title: Hereditary angioedema with F12 mutation: Clinical features and enzyme polymorphisms in 9 Southwestern Spanish families.
abstract: Information on F12 mutation hereditary angioedema (HAE) is still limited, but Spain is now recognized as having one of the highest concentrations of cases in Western Europe.
  
  
  
  To describe unique features of HAE in Spanish carriers of the F12 mutation and investigate a potential role for angiotensin-converting enzyme (ACE) and aminopeptidase-P polymorphisms in disease expression.
  
  
  
  This was a prospective observational cohort study of 35 individuals (80% females) from 9 unrelated families carrying the p.Thr309Lys mutation. We analyzed detailed medical records and complement activity (C4, C1q, C1 inhibitor) and screened for mutations in exon 9 of the F12 gene and 2 polymorphisms: XPNPEP2 c-2399A and the ACE insertion/deletion polymorphism.
  
  
  
  The p.Thr309Lys mutation was found in all individuals. Three of the 9 index patients had a clinically negative family history, and 72% of males and 29% of females were asymptomatic. Sixteen females (44% estrogen dependent, 56% estrogen sensitive) were clearly symptomatic. The most common locations of attacks were the abdomen (63%), face (25%), and peripheral structures (6%). Triggers other than hyperestrogenic states included stress and minor trauma or pressure. Short-term treatment with C1-inhibitor concentrate and icatibant and long-term prophylaxis with tranexamic acid were useful. The combination of the I allele and A allele was detected in 17% of patients.
  
  
  
  The polymorphisms analyzed were not a major determinant of disease expression in our population. We recommend searching for F12 mutations in women with edema attacks without associated wheals and with normal C1-inhibitor levels, particularly when they develop symptoms during hyperestrogenic states or are of Western European or African origin.
authors: Reference Unit for Angioedema in Andalusia, Allergy Department, Virgen del Rocío University Hospital, Seville, Spain.
authors: Macarena
authors: M
authors: Piñero-Saavedra
authors: Reference Unit for Angioedema in Andalusia, Allergy Department, Virgen del Rocío University Hospital, Seville, Spain. Electronic address: mtgonzalezq@gmail.com.
authors: Teresa
authors: T
authors: González-Quevedo
authors: Allergy Department, Jaen Hospital Complex, Jaen, Spain.
authors: Blanca
authors: B
authors: Saenz de San Pedro
authors: Allergy Department, Virgen Macarena University Hospital, Seville, Spain.
authors: Cristina
authors: C
authors: Alcaraz
authors: Allergy Department, Infanta Cristina University Hospital, Badajoz, Spain.
authors: Pedro
authors: P
authors: Bobadilla-González
authors: Allergy Department, Clideba Hospital, Badajoz, Spain.
authors: Lourdes
authors: L
authors: Fernández-Vieira
authors: Allergy Department, Virgen de la Cinta Specialities Center, Huelva, Spain.
authors: Belén
authors: B
authors: Hinojosa
authors: Immunology Department, Virgen del Rocío University Hospital, Seville, Spain.
authors: Raúl
authors: R
authors: García-Lozano
mesh_terms: D000293:Adolescent; D000328:Adult; D000626:Aminopeptidases / Q000235:genetics*; D054179:Angioedemas, Hereditary / Q000188:drug therapy / Q000235:genetics*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001920:Bradykinin / Q000031:analogs & derivatives / Q000627:therapeutic use; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use; D051056:Complement Inactivating Agents / Q000627:therapeutic use; D005174:Factor XII / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D009154:Mutation; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D013030:Spain; D014148:Tranexamic Acid / Q000627:therapeutic use; D044465:White People / Q000235:genetics; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000933:Antifibrinolytic Agents; D050718:Complement C1 Inhibitor Protein; D051056:Complement Inactivating Agents; D014148:Tranexamic Acid; C065679:icatibant; D005174:Factor XII; D000626:Aminopeptidases; C022750:X-Pro aminopeptidase; C488034:ACE protein, human; D007703:Peptidyl-Dipeptidase A; D001920:Bradykinin