title: Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks.
abstract: Acute angioedema attacks are conventionally treated with antihistamines and steroids, in line with a presumed mechanism of disease involving overwhelming mast-cell degranulation. This approach overlooks a small but important minority of cases in which attacks are bradykinin driven and exhibit poor responsiveness to steroid or anti-histamine therapy. These patients may have a family history of angioedema (hereditary angioedema), or a past medical history including B-cell lymphoproliferative disorders or autoimmune disease (acquired angioedema). Rather than steroid therapy, they respond to administration of a bradykinin inhibitor, or more commonly, a C1 esterase inhibitor substitute, to control acute symptoms and reduce the probability of invasive airway insertion. In the long-term, they require C1 esterase inhibitor sparing therapy and a treat-the-cause approach to reduce the risk of recurrent attacks. We present here a case of a middle-aged woman who presented with recurrent angioedema of initially uncertain aetiology.
authors: Royal London Hospital, London, UK sharif.ismail09@gmail.com.
authors: Sharif
authors: S
authors: Ismail
authors: St Bartholomew's, Royal London and Homerton University Hospitals, London, UK.
authors: Leo
authors: L
authors: Cheng
authors: Royal London Hospital, London, UK.
authors: Sofia
authors: S
authors: Grigoriadou
authors: Royal London Hospital, London, UK.
authors: James
authors: J
authors: Laffan
authors: Homerton University Hospital, London, UK.
authors: Manoj
authors: M
authors: Menon
mesh_terms: D000799:Angioedema / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D001920:Bradykinin / Q000037:antagonists & inhibitors*; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D050718:Complement C1 Inhibitor Protein; D013256:Steroids; D001920:Bradykinin
keywords: Angioedema; C1 esterase inhibitor; bradykinin; steroid
references: Am J Med. 2003 Oct 1;115(5):420-1
references: 14553889
references: Allergy Asthma Clin Immunol. 2010 Jul 28;6(1):14
references: 20667117
references: Allergy. 2012 Aug;67(8):1074-7
references: 22686628
references: Eur J Emerg Med. 2013 Feb;20(1):10-7
references: 22976464
references: Crit Rev Oncol Hematol. 2013 Sep;87(3):323-32
references: 23490322
references: J Allergy Clin Immunol. 2013 Jun;131(6):1491-3
references: 23726531
references: Clin Exp Immunol. 2014 Jan;175(1):59-67
references: 23786259