title: HAE update: determining optimal patient specific therapy.
abstract: Hereditary angioedema (HAE) is a rare autosomal dominant disease caused by deficient or dysfunctional C1 inhibitor (C1 INH). HAE patients experience recurrent episodes of angioedema affecting the extremities, face, genitalia or submucosal edema in the abdomen or upper airway. Laryngeal  attacks can be fatal. The determination of optimal therapy should be based on individualization of patient history and preferences. The parameters include attack frequency, location, severity and burden of illness on quality of life. Patients with HAE need medications for acute attacks; some  also require prophylaxis. This is an overview of HAE treatments currently available in the US and how to individualize therapy for patients based on their circumstances. A literature search was performed for HAE and therapeutic modalities currently available. HAE guidelines and randomized,  controlled clinical trials were evaluated. There are several options for acute and prophylactic treatment of HAE that have been approved by the Food and Drug Administration. Acute treatments include C1 INH, a replacement therapy; ecallantide, a kallikrein inhibitor; and icatibant, a bradykinin-2  receptor antagonist. Prophylactic treatments include attenuated androgens and C1 INH. These options have been proven safe and effective in clinical trials. Optimal therapy is based on the individual patients need regarding on-demand therapy and/or prophylactic therapy, short-term or long-term.  Patients with HAE have individual requirements, based on the nature and frequency of past attacks, occupation, proximity to trained medical personnel, and patient preference. These factors should be used to create a patient-centered approach to management of HAE.
authors: University of Washington, Marycliff Allergy Specialists, Spokane, WA 99204, USA. rgower@marycliffallergy.com
authors: Richard G
authors: RG
authors: Gower
mesh_terms: D000728:Androgens / Q000627:therapeutic use*; D054179:Angioedemas, Hereditary / Q000235:genetics / Q000628:therapy*; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D065094:Bradykinin B2 Receptor Antagonists; D003174:Complement C1 Inactivator Proteins / Q000235:genetics / Q000627:therapeutic use*; D050718:Complement C1 Inhibitor Protein; D018450:Disease Progression; D006801:Humans; D007610:Kallikreins / Q000037:antagonists & inhibitors; D010455:Peptides / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000728:Androgens; D065094:Bradykinin B2 Receptor Antagonists; D003174:Complement C1 Inactivator Proteins; D050718:Complement C1 Inhibitor Protein; D010455:Peptides; C469952:SERPING1 protein, human; C511194:ecallantide; C065679:icatibant; D007610:Kallikreins; D001920:Bradykinin