Evaluation and management of angioedema of the head and neck.
OBJECTIVE
Sudden occurrence of subcutaneous or submucosal swelling, the so-called angioedema, is an established and potentially life-threatening condition. Several forms of angioedema show a great variety of tissue localizations and different underlying mechanisms such as genetic mutations, allergic reactions and nonallergic reactions exist. Unfortunately, angioedema is often unrecognized and/or incorrectly treated. To change this situation, a better understanding of angioedema and possible therapeutic approaches appears necessary.


RESULTS
Recent investigations have shed new light on the pathomechanism of nonallergic drug-induced angioedema and new therapeutic options targeting the kallikrein-kinin system have become available for patients in clinical trials. Furthermore, extensive clinical evaluations of commonly used inhibitors of the renin-angiotensin system have provided reliable data on the incidence of angioedema induced by these drugs. Accordingly, several thousand patients worldwide experience severe fatal attacks although timely medical care would have saved their lives.


CONCLUSIONS
Current data suggest that the nonapetide bradykinin plays a crucial role in the pathogenesis of most forms of nonallergic angioedema, while histamine acts as the main biogenic mediator in allergic angioedema. Thus, correct diagnosis is crucial for effective treatment. Standard antiallergic drugs such as glucocorticoids and antihistamines are most probably ineffective in nonallergic angioedema forms.
Bas
Murat
M
Clinic of Otolaryngology, Heinrich-Heine-University, Düsseldorf, Germany.
Hoffmann
Thomas K
TK
Kojda
Georg
G
D000799:Angioedema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D054179:Angioedemas, Hereditary / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001920:Bradykinin / Q000009:adverse effects; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use; D006632:Histamine / Q000009:adverse effects; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans
D000893:Anti-Inflammatory Agents; D050718:Complement C1 Inhibitor Protein; D006634:Histamine H1 Antagonists; D006632:Histamine; D001920:Bradykinin