Allergo Journal

, Volume 22, Issue 2, pp 118–127

Angioödeme der Kopf-Hals-Region

Übersicht Review Article
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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.

Schlüsselwörter

Akutes Angioödem Bradykinin Icatibant C1-Inhibitor ACE-Hemmer Diagnostik Therapie 

Verwendete Abkürzungen

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

Angioedema of the head and neck

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.

Keywords

Acute angioedema bradykinin icatibant C1-inhibitor ACE inhibitor diagnostics therapy 

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Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  1. 1.Hals-Nasen-Ohrenklinik und Poliklinik Klinikum rechts der IsarTechnische Universität MünchenMünchenDeutchland

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