Peripheral edema due to increased vascular permeability: a clinical appraisal.
The release of vasoactive substances produces reversible changes of endothelial permeability with consequent edematous syndromes. We present 899 patients referred to our clinic for "non-hydrostatic non-hyponcotic" recurrent edema problems. Personal and family histories were recorded and a complete physical examination was carried out for each patient. In chronic situations laboratory tests [blood cell count, cryoglobulins, thyroid hormones, complement components (C3, C4, C1 inhibitor), total IgE, skin testing] were performed. Four subgroups of angioedema are identified for relevant clinical and etiopathogenetic differences. Seventy-three percent of patients had an urticaria-angioedema syndrome responding to antihistamine and/or corticosteroid treatment (histamine-dependent angioedema). Twenty-three percent had an angioedema related to a deficiency in C1 esterase inhibitor (complement-dependent angioedema). In a minority of patients, angioedema was due to the pharmacological effect of a drug (pharmacological angioedema) or was of a totally unknown origin (idiopathic angioedema). A generalized increase in vascular permeability was reported in 3 patients (systemic capillary leak syndrome). A brief survey of the literature is given with the review of our patients.
Agostoni
A
A
Institute of Internal Medicine, University of Milan, Italy.
Cicardi
M
M
Porreca
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000799:Angioedema / Q000139:chemically induced / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000503:physiopathology*; D002199:Capillary Permeability; D002648:Child; D002675:Child, Preschool; D003174:Complement C1 Inactivator Proteins / Q000172:deficiency / Q000235:genetics; D003165:Complement System Proteins / Q000032:analysis / Q000502:physiology; D003450:Cryoglobulins / Q000032:analysis; D005260:Female; D006632:Histamine / Q000502:physiology; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007223:Infant; D008297:Male; D008875:Middle Aged; D013963:Thyroid Hormones / Q000097:blood
D003174:Complement C1 Inactivator Proteins; D003450:Cryoglobulins; D013963:Thyroid Hormones; D007073:Immunoglobulin E; D006632:Histamine; D003165:Complement System Proteins