ALLERGY: ANAPHYLAXIS |
Treatment of 193 Episodes of Laryngeal Edema with C1 Inhibitor Concentrate in Patients with Hereditary Angioedema
Aurora, CO
Purpose. Hereditary angioedema (HAE) is an autosomal dominant disease (Mendelian Inheritance in Man 106100) caused by an inherited deficiency of C1 inhibitor (C1-INH) function. The clinical symptoms include skin swelling, abdominal pain, and life-threatening episodes of upper airway obstruction. The authors evaluated the efficacy of C1-INH concentrate for treating sudden airway compromise.
Patient Population and Methods. A series of 95 patients with HAE and a functional deficiency of C1-INH belonging to 59 families underwent screening for laryngeal edema. Double-blind treatment of randomized patients was not justifiable because of the life-threatening nature of this condition. Efficacy was evaluated by determining the interval from injection of C1-INH concentrate to the beginning of resolution of symptoms. The mean duration of episodes of laryngeal edema was compared in treated and untreated patients. Clinical information was obtained from emergency department physicians, the hospitals involved, reports of the general practitioners, and patients and their relatives.
Results. Forty-two patients had 517 episodes of laryngeal edema. Eighteen patients received 500- or 1000-U injections of C1-INH concentrate in 193 episodes. The C1-INH concentrate was effective in all laryngeal edemas. The interval from injection to interruption in progress of symptoms ranged from 10 minutes to 4 hours (mean standard deviation: 42.2 ± 19.9 minutes). The mean standard deviation duration of laryngeal edema was 15.3 ± 9.3 hours in patients who received C1-INH concentrate and 100.8 ± 26.2 hours in those who did not.
Conclusions. Injected C1-INH concentrate is highly and rapidly effective in the treatment of laryngeal edema of HAE. Relief and resolution of symptoms begins 30 to 60 minutes after injection, and duration of the upper airway obstruction is substantially reduced.
Reviewer’s Comments. Injection of the C1-INH preparation, now available in Europe, has been successful in helping resolution of the episodic swelling of the skin and intestinal mucosa, which commonly occur in HAE. However, before this study the use of the C1-INH concentrate had not been assessed in laryngeal edema of HAE because of the rapid onset and potential fatality of this complication. Although this study is not carefully controlled, the results are encouraging, especially because emergency measures, such as tracheostomy, were never required. Hopefully, this C1-INH concentrate will soon be readily available in all countries.
REFERENCES
Bork K, Barnstedt SE.
Arch Intern Med.2001; 161
:714
–718
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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