HWN Suggests

Update on bradykinin-mediated angioedema

Bradykinin-mediated angioedema is a rare disease, due to vasodilation and increased vascular permeability resulting from bradykinin. This kind of angioedema affects abdominal and/or upper airways. It differs clinically from histamine-mediated angioedema by the absence of urticaria or skin rash. Antihistamines and corticosteroids are not effective. Delayed diagnosis can lead to inadequate and potentially fatal management by asphyxiation. Bradykinin-mediated angioedema results from either overproduction of bradykinin or inhibition of its degradation. Etiology can be hereditary or acquired.

read full article

Featured

 Angioedema

Broadly speaking, we have the mast-cell / histamine-mediated vs bradykinin-mediated vs we-have-no-idea idiopathic mediated. Let’s focus on the more confusing treatments for bradykinin-mediated angioedema.

 Treatment of Severe ACE Inhibitor Angioedema: Current and Future Therapies

For many years, corticosteroids, antihistamines, and epinephrine have been used to treat severe angioedema related to therapy with angiotensin-converting enzyme inhibitors (ACEIs). However, no clear evidence exists to support these therapies in patients who present with ACEI-induced angioedema.

Articles of Interest

An Evaluation of the Use of Tranexamic Acid in the Treatment of Bradykinin-Mediated Angioedema in the Emergency Department

Current treatment options include fresh frozen plasma, bradykinin-2 receptor antagonists, plasma-kallikrein inhibitors and C1 esterase inhibitors. Tranexamic acid (TXA) has been used for moderate cases of angioedema but is not well established in the emergent setting. This small study showed the potential for utilization of intravenous TXA as a first line agent for bradykinin-mediated angioedema.

Asphyxiation Deaths Due to Angioedema Mostly Caused by Bradykinin-mediated Disease, Study Says

In fact, bradykinin-mediated disease is 45 times more likely to be fatal than angioedema caused by mast cell activation, which in most cases consists in allergies, its researchers said.

Bradykinin-induced angioedema in the emergency department

Histamine-induced angioedema often presents with urticaria and other manifestations of anaphylaxis such as bronchospasm, wheezing and hypotension. Onset is rapid and attack duration may be brief. In contrast, bradykinin-induced angioedema is usually not associated with urticaria and tends to have slower onset, longer duration and involve abdominal symptoms. A defining feature that distinguishes between these two types of angioedema is that bradykinin-induced angioedema responds poorly, if at all, to epinephrine, antihistamines or corticosteroids.

PulmCrit Wee: Reconceptualizing bradykinin-mediated angioedema as a universal vicious spiral

A vicious spiral of enzymatic activation is proposed as a new model to explain bradykinin-mediated angioedema. This spiral may be a universal feature in every type of bradykinin-mediated angioedema.

The role of bradykin in urticaria and angioedema, investigation and treatment

Bradykinin is an angioedema maker...