Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care.
Hereditary angioedema (HAE) is a nonhistamine-mediated process causing edema of the tissues of the upper airway, dermis, and subcutaneous tissue. As such it does not respond well to epinephrine, antihistamines, or glucocorticoids. Instead it is treated with attenuated androgenic hormones, episolone aminocaproic acid (EACA), or tranexamic acid, C1 esterase inhibitor, and fresh-frozen plasma. Medical or surgical management of the airway may be necessary in an acute situation. Minor trauma, such as that associated with dental procedures and psychologic stress, may precipitate an attack; however, swelling may not manifest itself for 12-48 hours after a procedure. Symptoms of angioedema may be exacerbated in these patients if they are given an angiotensin-converting enzyme inhibitor. This paper reviews this entity and presents 2 patients who presented for acute care with dental/oral surgical complaints.
Van Sickels
Nicholas J
NJ
Internal Medicine, Tulane Medical Center, New Orleans, Louisiana, USA. vansick@email.uky.edu
Hunsaker
Robert B
RB
Van Sickels
Joseph E
JE
D000208:Acute Disease; D000328:Adult; D000402:Airway Obstruction / Q000517:prevention & control; D015119:Aminocaproic Acid / Q000627:therapeutic use; D000728:Androgens / Q000627:therapeutic use; D054179:Angioedemas, Hereditary / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003174:Complement C1 Inactivator Proteins / Q000172:deficiency / Q000235:genetics; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use; D051056:Complement Inactivating Agents / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007819:Laryngeal Edema / Q000517:prevention & control; D008875:Middle Aged; D010949:Plasma; D014148:Tranexamic Acid / Q000627:therapeutic use
D000728:Androgens; D000933:Antifibrinolytic Agents; D003174:Complement C1 Inactivator Proteins; D050718:Complement C1 Inhibitor Protein; D051056:Complement Inactivating Agents; D004965:Estrogen Antagonists; C469952:SERPING1 protein, human; D014148:Tranexamic Acid; D015119:Aminocaproic Acid