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Therapies
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 27 février 2020
Doi : 10.1016/j.therap.2020.02.011
Received : 16 September 2019 ;  accepted : 15 November 2019
Update on bradykinin-mediated angioedema in 2020
 

Marion Lepelley a, , Claire Bernardeau a, Federica Defendi b, Julia Crochet c, Michel Mallaret a, Laurence Bouillet d
a Centre régional de pharmacovigilance, centre hospitalier universitaire Grenoble-Alpes, 38000 Grenoble, France 
b Laboratoire d’immunologie, centre hospitalier universitaire Grenoble-Alpes, 38000 Grenoble, France 
c Service de dermatologie et allergologie, centre hospitalier Métropole Savoie, 73000 Chambéry, France 
d Centre de référence national des angioedèmes (CREAK), centre hospitalier universitaire Grenoble-Alpes, 38000 Grenoble, France 

Corresponding author. Pôle santé publique, centre régional de pharmacovigilance, CHU Grenoble, 38000 Grenoble, France.Pôle santé publique, centre régional de pharmacovigilance, CHU GrenobleGrenoble38000France
Summary

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. Deficiency of C1 inhibitor and drug induced are the main causes of bradykinin-mediated angioedema. Its diagnosis is clinical (presentation, family history, seriousness, frequency, etc.) and biological (dosage of C1-INH level, C1-INH activity, and complement protein 4 level). Acute attack treatment is based on C1-inhibitor concentrates and icatibant, a bradykinin receptor antagonist. Long-term prophylaxis can be necessary, especially before surgical and dental procedures. New drugs, including gene therapy, are being tested.

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Keywords : Angioedema, Bradykinin, Pharmacology, C1-inhibitor deficiency, Angiotensin converting enzyme




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