Journal Information
Vol. 98. Issue 4.
Pages 240-249 (May 2007)
Vol. 98. Issue 4.
Pages 240-249 (May 2007)
Practical dermatology
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Practical Management of C1 Inhibitor Deficiency
Manejo Práctico del Déficit de C1 Inhibidor
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J. Pedraz
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javierpedraz@aedv.es

Correspondence: Servicio de Dermatología, Hospital Universitario de la Princesa, C/ Diego de León, 62, 28006 Madrid, Spain.
, E. Daudén, A. García-Diez
Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain
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Abstract

C1 inhibitor deficiency is a rare syndrome clinically characterized by recurrent episodes of swelling of subcutaneous tissue or angioedema. It can involve the skin, upper respiratory airways and abdomen. There are two main types: hereditary and acquired. Angioedema can involve practically any part of the cutaneous surface, it can cause lethal laryngeal edema and can present as gastrointestinal obstruction. The attacks can be triggered, in general, by trauma, drugs or infections. Diagnosis is confirmed by decreased serum levels of C4 and absence or marked decrease of the level or function of C1 inhibitor. Commonly employed drugs for prophylaxis and treatment of these patients include anabolic steroids, antifibrinolytic agents, and infusion of C1 inhibitor concentrate. Fresh frozen plasma is an option to be considered for short term prophylaxis or treatment of the acute attack. It is convenient to know this syndrome as it is a potentially life-threatening disease. Diagnosis of this rare syndrome is based on clinical features and characteristic alterations of laboratory tests. The acute attack should be treated as quickly as possible. Prophylactic therapy is indicated in certain circumstances (dental procedures, oral surgery).

Key words:
angioedema
C1 inhibitor deficiency
androgens
antifibrinolytics
Resumen

El déficit de C1 inhibidor es un raro síndrome caracterizado clínicamente por episodios recurrentes de tumefacción en el tejido celular subcutáneo o angioedema. Puede afectar a la piel, las vías respiratorias superiores y el abdomen. Se describen principalmente dos tipos: hereditario y adquirido. El angioedema puede afectar a prácticamente cualquier parte de la superficie cutánea, puede causar edema laríngeo mortal y cursar con características clínicas idénticas a una obstrucción del tracto gastrointestinal. Los ataques pueden ser desencadenados, de forma general por traumatismos, fármacos o infecciones. El diagnóstico se confirma mediante la presencia de C4 disminuido en suero y la ausencia o gran reducción del nivel o la función de C1 inhibidor. Los andrógenos atenuados, los agentes antifibrinolíticos y la infusión de concentrado de C1 inhibidor son los fármacos habitualmente utilizados en el manejo profiláctico y terapéutico de estos pacientes. El plasma fresco congelado es una opción a considerar en caso de profilaxis a corto plazo o ataque agudo. Es conveniente conocer este síndrome, ya que se trata de una enfermedad potencialmente mortal. El diagnóstico de este raro síndrome se basa en el reconocimiento de las características clínicas y en las alteraciones características de las pruebas de laboratorio. El tratamiento del ataque agudo se debe realizar lo más rápidamente posible. El tratamiento profiláctico está indicado en determinadas situaciones (manejo dental y cirugía oral).

Palabras clave:
angioedema
déficit C1 inhibidor
andrógenos
antifibrinolíticos
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References
[1.]
T. Bowen, M. Cicardi, H. Farkas, K. Bork, W. Kreuz, L. Zingale, et al.
Canadian 2003 International Consensus Algorithm for the diagnosis, therapy, and management of hereditary angioedema.
J Allergy Clin Immunol, 114 (2004), pp. 629-637
[2.]
M.M. Gompels, R.J. Lock, M. Abinun, C.A. Bethune, G. Davies, C. Grattan, et al.
C1 inhibitor deficiency: consensus document.
Clin Exp Immunol, 139 (2005), pp. 379-394
[3.]
J.E. Fabiana, A. Avigliano, J.C. Dupont.
Hereditary angioedema. Long-term follow-up of 88 patients. Experience of the Argentine Allergy and Immunology Institute.
Allergol Immunopathol, 28 (2000), pp. 267-271
[4.]
K. Bork, S. Barnstedt, P. Koch, H. Traupe.
Hereditary angioedema with normal C1-inhibitor activity in women.
[5.]
J.C. Starr, G.W. Brasher.
Erythema marginatum preceding hereditary angioedema.
J Allergy Clin Immunol, 53 (1974), pp. 352-355
[6.]
D.M. Williamson.
Reticulate erythema – a prodrome in hereditary angio-oedema.
Br J Dermatol, 101 (1979), pp. 549-552
[7.]
M.M. Frank, J.A. Gelfand, J.P. Atkinson.
Hereditary angioedema: the clinical syndrome and its management.
Ann Intern Med, 84 (1976), pp. 580-593
[8.]
V. Karlis, R.S. Glickman, R. Stern, L. Kinney.
Hereditary angioedema: case report and review of management.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 83 (1997), pp. 462-464
[9.]
K. Bork, B. Fischer, G. Dewald.
Recurrent episodes of skin angioedema and severe attacks of abdominal pain induced by oral contraceptives or hormone replacement therapy.
Am J Med, 114 (2003), pp. 294-298
[10.]
O. Chappatte, M. De Swiet.
Hereditary angioneurotic oedema and pregnancy. Case reports and review of the literature.
Br J Obstet Gynaecol, 95 (1988), pp. 938-942
[11.]
M. Rais, J. Unzeiting, J.A. Grant.
Refractory exacerbations of hereditary angioedema with associated Helicobacter pylori infection.
J Allergy Clin Immunol, 103 (1999), pp. 713-714
[12.]
H. Farkas, L. Gyeney, P. Majthenyi, G. Fust, L. Varga.
Angioedema due to acquired C1-esterase inhibitor deficiency in a patient with Helicobacter pylori infection.
Z Gastroenterol, 37 (1999), pp. 513-518
[13.]
R.A. Longan, M.W. Greaves.
Hereditary angio-oedema: treatment with C1 esterase inhibitor concentrate.
J R Soc Med, 77 (1984), pp. 1046-1048
[14.]
M.M. Gompels, R.J. Lock, J.E. Morgan, J. Osborne, A. Brown, P.F. Virgo.
A multi-centre evaluation of the diagnostic efficiency of serological investigations for C1 inhibitor deficiency.
J Clin Pathol, 55 (2002), pp. 145-147
[15.]
M.M. Gompels, R.J. Lock.
C1 inhibitor deficiency: diagnosis.
Clin Exp Dermatol, 30 (2005), pp. 460-462
[16.]
E.W. Nielsen, H.T. Johansen, J. Holt, T.E. Mollnes.
C1 inhibitor and diagnosis of hereditary angioedema in newborns.
Pediatr Res, 35 (1994), pp. 184-187
[17.]
C.R. Weiler, R.G. Van Dellen.
Genetic test indications and interpretations in patients with hereditary angioedema.
Mayo Clin Proc, 81 (2006), pp. 958-972
[18.]
J.A. Gelfand, R.J. Sherins, D.W. Alling, M.M. Frank.
Treatment of hereditary angioedema with danazol. Reversal of clinical and biochemical abnormalities.
N Engl J Med, 295 (1976), pp. 1444-1448
[19.]
A. Agostini, M. Cicardi, G.C. Martignoni, L. Bergamaschini, B. Marasini.
Danazol and stanozolol in long-term prophylactic treatment of hereditary angioedema.
J Allergy Clin Immunol, 65 (1980), pp. 75-79
[20.]
A.L. Sheffer, D.T. Fearson, K.F. Austen.
Hereditary angioedema: a decade of management with stanozolol.
J Allergy Clin Immunol, 80 (1987), pp. 855-860
[21.]
K. Bork, M. Pitton, P. Harten, P. Koch.
Hepatocellular adenomas in patients taking danazol for hereditary angio-edema.
Lancet, 353 (1999), pp. 1066-1067
[22.]
M.M. Frank, J.S. Sergent, M.A. Kane, D.W. Alling.
Epsilon aminocaproic acid therapy of hereditary angioneurotic edema: a double blind study.
N Engl J Med, 286 (1972), pp. 808-812
[23.]
K. Bork, S. Barnstedt.
Treatment of 193 episodes of laryngeal edema with C1 inhibitor concentrate in patients with hereditary angioedema.
Arch Intern Med, 161 (2001), pp. 714-718
[24.]
P. Naish, J. Barratt.
Hereditary angioedema.
Lancet, i (1979), pp. 611
[25.]
K. Bork, K. Siedlecki, S. Bosch, R. Schopf, W. Kreuz.
Asphyxiation by laryngeal edema in patients with hereditary angioedema.
Mayo Clin Proc, 75 (2000), pp. 349-354
[26.]
M. Cicardi, L.C. Zingale, E. Pappalardo, A. Folcioni, A. Agostini.
Autoantibodies and lymphoproliferative diseases in acquired C1-inhibitor deficiencies.
Medicine (Baltimore), 82 (2003), pp. 274-281
[27.]
G. Herrmann, L. Schneider, T. Krieg, N. Hunzelmann, K. Scharffetter-Kochanek.
Efficacy of danazol treatment in a patient with the new variant of hereditary angio-edema (HAE III).
Br J Dermatol, 150 (2004), pp. 155-177
[28.]
M.M. Frank.
Urticaria and angioedema.
Cecil Textbook of Medicine, 21st ed., pp. 1440-1445
[29.]
J. Laurent, M.T. Guinnepain.
Angioedema associated with C1 inhibitor deficiency.
Clin Rev Allergy Immunol, 17 (1999), pp. 513-523
[30.]
M. Bas, H. Bier, J. Greve, G. Kojda, T.K. Hoffmann.
Novel pharmacotherapy of acute hereditary angioedema with bradykinin B2-receptor antagonist icatibant.
[31.]
M.B. Van Doom, J. Burggraaf, T. Van Dam, A. Eerenberg, M. Levi, C.E. Hack, et al.
A phase I study of recombinant human C1 inhibitor in asymptomatic patients with hereditary angioedema.
J Allergy Clin Immunol, 116 (2005), pp. 876-883
Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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