Cosatti Micaela, Fernández Romero Diego S, Juri María Cecilia, Malbrán Alejandro
Unidad de Alergia, Asma e Inmunología Clínica, Hospital Británico de Buenos Aires, Argentina.
Medicina (B Aires). 2010;70(6):513-7.
The use of fillers for cosmetic purposes is becoming increasingly frequent. Although initially considered inert, these products produce adverse reactions around the injection site. We present 5 cases of women with a history of filler injections who presented a hard and persistent angioedema followed by local subcutaneous nodules. They were referred to the allergist for suspected allergy related angioedema without response to usual antihistamine treatment. The angioedema episodes initiated 27.6 months (range 1 to 48) after the fillers treatment. The patients underwent exacerbations and remissions of angioedema, partially relieved with oral steroids and, in 2 cases, local triamcinolone injections. Mean time from onset of symptoms to remission of angioedema was 8.75 months (range 1 to 24). Until October 2009 four patients continued into remission after 24.5 months (range 7 to 36) free of symptoms. One patient continued with exacerbations 11 months after the initial symptoms. Fillers may cause angioedema as an adverse event and should be considered in the differential diagnosis of persistent angioedema. They are only sensitive to steroid treatment and in some steroid dependent cases they respond to ciclosporin. The frequency of angioedema after filler injections among patients with angioedema in the Unit of Asthma Allergy and Clinical Immunology was 0.5%.
出于美容目的使用填充剂的情况越来越频繁。尽管这些产品最初被认为是惰性的，但它们会在注射部位产生不良反应。我们报告了5例有填充剂注射史的女性病例，她们出现了坚硬且持续的血管性水肿，随后出现局部皮下结节。她们因疑似与过敏相关的血管性水肿被转诊至过敏症专科医生处，但对常规抗组胺治疗无反应。血管性水肿发作于填充剂治疗后27.6个月（范围为1至48个月）。患者经历了血管性水肿的加重和缓解，口服类固醇可部分缓解，2例患者还接受了局部曲安奈德注射。从症状出现到血管性水肿缓解的平均时间为8.75个月（范围为1至24个月）。截至2009年10月，4例患者在无症状的24.5个月（范围为7至36个月）后持续缓解。1例患者在初始症状出现11个月后仍有病情加重。填充剂可能会导致血管性水肿作为一种不良事件，在持续性血管性水肿的鉴别诊断中应予以考虑。它们仅对类固醇治疗敏感，在一些依赖类固醇的病例中，它们对环孢素也有反应。哮喘过敏与临床免疫科血管性水肿患者中填充剂注射后血管性水肿的发生率为0.5%。
