Concomitant medication in patients with bradykinin‐mediated angioedema – there's more than ACE inhibitors

Lochbaum, Robin; Hoffmann, Thomas; Greve, Jens; Hahn, Janina

doi:10.1111/ddg.15154

Cited by 5 publications

(1 citation statement)

References 73 publications

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“…The available treatments are based on C1-INH substitution, inhibition of the kallikrein-kinin pathway (ecallantide, tranexamic acid) and bradykinin type 2 receptors (B2R) antagonist (icatibant). In particular, tranexamic acid inhibits the activation of plasminogen to plasmin, essential to kallikrein activation and bradykinin formation [ 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies

Nunes,

Anselmo,

Brito

2023

Arch Clin Cases

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Angioedema is a potentially life-threatening condition that can have an allergic origin, usually mediated by histamine or a non-allergic origin, mediated by bradykinin. The distinction between these origins may present a clinical challenge at first approach, especially in cases that appear as an emergency and the outcome is time dependent. The authors describe a rare case of bradykinin angioedema associated with airway obstruction and discuss the right approach and therapeutic options. A 46-year-old patient under ACE inhibitor, renin-angiotensin-aldosterone blocker and beta blocker presented with difficulty swallowing, shortness of breath and angioedema, associated with inspiratory stridor, incapacity of talking, plantar pruritus and vomits minutes after ingestion of shrimp. The symptoms did not respond to epinephrine, anti-histamines or steroids. The airway quickly became an emergency and the authors discuss the importance of airway obstruction management and having a multidisciplinary well-defined plan of approach with backup plans. Exuberant angioedema persisted leading to the suspicion of drug induced angioedema. Treatment with tranexamic acid 1g 6/6h and icatibant 30 mg 6/6h (3 doses) was started with resolution. In these cases, the rapid institution of the right pharmacological line will relate significantly to a better outcome. It is particularly important because, as their underlying physiopathologic mechanism differ, bradykinin mediated angioedema does not respond to drugs that histamine mediated angioedema does, like corticosteroids and antihistaminic. In severe and life-threatening cases icatibant and tranexamic acid have proven to be an effective therapy.

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Section: Introductionmentioning

confidence: 99%

A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies

Nunes,

Anselmo,

Brito

2023

Arch Clin Cases

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Substance Use Disorder as Risk Factor for Intubation in Angioedema: A Nationwide Cohort Study

Bogart,

Otteson

2024

The Laryngoscope

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ObjectivesIndividuals with angioedema (AE) are at high risk for airway compromise and often require endotracheal intubation. Patient factors predisposing one to airway compromise are not well described. The objective of this study is to examine whether substance use disorder (SUD) in patients with AE is associated with need for airway intervention.MethodsThis population‐based retrospective cohort study compared AE patients with SUD versus propensity‐matched control groups. Outcomes were hospitalization, intubation, and tracheotomy. Using the TriNetX National Database, this study included 28,931 patients with SUD and 117,509 patients without SUD who presented with AE.ResultsAmong patients with AE, those with each subtype of SUD (alcohol, cannabis, cocaine, tobacco, and opioids) were found to have higher risk of severe AE compared to propensity‐matched non‐SUD cohorts. Rate of hospitalization after cohort matching ranged from 20.4% for tobacco use disorder to 30.4% for cocaine use disorder, all significantly higher than the 8.0% in a population without SUD. Each SUD subtype was associated with a higher rate of intubation compared with matched non‐SUD groups, with cannabis use disorder having the highest relative risk (RR) of 3.67 (95% CI: 2.69–5.02). Tobacco (RR = 2.45, 95% CI: 1.79–3.34) and alcohol (RR = 2.82, 95% CI: 1.73–4.58) use disorders were both associated with significantly higher risk of tracheotomy.ConclusionThese data suggest that patients with SUD, regardless of subtype, and after propensity matching for demographics and comorbidities are at higher risk for adverse outcomes when presenting with AE. This study highlights clinically relevant predictors of airway compromise.Level of EvidenceLevel 3 Laryngoscope, 2024

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Establishment of the deuterium oxide dilution method as a new possibility for determining the transendothelial water permeability

Müller,

Hahn,

Gierke

et al. 2024

Pflugers Arch - Eur J Physiol

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Increase in transendothelial water permeability is an essential etiological factor in a variety of diseases like edema and shock. Despite the high clinical relevance, there has been no precise method to detect transendothelial water flow until now. The deuterium oxide (D2O) dilution method, already established for measuring transepithelial water transport, was used to precisely determine the transendothelial water permeability. It detected appropriate transendothelial water flow induced by different hydrostatic forces. This was shown in four different endothelial cell types. The general experimental setup was verified by gravimetry and absorbance spectroscopy. Determination of transendothelial electrical resistance (TEER) and immunocytochemical staining for proteins of the cell-cell contacts were performed to ensure that no damage to the endothelium occurred because of the measurements. Furthermore, endothelial barrier function was modulated. Measurement of transendothelial water flux was verified by measuring the TEER, the apparent permeability coefficient and the electrical capacity. The barrier-promoting substances cyclic adenosine monophosphate and iloprost reduced TEER and electrical capacity and increased permeability. This was accompanied by a reduced transendothelial water flux. In contrast, the barrier-damaging substances thrombin, histamine and bradykinin reduced TEER and electrical capacity, but increased permeability. Here, an increased water flow was shown. This newly established in vitro method for direct measurement of transendothelial water permeability was verified as a highly precise technique in various assays. The use of patient-specific endothelial cells enables individualized precision medicine in the context of basic edema research, for example regarding the development of barrier-protective pharmaceuticals.

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Concomitant medication in patients with bradykinin‐mediated angioedema – there's more than ACE inhibitors

Cited by 5 publications

References 73 publications

A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies

A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies

Substance Use Disorder as Risk Factor for Intubation in Angioedema: A Nationwide Cohort Study

Establishment of the deuterium oxide dilution method as a new possibility for determining the transendothelial water permeability

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