Consensus statement on the diagnosis, management, and treatment of Angiodema mediated by Bradykinin. Part I. Classification, epidemiology, pathophysiology, genetics, clinical symptoms, and diagnosis

Abstract

Background: There are no Spanish guidelines or consensus statement on bradykinin-induced angioedema. Aim: To review the pathophysiology, genetics, and clinical symptoms of the different types of bradykinin-induced angioedema and to draft a consensus statement in light of currently available scientifi c evidence and the experience of experts. This statement will serve as a guideline to health professionals. Methods: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema (SGBA), a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientifi c papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor defi ciency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings of the SGBA were held in Madrid to reach the consensus. Results: The pathophysiology, genetics, and clinical symptoms of the different types of angioedema are reviewed. Diagnostic approaches are discussed and the consensus reached is described. Conclusions: A review of bradykinin-induced angioedema and a consensus on diagnosis are presentedIntroducción: No existen guías previas españolas sobre el manejo del angioedema mediado por bradicinina. Objetivos: Revisar la fi siopatología, genética y clínica y alcanzar un consenso sobre el diagnóstico de los diferentes tipos de angioedema mediado por bradicinina a la luz de la evidencia científi ca disponible y la experiencia de los expertos, que sirva como guía para profesionales de la salud. Métodos: SGBA/GEAB, un grupo de trabajo de la SEAIC dirigió el consenso. Se realizó una revisión de los documentos científi cos publicados sobre los diferentes tipos de angioedema mediado por bradicinina [angioedema hereditario o adquirido por defi ciencia de inhibidor de la C1 esterasa, angioedema hereditario relacionado con estrógenos (AEH tipo III, AEH-FXII), angioedema inducido por IECA (inhibidores del enzima convertidor de angiotensina]. Hubo varias reuniones del SGBA/GEAB para alcanzar el consenso. Resultados: Se revisan la fi siopatología, genética y clínica de los diferentes tipos de angioedema por bradicinina. Por otro lado, se discuten los procedimientos diagnósticos y se describe el consenso alcanzado sobre el diagnóstico. Conclusiones: Se presenta una revisión del angioedema mediado por bradicinina y un consenso sobre el diagnóstico del angioedema mediado por bradicina.Dr. Teresa Caballero is a researcher with the Hospital La Paz Health Research Institute (IdiPaz) program for promoting research activities (2009). Publication of this manuscript is sponsored by the Spanish Society of Allergy and Clinical Immunology (SEAIC) and IdiPa