The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine

Authors

  • Ljerka Karadža-Lapić Department of Otorhinolaryngology, General Hospital Šibenik, Šibenik
  • Tamara Pikivaca University of Zagreb, School of Medicine Zagreb, Zagreb, Public Health Centre Zagreb, Zagreb
  • Petra Pervan University of Zagreb, School of Medicine Zagreb, Zagreb, Public Health Centre Zagreb, Zagreb
  • Josipa Jović Zlatović Department of Internal Medicine, General Hospital Šibenik, Šibenik
  • Sanja Delin Department of Pediatric, General Hospital Zadar, Zadar
  • Ingrid Prkačin University of Zagreb, School of Medicine Zagreb, Zagreb, Clinical Hospital Merkur, Department of Internal Medicine/Emergency Unit, Zagreb

DOI:

https://doi.org/10.5644/ama2006-124.210

Keywords:

Angioedema, Emergency, Bradykinin, Icatibant, Plasma-derived C1-inhibitor

Abstract

Objective. Angioedema (AE) is a potentially life-threatening event. We investigated the etiology of AE, with the emphasis on bradykinininduced angioedema treatment in emergency medicine.

Methods. The retrospective study included 237 patients with AE, who were examined and treated in two hospitals (group A and B) in Croatia from 2009 to 2016. The location and duration of AE, data about chronic diseases and treatment, potential causative agents (food, drugs, insect bites and chemicals), physical examination data and the subsequent treatment were analyzed.

Results. There was no statistical difference regarding age or comorbidities but there was a statistically significant difference in etiology between the groups (Chi-square, P=0.03). Renin-angiotensin-aldosterone system (RAAS) blocker induced AE was the main cause of emergency attendance in group A (37.5%) and among the leading causes in group B (18.8%). Bradykinin-induced AE (hereditary angioedema (HAE) and RAAS-AE) were the leading causes in a total of 75 (31.5%) patients. RAAS-AE was treated with glucocorticoids and antihistamines. HAE attacks in both groups (2/7 patients, 1.5/6%) were treated with specific therapy. Other causes of AE in groups A/B were insect bites (15/23 patients, 13.5/20%), use of antibiotics/analgetics (11/17 patients, 9/15%), gastroesophageal reflux disease (10/11 patients, 8/9%), neoplasms (5/6 patients, 4/5%) and idiopatic (32/31 patients, 26.5/26%). 21% of patients were hospitalized.

Conclusion. Bradykinin-mediated AE was the main cause of emergency attendance associated with AE. Advances in the treatment of HAE, with case reports of patients with RAAS-AE treated with C1 esterase inhibitor concentrate or bradykinin receptor antagonist, may prove to be a new, reliable and efficacious therapy option.

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Published

2018-06-25

How to Cite

Karadža-Lapić, L., Pikivaca, T., Pervan, P., Jović Zlatović, J., Delin, S., & Prkačin, I. (2018). The Incidence and Frequency of Various Causes of Angioedema in Emergency Medicine. Acta Medica Academica, 47(1), 11–17. https://doi.org/10.5644/ama2006-124.210

Issue

Section

Clinical Science