Acute angioedema of the head and neck region as an emergency

Acute angioedema of the head and neck region as an emergency Acute angioedema of the head and neck region can lead to a life-threatening condition by narrowing of the upper airways (tongue, pharynx and larynx). In the clinical routine the differentiation between allergic, inflammatic and neoplastic causes is essential. In adults, in contrast to other body regions, allergy-induced angioedema in the upper airways appears in only 1% of the cases. Nevertheless, the treatment of angioedema in the upper airways on an anti-allergic concept, prevailingly is based on antihistamines and corticosteroids. Mostly non-allergic acute edema of the upper airways is caused by local inflammation, the second frequent cause is bradykinin-induced angioedema (8%). It has to be differentiated between diseases with an increased generation of bradykinin, like in hereditary angioedema (RAE) and acquired angioedema (AAE), and diseases with decreased catabolism of bradykinin. ACE inhibitors (ACEi) decrease the degradation of bradykinin. Nearly all bradykinin-induced angioedemas of the head and neck region develop as a side effect of ACEi. While the inflammation-induced edemas often need surgical intervention (abscess-splitting), so far ACEi-induced angioedemas have been treated with anti-allergic drugs - despite the knowledge that they are non-allergic. On the other hand, there are some anti-bradykinin drugs available like C1 inhibitor concentrate and the bradykinin B-2 receptor antagonist icatibant for hereditary angioedema (RAE). First off-label treatment results with icatibant (Firazyr) and C1 inhibitor concentrates (Berinert) show successful new treatment options. In this manuscript the focus is put on the clinical and therapeutic challenge of angioedema in the upper airways and the head and neck region.     «

Acute angioedema of the head and neck region as an emergency Acute angioedema of the head and neck region can lead to a life-threatening condition by narrowing of the upper airways (tongue, pharynx and larynx). In the clinical routine the differentiation between allergic, inflammatic and neoplastic causes is essential. In adults, in contrast to other body regions, allergy-induced angioedema in the upper airways appears in only 1% of the cases. Nevertheless, the treatment of angioedema in the upp...     »