Bradykinin-Mediated Angioedema and Emergency Medicine: Progress towards Optimising Treatment Strategies

Abstract

Morbidity and mortality from bradykinin-mediated (BK) angioedema (AE) are considerable. If the upper respiratory tract is involved, this is associated with emergency treatment and admission to the intensive care department. Laryngeal oedema and macroglossia are more common in patients presenting with an AE as an effect of taking converting enzyme inhibitors (ACE inhibitors) than in hereditary forms, where abdominal pain is more common. Involvement of the larynx and the progressive nature of the oedema are risk factors for admission to hospital for an AE attack following a reaction to ACE inhibitors. Emergency-specific treatments primarily include a C1 inhibitor concentrate and icatibant. They must be administered as early as possible given that anti-allergy treatments are ineffective. Specialist advice, including in the emergency department, appears to be required for the appropriate care of patients. Treatment of these patients was recently changed, with the development of links between doctors specialising in emergency medicine and referring physicians at the bradykinin-mediated angioedema reference centre. An appropriate treatment pathway and multidisciplinary management are vital in providing the correct care for these patients, with a view to ensuring emergency-specific treatments are available.