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Uncommon Diseases in the ICU pp 175–190Cite as

Bradykinin-Mediated Angioedema

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Abstract

Bradykinin-mediated angioedema (AE) is a clinical syndrome characterised by episodes of subcutaneous or mucosal oedema (extremities, throat, respiratory and digestive tracts) referred to as attacks. Any ICU physician could encounter patient during an attack. The diagnosis of AE must be evoked in cases of transient and recurrent oedema and/or abdominal pain. All attacks localised over the shoulders (face, neck, throat and respiratory tract) and all abdominal attacks with pain rated >5 on the VAS must be considered severe. Severe ENT attacks may be life-threatening. In the absence of specific treatment, the mortality rate reaches 25–30 % due to asphyxia. In emergency situations, a step-by-step approach is necessary to establish a diagnosis and evaluate the severity. This is not an allergic reaction. Antihistamines are not effective because bradykinin is the key mediator. There are hereditary and acquired forms, notably associated with the use of ACE inhibitors. All severe attacks should benefit from early specific treatment. The availability of these treatments varies by country and there is currently no consensus as to the correct choice of a specific treatment. Even in the absence of previous attack, short-term prophylaxis is necessary during the perioperatory period. The rarity of this disease and the characteristics of the specific drugs (i.e., their retention periods, modes of delivery, prices and methods for reimbursement) should encourage hospitals to make strategic choices regarding the creation of an emergency supply of drugs or an institute-wide protocol for the rapid transfer of patients to specialised centres for treatment.

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Author information

Authors and Affiliations

  1. Département d’anesthésie réanimation, Centre de Référence des Angiœdèmes à Bradykinine, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Bernard Floccard, Jullien Crozon & Bernard Allaouchiche

  2. Service de Médecine Interne, Centre de Référence des Angiœdèmes à Bradykinine, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Brigitte Coppere

  3. Clinique Universitaire de Médecine Interne, Centre National de Référence des Angiœdèmes à Bradykinine, Hôpital Albert Michallon, Grenoble, France

    Laurence Bouillet

Authors
  1. Bernard Floccard
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  2. Jullien Crozon
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  3. Brigitte Coppere
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  4. Laurence Bouillet
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  5. Bernard Allaouchiche
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Corresponding author

Correspondence to Bernard Floccard .

Editor information

Editors and Affiliations

  1. Anesthésie et réanimation, CHU Nord, Marseille, France

    Marc Leone

  2. Anesthésie et réanimation, CHU Nord, Marseille, France

    Claude Martin

  3. Dept of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent

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Floccard, B., Crozon, J., Coppere, B., Bouillet, L., Allaouchiche, B. (2014). Bradykinin-Mediated Angioedema. In: Leone, M., Martin, C., Vincent, JL. (eds) Uncommon Diseases in the ICU. Springer, Cham. https://doi.org/10.1007/978-3-319-04576-4_16

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  • DOI: https://doi.org/10.1007/978-3-319-04576-4_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04575-7

  • Online ISBN: 978-3-319-04576-4

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