Proper
- From the Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - William J. Lavery
- From the Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; and
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12
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Angioedema. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society (PTD) and Polish Society of Allergology (PTA). Postepy Dermatol Alergol 2020; 37:445-451. [PMID: 32994763 PMCID: PMC7507159 DOI: 10.5114/ada.2020.98226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Angioedema is a non-inflammatory oedema of the subcutaneous tissue and/or mucosal membranes. It most commonly coexists with urticaria wheals and is considered to be a deep form of urticaria. Less commonly, it occurs in isolation and can take two basic forms: acquired angioedema and hereditary angioedema. Currently, there are 4 defined types of acquired angioedema and 7 types of hereditary angioedema. Treatment of angioedema depends on its form and etiological factors. Especially the genetic form, i.e. hereditary angioedema, is a considerable challenge for medical specialists, particularly dermatologists and allergists.
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13
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Veronez CL, Campos RA, Constantino-Silva RN, Nicolicht P, Pesquero JB, Grumach AS. Hereditary Angioedema-Associated Acute Pancreatitis in C1-Inhibitor Deficient and Normal C1-Inhibitor Patients: Case Reports and Literature Review. Front Med (Lausanne) 2019; 6:80. [PMID: 31058156 PMCID: PMC6478673 DOI: 10.3389/fmed.2019.00080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/12/2022] Open
Abstract
Abdominal pain due to intestinal swellings is one of the most common manifestations in hereditary angioedema (HAE). Bowel swellings can cause severe abdominal pain, nausea, vomiting, and diarrhea, which may lead to misdiagnosis of gastrointestinal disorders. In rare cases, HAE abdominal attacks can be accompanied by acute pancreatitis. Here, we report 3 patients with HAE and acute pancreatitis and present a literature review of similar cases. Patients with confirmed diagnosis of HAE secondary to C1-inhibitor (C1-INH) deficiency (n = 2) and HAE with normal C1-INH and F12 mutation (F12-HAE) (n = 1) were included. Pancreatitis was diagnosed based on clinical symptoms and high lipase and amylase levels. Three HAE patients were diagnosed with acute pancreatitis based on increased amylase levels during severe abdominal swelling episodes. Two were previously diagnosed with HAE type I and one with F12-HAE. Pancreatitis was efficiently treated in two patients using Icatibant, with pain relief within hours. When conservatively treated, pancreatitis pain took longer time to resolve. Eighteen pancreatitis cases in HAE with C1-INH deficiency were previously reported and none in F12-HAE. Most patients (12/18) underwent invasive procedures and/or diagnostic methods. Although rare, severe abdominal HAE attacks could cause pancreatitis; HAE-specific treatments may be efficient for HAE-associated pancreatitis. HAE should be considered as a differential diagnosis of acute idiopathic pancreatitis. To our knowledge, this is the first report of HAE-associated pancreatitis in a F12-HAE patient treated with Icatibant.
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Affiliation(s)
| | | | | | - Priscila Nicolicht
- Department of Biophysics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - João Bosco Pesquero
- Department of Biophysics, Universidade Federal de São Paulo, São Paulo, Brazil
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14
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Al-Qahtani AH, Arnaout R, Rehan Khaliq AM, Al Gazlan S, Sheikh F. Hereditary angioedema may be associated with the development of fatty liver. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2082-2083. [PMID: 30825607 DOI: 10.1016/j.jaip.2019.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Abdul Hadi Al-Qahtani
- Department of Medicine, Allergy and Immunology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Rand Arnaout
- Department of Medicine, Allergy and Immunology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia; Department of Immunology, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Agha M Rehan Khaliq
- Department of Medicine, Allergy and Immunology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia; Department of Immunology, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman Al Gazlan
- Department of Immunology, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Farrukh Sheikh
- Department of Medicine, Allergy and Immunology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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15
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Garcia JFB, Takejima P, Veronez CL, Aun MV, Motta AA, Kalil J, Pesquero JB, Giavina-Bianchi P. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:754-755. [PMID: 30717878 DOI: 10.1016/j.jaip.2018.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Juliana F B Garcia
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Priscila Takejima
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | | | - Marcelo V Aun
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Antonio A Motta
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - João Bosco Pesquero
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil.
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16
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Giavina-Bianchi P, Kalil J. Improving the Management of Hereditary Angioedema. Clinics (Sao Paulo) 2018; 73:e354. [PMID: 29791522 PMCID: PMC5938487 DOI: 10.6061/clinics/2018/e354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pedro Giavina-Bianchi
- Divisao de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Jorge Kalil
- Divisao de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
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