title: The role of icatibant-the B2 bradykinin receptor antagonist-in life-threatening laryngeal angioedema in the ED.
abstract: Angioedema is a localized, sudden, transient, and often recurrent swelling of the deeper layers of the skin or mucosa with no epidermal component. It is caused by vasoactive substances that produce a transient increase in endothelial permeability. Angioedema involving the laryngeal components is a life-threatening situation for the patient,and it is a challenge for the emergency medicine physician to rapidly achieve a safety airway. Most cases of laryngeal angioedema are induced by histamine release; but 10% are bradykinin induced, which does not respond to the conventional algorithm of treating allergic induced angioedema. We present a case report of an angiotensin converting enzyme (ACE) inhibitor–induced laryngeal angioedema alleviated only after treatment with the new bradykinin receptor inhibitor medication icatibant which was licensed only for use in hereditary angioedema. We reviewed the literature for the use of icatibant in acquired drug-induced angioedema; and because of the similar pathogenesis between the hereditary angioedema and the ACE inhibitor–induced angioedema,we propose an algorithm for careful use of icatibantin life-threatening angioedema in the emergency department.
authors.affiliation: The Emergency Medicine Department, "Soroka" University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: carmibt@zahav.net.il.
authors.forename: Carmi
authors.initials: C
authors.lastname: Bartal
authors.affiliation: The Emergency Medicine Department, "Soroka" University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Zeldetz
authors.affiliation: Internal Medicine Division, "Soroka" University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Vered
authors.initials: V
authors.lastname: Stavi
authors.affiliation: Internal Medicine Division, "Soroka" University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Barski
mesh_terms: D000368:Aged; D000799:Angioedema / Q000139:chemically induced / Q000188:drug therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065094:Bradykinin B2 Receptor Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007819:Laryngeal Edema / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D065094:Bradykinin B2 Receptor Antagonists; C065679:icatibant; D001920:Bradykinin