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Angioödeme der Kopf-Hals-Region

Angioedema of the head and neck

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Zusammenfassung

Das Angioödem ist eine akute ödematöse Schwellung tieferer Hautschichten. Bei Manifestationen im Bereich der oberen Atemschluckstraße kann es zu einem lebensbedrohlichen Notfall kommen. Für eine rasche und wirksame Therapie ist es notwendig, histaminvermittelte von nichthistaminvermittelten Angioödemen zu unterscheiden und die nichthistaminvermittelten weiter zu differenzieren.

Histaminvermittelte Ödeme der oberen Atemschluckstraße sind sehr selten. Sie stellen hier nur etwa 1 % aller Fälle mit akuten Ödemen dar. Demnach stellen nichthistaminvermittelte Ödeme entsprechend 99 % aller akuten Ödeme der oberen Atemschluckstraße dar. Rund 80 % aller akuten Ödeme treten im Rahmen lokaler entzündlicher Erkrankungen auf. Die zweithäufigste Gruppe stellen mit 8 % die Bradykinin-induzierten Angioödeme dar. Hier unterscheidet man zwischen den durch Blocker des Renin-Angiotensin-Aldosteron-Systems (RAAS) induzierten Angioödemen (RAE), dem hereditären Angioödem (HAE) sowie dem erworbenen („acquired“) Angioödem (AAE). Antihistaminika und Kortikoide können bei histaminvermittelten Angioödemen eingesetzt werden, zeigen bei akuten Attacken Bradykinin-induzierter Angioödeme jedoch keine Wirkung. Hier stellen der Bradykinin-B2-Rezeptorantagonist Icatibant (Firazyr®) oder das C1-Inhibitor-Konzentrat (Berinert®) Therapieoptionen dar, die zu einer raschen Remission führen. Die folgende Arbeit gibt eine Übersicht zur Diagnostik und Therapie in der Notfallsituation „akutes Angioödem“, insbesondere bei Schwellungen im Kopf-Hals-Bereich.

Summary

An angioedema is an oedematous swelling of the (sub-)mucosa or (sub-)cutis. Pharyngeal, laryngeal and lingual manifestations can cause life-threatening emergencies. For rapid and effective treatment it is necessary to differentiate histamine-induced and non-histamine-induced angioedema. The incidence of allergic edema of the upper aerodigestive tract is 1 % only. Most of the remaining 99 % of non-allergic edema are caused by inflammation (80 %). Bradykinin induced angioedema (8 %) constitute the second largest group. This group can be subdivided into three types: renin-angiotensin-aldosterone system (RAAS)-blocker-induced angioedema (RAE), hereditary angioedema (HAE) and acquired angioedema (AAE). Antihistamines, corticosteroids and occasionally adrenalin may be used for treatment of histamine-induced angioedema. However, these drugs are ineffective in acute attacks of non-histamine-induced angioedema. In such cases the bradykinin-B2-receptor antagonist Icatibant (in HAE, or RAE) or C1-inhibitor concentrate (in HAE, or AAE) are therapeutic options to achieve a rapid remission of symptoms of acute angioedema. The following article provides an overview of the diagnostics and treatment in emergencies of „acute angioedema“, especially if swelling of the head-and-neck region occurs.

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Abbreviations

AAE:

Erworbenes Angioödem

ACE:

Angiotensin converting enzyme

ACEH:

ACE-Hemmer

ASL:

Antistreptolysin

CRP:

C-reaktives Protein

FFP:

Fresh frozen plasma

HAE:

Hereditäres Angioödem

IAE:

Idiopathisches Angioödem

INH:

Inhibitor

RAAS:

Renin-Angiotensin-Aldosteron-System

RAE:

RAAS-Blocker-induziertes Angioödem

TNF:

Tumornekrosefaktor

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Authors and Affiliations

  1. Hals-Nasen-Ohrenklinik und Poliklinik Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutchland

    Murat Bas & Ulrich Strassen

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  1. Murat Bas
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  2. Ulrich Strassen
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Correspondence to Murat Bas.

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*You can find an authorised Englisch version of this article online at http://link.springer.com

Interessenkonflikt

Murat Bas erhielt von Shire, CSL Behring und Viropharma finanzielle Forschungsunterstützung und Honorare für Beratungen.

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Bas, M., Strassen, U. Angioödeme der Kopf-Hals-Region. Allergo J 22, 118–127 (2013). https://doi.org/10.1007/s15007-013-0050-2

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