Ecallantide for the Acute Treatment of Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema: A Multicenter, Randomized, Controlled Trial

Lewis, Lawrence M.; Graffeo, Charles S.; Crosley, Pascal; Klausner, Howard; Clark, Carol L.; Frank, Anthony; Miner, James R.; Iarrobino, Ryan; Chyung, Yung

doi:10.1016/j.annemergmed.2014.07.014

Cited by 62 publications

(44 citation statements)

References 24 publications

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“…34 Similar to our study, the primary Serious adverse events included hospitalization for longer than 24 hours because of worsening of angioedema, chest pain, recurrence of angioedema, and supraventricular tachycardia for the placebo group and hospitalization for longer than 24 hours because of angioedema, gastric pain, and chest pain for the ecallantide group.…”

Section: Discussionmentioning

confidence: 53%

Effectiveness of ecallantide in treating angiotensin-converting enzyme inhibitor–induced angioedema in the emergency department

Bernstein

Moellman

Collins

et al. 2015

Annals of Allergy, Asthma & Immunology

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Section: Discussionmentioning

confidence: 53%

Effectiveness of ecallantide in treating angiotensin-converting enzyme inhibitor–induced angioedema in the emergency department

Bernstein

Moellman

Collins

et al. 2015

Annals of Allergy, Asthma & Immunology

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“…A second RCT 17 was performed in which 76 adults with angioedema on current ACEI therapy presented for emergency care within 12 hours of symptom onset; 86% received standard therapy (glucocorticoid, antihistamine, epinephrine) and either ecallantide (at doses of 10 mg, 30 mg, or 60 mg) or placebo. The mean time from symptom onset to treatment was 7.2 hours, and 72% of patients who received placebo improved during that time.…”

Section: Discussionmentioning

confidence: 99%

Angiotensin-Converting Enzyme Inhibitor-associated Angioedema Treated with c1-esterase Inhibitor: A Case Report and Review of the Literature

Erickson

Coop

2016

Allergy�Rhinol (Providence)

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Case Report:A 59-year old man currently on >5 years of angiotensin-converting enzyme inhibitor (ACEI) therapy presented to the emergency department with angioedema of the tongue and difficulty swallowing. After receiving conventional therapy of antihistamine, steroids, and epinephrine, the patient's condition continued to deteriorate, with imminent intubation. The patient was treated with a C1-esterase inhibitor (C1-INH) and experienced rapid resolution of symptoms, which avoided airway complications.Discussion:Although no therapy has been approved for the treatment of ACEI–associated angioedema (AAE), the conventional therapy (antihistamine, steroids, and epinephrine) often proves ineffective in this bradykinin-mediated angioedema. There are drugs approved and used for hereditary angioedema that may be effective in the acute phase of ACEI-AAE that may prevent the need for further interventions, such as intubation and tracheotomy. These drugs include icatibant, ecallantide, fresh frozen plasma, and C1-INH.Conclusion:The literature and clinical evidence indicate C1-INH can be effectively used in the treatment of ACEI-AAE to halt the progression of the condition, prevent airway compromise and the need for intervention, and lead to rapid resolution of symptoms.

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“…Lewis et al compared the addition of ecallantide to standard therapy in patients with mild to moderate ACEi-induced angioedema with an endpoint of discharge eligibility within 6 h of treatment. Discharge eligibility was similar in patients receiving ecallantide or placebo [53]. Using a shorter discharge time as an endpoint, Bernstein et al found that eight of 26 (31%) patients receiving ecallantide versus five of 24 (21%) patients receiving placebo were discharged in ≤4 h (95% confidence interval, −14 to 34%) [52].…”

Section: Reviewmentioning

confidence: 99%

Angioedema in the emergency department: a practical guide to differential diagnosis and management

et al. 2017

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BackgroundAngioedema is a common presentation in the emergency department (ED). Airway angioedema can be fatal; therefore, prompt diagnosis and correct treatment are vital.Objective of the reviewBased on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED.ReviewThe most common pathophysiology underlying angioedema is mediated by histamine; however, ED staff must be alert for the less common bradykinin-mediated forms of angioedema. Crucially, bradykinin-mediated angioedema does not respond to the same treatment as histamine-mediated angioedema. Bradykinin-mediated angioedema can result from many causes, including hereditary defects in C1 esterase inhibitor (C1-INH), side effects of angiotensin-converting enzyme inhibitors (ACEis), or acquired deficiency in C1-INH. The increased use of ACEis in recent decades has resulted in more frequent encounters with ACEi-induced angioedema in the ED; however, surveys have shown that many ED staff may not know how to recognize or manage bradykinin-mediated angioedema, and hospitals may not have specific medications or protocols in place.ConclusionED physicians must be aware of the different pathophysiologic pathways that lead to angioedema in order to efficiently and effectively manage these potentially fatal conditions.

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Ecallantide for the Acute Treatment of Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema: A Multicenter, Randomized, Controlled Trial

Cited by 62 publications

References 24 publications

Effectiveness of ecallantide in treating angiotensin-converting enzyme inhibitor–induced angioedema in the emergency department

Effectiveness of ecallantide in treating angiotensin-converting enzyme inhibitor–induced angioedema in the emergency department

Angiotensin-Converting Enzyme Inhibitor-associated Angioedema Treated with c1-esterase Inhibitor: A Case Report and Review of the Literature

Angioedema in the emergency department: a practical guide to differential diagnosis and management

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