title: Hereditary angioedema: management of laryngeal attacks.
abstract: BACKGROUND
  Hereditary angioedema (HAE) patients suffering from laryngeal attacks in the United States faced severely limited treatment options until 2008. These potentially life-threatening episodes occur in over one-half of the patients affected by HAE during their lifetimes. Acute therapy had been relegated to supportive care, intubation, and consideration of fresh frozen plasma (FFP)--the latter with the potential for actually accelerating the speed and severity of the swelling.
  
  
  METHODS
  In this article we will review the recently approved and emerging HAE treatments that have evolved from the recognition that bradykinin generation is the fundamental abnormality leading to attacks of angioedema.
  
  
  RESULTS
  Acute therapy for laryngeal attacks will be discussed including purified plasma-derived C1 inhibitor (C1INH), recombinant C1INH, an inhibitor of plasma kallikrein (ecallantide), and a B2 receptor antagonist (icatibant). Prophylactic care has also been transformed from a reliance on attenuated androgens with their attendant side effects to C1INH replacement.
  
  
  CONCLUSIONS
  The arrival of these novel therapies promises to transform the future management of HAE.
authors.affiliation: Department of Allergy, Kaiser Permanente and University of California, San Diego, California, USA.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Christiansen
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Zuraw
mesh_terms: D054179:Angioedemas, Hereditary / Q000150:complications / Q000188:drug therapy*; D001920:Bradykinin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D003174:Complement C1 Inactivator Proteins / Q000627:therapeutic use*; D050718:Complement C1 Inhibitor Protein; D019468:Disease Management; D006801:Humans; D007819:Laryngeal Edema / Q000188:drug therapy* / Q000209:etiology; D010455:Peptides / Q000627:therapeutic use*; D014481:United States
chemical_list: D003174:Complement C1 Inactivator Proteins; D050718:Complement C1 Inhibitor Protein; D010455:Peptides; C469952:SERPING1 protein, human; C511194:ecallantide; C065679:icatibant; D001920:Bradykinin