Exploring the management of recurrent angioedema caused by different mechanisms.

IF 3 4区医学 Q2 ALLERGY Current Opinion in Allergy and Clinical Immunology Pub Date : 2025-02-01 Epub Date: 2024-11-28 DOI:10.1097/ACI.0000000000001047

Ilaria Mormile, Chiara Suffritti, Maria Bova

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Abstract

Purpose of review: We aim to explore the most recent insights into the pathogenesis of recurrent angioedema caused by different mechanisms and then focus on the management and treatment approaches available.

Recent findings: The recently developed DANCE consensus classification identifies five types of angioedema: mast cell-mediated (AE-MC), bradykinin-mediated, because of intrinsic vascular endothelium dysfunction (AE-VE), drug-induced (AE-DI), and due to unknown mechanisms (AE-UNK). These subtypes require different management with treatment choices targeting the main pathogenetic pathways involved in each form. For AE-MC and AE-BK, the therapeutic landscape has been significantly widened in recent years. Conversely, there is a lack of consensus for the hereditary forms because of newly discovered mutations ( factor 12 , plasminogen, kininogen-1 , myoferlin, angiopoietin-1 , heparan sulfate 3-O-sulfotransferase 6 ) and AE-UNK.

Summary: Recurrent angioedema can present with or without wheals. Angioedema without wheals may be driven by bradykinin and/or mast cell mediators. The different forms respond to specific drugs and require a different management. For its potentially life-threatening and disfiguring features, angioedema should be promptly recognized and effectively treated. For this reason, enhancing awareness about various angioedema subtypes and their management provide a useful tool for the clinical practice.

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探讨不同机制所致复发性血管性水肿的处理。

综述的目的：我们旨在探讨由不同机制引起的复发性血管性水肿的发病机制的最新见解，然后重点介绍现有的管理和治疗方法。最近的发现：最近发展的DANCE共识分类确定了五种类型的血管性水肿：肥大细胞介导（AE-MC），缓激素介导，由于内在血管内皮功能障碍（AE-VE），药物诱导（AE-DI）和由于未知机制（AE-UNK）。这些亚型需要针对每种形式的主要发病途径选择不同的治疗方法。对于AE-MC和AE-BK，近年来治疗前景已显著扩大。相反，由于新发现的突变（因子12、纤溶酶原、激肽原-1、肌血红素、血管生成素-1、硫酸肝素3- o -硫转移酶6）和AE-UNK，对遗传形式缺乏共识。总结：复发性血管性水肿可伴有或不伴有小轮。无轮的血管性水肿可能由缓激素和/或肥大细胞介质驱动。不同的形式对特定的药物有反应，需要不同的管理。由于其潜在的危及生命和毁容的特征，血管性水肿应及时识别和有效治疗。因此，提高对各种血管性水肿亚型及其管理的认识为临床实践提供了有用的工具。

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来源期刊

Current Opinion in Allergy and Clinical Immunology 医学-过敏

CiteScore

5.90

自引率

3.60%

发文量

109

审稿时长

6-12 weeks

期刊介绍： This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on one to three topics, every issue of Current Opinion in Allergy and Clinical Immunology delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as upper airway disease; mechanisms of allergy and adult asthma; paediatric asthma and development of atopy; food and drug allergies; and immunotherapy.

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