Subscribe to RSS
DOI: 10.1055/s-0030-1253694
© Georg Thieme Verlag KG Stuttgart · New York
Notfallsituation akutes Angioödem
Emergency management of acute angioedemaPublication History
eingereicht: 4.12.2009
akzeptiert: 29.4.2010
Publication Date:
11 May 2010 (online)

Zusammenfassung
Das Angioödem ist eine ödematöse Schwellung tieferer Hautschichten. Akute Angioödeme bedeuten vor allem dann einen klinischen Notfall, wenn die obere Atem-Schluckstraße betroffen und die Atmung der Patienten beeinträchtigt ist. Für eine rasche und wirksame Therapie ist es notwendig, allergische von nicht-allergischen Angioödemen zu unterscheiden. Von den fünf Unterformen nicht-allergischer Angioödeme sind drei durch Bradykinin vermittelt: Das durch Blocker des Renin-Angiotensin-Aldosteron-Systems (RAAS) induzierte Angioödem (RAE), das hereditäre Angioödem (HAE) sowie das erworbene Angioödem (AAE). Antihistaminika, Kortikoide und Adrenalin können bei allergischen Angioödemen eingesetzt werden, zeigen bei akuten Attacken nicht-allergischer Angioödeme jedoch keine Wirkung. Hier stellen der Bradykinin-B2-Rezeptor-Antagonist Icatibant (HAE, ggf. RAE) oder C1-INH-Konzentrat (bei HAE, ggf. AAE) Therapieoptionen dar, die akute Angioödeme rasch zum Rückgang bringen. Die folgende Arbeit möchte eine Übersicht zur Diagnostik und Therapie für die Notfallsituation „akutes Angioödem”, insbesondere mit Schwellung im Kopf-Hals-Bereich, geben.
Abstract
Angioedema is an oedematous swelling of the mucosa or submucosa of the skin. Acute angioedema represents a clinical emergency when the pharynx or larynx are involved and breathing of the patient is impaired. For rapid and effective treatment it is necessary to differentiate between allergic and non-allergic angioedema. Three of the five subforms of non-allergic angioedema are mediated by bradykinin: renin-angiotensin-aldosterone system (RAAS)-blocker-induced angioedema (RAE), hereditary angioedema (HAE) and acquired angioedema (AAE). Antihistamines, corticosteroids and adrenalin can be used to treat allergic angioedema but are ineffective in acute attacks of non-allergic angioedema. In these events the bradykinin-B2-receptor antagonist icatibant (in HAE, or RAE) or C1-INH concentrate (in HAE, or AAE) are therapeutic options for rapid alleviation of acute angioedema. The following article gives an overview of the diagnostics and treatment in the emergency situation of „acute angioedema”, especially if swelling of the head-and-neck region is present.
Schlüsselwörter
akutes Angioödem - hereditäres Angioödem - Bradykinin - Icatibant - C1-INH - ACE-Hemmer
Keywords
acute angioedema - hereditary angioedema - bradykinin - icatibant - C1-INH - ACE inhibitor
Literatur
- 1
Agostoni A, Aygoren-Pursun E, Binkley K E, Blanch A, Bork K, Bouillet L. et al .
Hereditary
and acquired angioedema: problems and progress: proceedings of the
third C1 esterase inhibitor deficiency workshop and beyond.
J
Allergy Clin Immunol.
2004;
114
S51-131
MissingFormLabel
- 2
Agostoni A, Cicardi M.
Hereditary and acquired
C1-inhibitor deficiency: biological and clinical characteristics
in 235 patients.
Medicine (Baltimore).
1992;
71
206-215
MissingFormLabel
- 3
Bas M, Adams V, Suvorava T, Niehues T, Hoffmann T K, Kojda G.
Non-Allergic Angioedema.
Role of bradykinin.
Allergy.
2007;
62
842-856
MissingFormLabel
- 4
Bas M, Bier H, Greve J, Kojda G, Hoffmann T K.
Novel
pharmacotherapy of acute hereditary angioedema with bradykinin B2-receptor
antagonist icatibant.
Allergy.
2006;
61
1490-1492
MissingFormLabel
- 5
Bas M, Greve J, Stelter K, Bier H, Stark T, Hoffmann T K, Kojda G.
Therapeutic
Efficacy of Icatibant in Angioedema Induced by Angiotensin-Converting
Enzyme Inhibitors: A Case Series.
Ann Emerg Med.
2010 in press;
MissingFormLabel
- 6
Bas M, Hoffmann T K, Kojda G.
Evaluation and management of angioedema of the head and neck.
Curr Opin Otolaryngol Head Neck Surg.
2006;
14
170-175
MissingFormLabel
- 7
Bas M, Hoffmann T K, Kojda G, Bier H.
[ACE-inhibitor
induced angioedema].
Laryngorhinootologie.
2007;
86
804-8,
quiz
MissingFormLabel
- 8
Bas M, Kojda G, Bier H, Hoffmann T K.
[ACE inhibitor-induced
angioedema in the head and neck region. A matter of time?].
HNO.
2004;
52
886-890
MissingFormLabel
- 9
Bork K, Staubach P, Hardt J.
Treatment of skin swellings with C1-inhibitor concentrate in
patients with hereditary angio-oedema.
Allergy.
2008;
63
751-757
MissingFormLabel
- 10
Bork K.
Hereditary angioedema with normal c1 inhibition.
Curr
Allergy Asthma Rep.
2009;
9
280-285
MissingFormLabel
- 11 CHMP ASSESSMENT REPORT FOR
Firazyr. Ref Type: Internet Communication. http://www.emea.europa.eu/humandocs/PDFs/EPAR/firazyr/H-899-en6 2008
MissingFormLabel
- 12
Cicardi M, Zingale L C, Pappalardo E, Folcioni A, Agostoni A.
Autoantibodies and lymphoproliferative diseases
in acquired C1-inhibitor deficiencies.
Medicine (Baltimore).
2003;
82
274-281
MissingFormLabel
- 13
Cohen H, Hunt J B, Dixit M, Kanwar S, Thomas H C.
Decreased contact factor mediated fibrinolysis in cirrhosis.
Br J Haematol.
1993;
85
542-545
MissingFormLabel
- 14
Danielsson A, Nilsson T K, Uddenfeldt P.
Alterations in C1 inhibitor and clotting
factor concentrations in primary biliary cirrhosis and other chronic
liver diseases.
Scand J Gastroenterol.
1990;
25
149-154
MissingFormLabel
- 15
Gompels M M, Lock R J, Abinun M, Bethune C A, Davies G, Grattan C. et al .
C1 inhibitor
deficiency: consensus document.
Clin Exp Immunol.
2005;
139
379-394
MissingFormLabel
- 16
Goring H D, Bork K, Spath P J, Bauer R, Ziemer A, Hintner H. et al .
[Hereditary
angioedema in the German-speaking region].
Hautarzt.
1998;
49
114-122
MissingFormLabel
- 17
Herrlinger P, Gundlach P.
[Hypertrophy
of the salivary glands in bulimia].
HNO.
2001;
49
557-559
MissingFormLabel
- 18
Kaplan A P, Greaves M W.
Angioedema.
J Am Acad Dermatol.
2005;
53
373-388
MissingFormLabel
- 19
Longhurst H J, Bork K.
Hereditary angioedema:
causes, manifestations and treatment.
Br J Hosp Med (Lond).
2006;
67
654-657
MissingFormLabel
- 20
Markovic S N, Inwards D J, Frigas E A, Phyliky R P.
Acquired
C1 esterase inhibitor deficiency.
Ann Intern Med.
2000;
132
144-150
MissingFormLabel
- 21
Morwood K, Gillis D, Smith W, Kette F.
Aspirin-sensitive asthma.
Intern Med J.
2005;
35
240-246
MissingFormLabel
- 22
Nussberger J, Cugno M, Amstutz C, Cicardi M, Pellacani A, Agostoni A.
Plasma bradykinin in
angio-oedema.
Lancet.
1998;
351
1693-1697
MissingFormLabel
- 23
Temino V M, Peebles Jr R S.
The
spectrum and treatment of angioedema.
Am J Med.
2008;
121
282-286
MissingFormLabel
Dr. Murat Bas
Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum
rechts der Isar der Technischen Universität München
Ismaninger Straße 22
81675 München
Phone: 089/4140-2370
Fax: 089/4140-4853
Email: basmurat@web.de