Efficacy of Treatment of Non-hereditary Angioedema

被引:15
作者
van den Elzen, Mignon [1 ,2 ]
Go, M. F. C. L. [1 ]
Knulst, A. C. [1 ]
Blankestijn, M. A. [1 ]
van Os-Medendorp, H. [1 ]
Otten, H. G. [3 ]
机构
[1] Univ Med Ctr Utrecht, Div Internal Med & Dermatol, Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Dermatol & Allergol, G02-124,POB 85-500, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Lab Translat Immunol, Utrecht, Netherlands
关键词
Angioedema; Angiotensin-converting enzyme inhibitor; Idiopathic; Treatment; Wheals; CHRONIC SPONTANEOUS URTICARIA; CHRONIC IDIOPATHIC/SPONTANEOUS URTICARIA; CONVERTING ENZYME-INHIBITORS; FRESH-FROZEN PLASMA; NORMAL C1 INHIBITOR; HEREDITARY ANGIOEDEMA; HISTAMINERGIC ANGIOEDEMA; RECEPTOR ANTAGONIST; OMALIZUMAB; ICATIBANT;
D O I
10.1007/s12016-016-8585-0
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Non-hereditary angioedema (AE) with normal C1 esterase inhibitor (C1INH) can be presumably bradykinin- or mast cell-mediated, or of unknown cause. In this systematic review, we searched PubMed, EMBASE, and Scopus to provide an overview of the efficacy of different treatment options for the abovementioned subtypes of refractory non-hereditary AE with or without wheals and with normal C1INH. After study selection and risk of bias assessment, 61 articles were included for data extraction and analysis. Therapies were described for angiotensin-converting enzyme inhibitor-induced AE (ACEi-AE), for idiopathic AE, and for AE with wheals. Described treatments consisted of ecallantide, icatibant, C1INH, fresh frozen plasma (FFP), tranexamic acid (TA), and omalizumab. Additionally, individual studies for anti-vitamin K, progestin, and methotrexate were found. Safety information was available in 26 articles. Most therapies were used off-label and in few patients. There is a need for additional studies with a high level of evidence. In conclusion, in acute attacks of ACEi-AE and idiopathic AE, treatment with icatibant, C1INH, TA, and FFP often leads to symptom relief within 2 h, with limited side effects. For prophylactic treatment of idiopathic AE and AE with wheals, omalizumab, TA, and C1INH were effective and safe in the majority of patients.
引用
收藏
页码:412 / 431
页数:20
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