Quincke's edema: diagnosis and management of 102 patients with sudden upper airway obstruction
Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study...
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Veröffentlicht in: | Laryngo- rhino- otologie 2007-06, Vol.86 (6), p.416-419 |
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description | Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study is to provide information on the incidence, diagnosis and treatment of laryngeal edema with upper airway obstruction in general and due to HAE.
102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004.
63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH).
According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives. |
doi_str_mv | 10.1055/s-2007-966506 |
format | Article |
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102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004.
63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH).
According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives.</description><identifier>ISSN: 0935-8943</identifier><identifier>DOI: 10.1055/s-2007-966506</identifier><identifier>PMID: 17487816</identifier><language>ger</language><publisher>Germany</publisher><subject>Adult ; Aged ; Airway Obstruction - diagnosis ; Airway Obstruction - etiology ; Airway Obstruction - therapy ; Angioedema - diagnosis ; Angioedema - genetics ; Angioedema - therapy ; Combined Modality Therapy ; Complement C1 Inactivator Proteins - deficiency ; Dimethindene - therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Intubation, Intratracheal ; Laryngeal Edema - diagnosis ; Laryngeal Edema - etiology ; Laryngeal Edema - therapy ; Male ; Middle Aged ; Prednisolone - analogs & derivatives ; Prednisolone - therapeutic use</subject><ispartof>Laryngo- rhino- otologie, 2007-06, Vol.86 (6), p.416-419</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17487816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stelter, K</creatorcontrib><creatorcontrib>Lübbers, C W</creatorcontrib><creatorcontrib>Andratschke, M</creatorcontrib><creatorcontrib>Leunig, A</creatorcontrib><title>Quincke's edema: diagnosis and management of 102 patients with sudden upper airway obstruction</title><title>Laryngo- rhino- otologie</title><addtitle>Laryngorhinootologie</addtitle><description>Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study is to provide information on the incidence, diagnosis and treatment of laryngeal edema with upper airway obstruction in general and due to HAE.
102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004.
63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH).
According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives.</description><subject>Adult</subject><subject>Aged</subject><subject>Airway Obstruction - diagnosis</subject><subject>Airway Obstruction - etiology</subject><subject>Airway Obstruction - therapy</subject><subject>Angioedema - diagnosis</subject><subject>Angioedema - genetics</subject><subject>Angioedema - therapy</subject><subject>Combined Modality Therapy</subject><subject>Complement C1 Inactivator Proteins - deficiency</subject><subject>Dimethindene - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Intubation, Intratracheal</subject><subject>Laryngeal Edema - diagnosis</subject><subject>Laryngeal Edema - etiology</subject><subject>Laryngeal Edema - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prednisolone - analogs & derivatives</subject><subject>Prednisolone - therapeutic use</subject><issn>0935-8943</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kEtLxDAUhbNQnHF06Vay0lU1ado83MkwPmBABN1abpLbMTpNa9MyzL-34Lg6HPg4cD5CLji74awsb1OWM6YyI2XJ5BGZMyPKTJtCzMhpSl-M8cIwfUJmXBVaaS7n5ON1DNF943Wi6LGBO-oDbGKbQqIQPW0gwgYbjANta8pZTjsYwlQT3YXhk6bRe4x07DrsKYR-B3va2jT0oxtCG8_IcQ3bhOeHXJD3h9Xb8ilbvzw-L-_XWceFGbJc5wV3srbMKl8IMKVBlKzOVQ12emONcVY47UChMVx7o5QRxiLIidEgFuTqb7fr258R01A1ITncbiFiO6ZKTXq0yNkEXh7A0Tboq64PDfT76t-I-AX2IGE3</recordid><startdate>200706</startdate><enddate>200706</enddate><creator>Stelter, K</creator><creator>Lübbers, C W</creator><creator>Andratschke, M</creator><creator>Leunig, A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200706</creationdate><title>Quincke's edema: diagnosis and management of 102 patients with sudden upper airway obstruction</title><author>Stelter, K ; Lübbers, C W ; Andratschke, M ; Leunig, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p139t-28241c6fb0b7d43a959ee60f27fab665b99cb3c8ca7e9918d977939bea6f278a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>ger</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Airway Obstruction - diagnosis</topic><topic>Airway Obstruction - etiology</topic><topic>Airway Obstruction - therapy</topic><topic>Angioedema - diagnosis</topic><topic>Angioedema - genetics</topic><topic>Angioedema - therapy</topic><topic>Combined Modality Therapy</topic><topic>Complement C1 Inactivator Proteins - deficiency</topic><topic>Dimethindene - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Intubation, Intratracheal</topic><topic>Laryngeal Edema - diagnosis</topic><topic>Laryngeal Edema - etiology</topic><topic>Laryngeal Edema - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prednisolone - analogs & derivatives</topic><topic>Prednisolone - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stelter, K</creatorcontrib><creatorcontrib>Lübbers, C W</creatorcontrib><creatorcontrib>Andratschke, M</creatorcontrib><creatorcontrib>Leunig, A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Laryngo- rhino- otologie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stelter, K</au><au>Lübbers, C W</au><au>Andratschke, M</au><au>Leunig, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quincke's edema: diagnosis and management of 102 patients with sudden upper airway obstruction</atitle><jtitle>Laryngo- rhino- otologie</jtitle><addtitle>Laryngorhinootologie</addtitle><date>2007-06</date><risdate>2007</risdate><volume>86</volume><issue>6</issue><spage>416</spage><epage>419</epage><pages>416-419</pages><issn>0935-8943</issn><abstract>Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study is to provide information on the incidence, diagnosis and treatment of laryngeal edema with upper airway obstruction in general and due to HAE.
102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004.
63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH).
According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives.</abstract><cop>Germany</cop><pmid>17487816</pmid><doi>10.1055/s-2007-966506</doi><tpages>4</tpages></addata></record> |
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subjects | Adult Aged Airway Obstruction - diagnosis Airway Obstruction - etiology Airway Obstruction - therapy Angioedema - diagnosis Angioedema - genetics Angioedema - therapy Combined Modality Therapy Complement C1 Inactivator Proteins - deficiency Dimethindene - therapeutic use Drug Therapy, Combination Female Humans Intubation, Intratracheal Laryngeal Edema - diagnosis Laryngeal Edema - etiology Laryngeal Edema - therapy Male Middle Aged Prednisolone - analogs & derivatives Prednisolone - therapeutic use |
title | Quincke's edema: diagnosis and management of 102 patients with sudden upper airway obstruction |
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