Bradykinin mediated angioedema

Bradykinin angioedema (AE) are characterized by acute recurrent episodes of localized swelling. They are not associated with pruritus or erythema, and are short-lived (24 to 72 hours), disappearing without any sequelae. Corticosteroids are useless. Skin or mucous membranes (upper respiratory and intestinal) could be affected. Bradykinin AE can be secondary to: (1) AE associated with Cl inhibitor deficiency (hereditary or acquired); (2) drug-induced AE (converting enzyme inhibitors...): (3) type III AE type (oestrogen dependant) without Cl inhibitor deficiency. These type III AE can be associated with a gain of function mutation that markedly increases factor XII activity. Prognosis depends on the laryngeal attacks (resulting in 25% of death in the absence of specific treatment). In case of severe attacks, icatibant (bradykinin receptor antagonist) or Cl inhibitor concentrate can be used. In case of frequent attacks, long-term therapy with danazol or tranexamic acid is effective. (C) 2010 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.