Boccon-Gibod I, Bouillet L
Centre national de référence des angioedèmes (CREAK), CHU de Grenoble, Hôpital Nord, Boulevard de la Chantourne, 38700 La Tronche, France; Clinique universitaire de médecine interne, Pôle pluridisciplinaire de médecine, CHU de Grenoble - Hôpital Albert Michallon, BP 217, Boulevard de la Chantourne, 38043 Grenoble cedex 9, France.
Centre national de référence des angioedèmes (CREAK), CHU de Grenoble, Hôpital Nord, Boulevard de la Chantourne, 38700 La Tronche, France; Clinique universitaire de médecine interne, Pôle pluridisciplinaire de médecine, CHU de Grenoble - Hôpital Albert Michallon, BP 217, Boulevard de la Chantourne, 38043 Grenoble cedex 9, France.
Ann Dermatol Venereol. 2014 Nov;141 Suppl 3:S586-95. doi: 10.1016/S0151-9638(14)70162-0.
Angiœdema (AE) is the clinical expression of urticaria (U) which occurs when urticaria is located within the subcutis. It is a syndrome characterized by a sudden and limited subcutaneous and/or submucous swelling. The updated classification of urticaria distinguishes acute and chronic urticaria. Chronic urticaria is spontaneous (CSU) or inducible (CIU). Angioedema in chronic urticaria is rarely allergic, but most of the time caused by a non-specific histamine release from activated mast-cell (non IgE mediated reaction). Angioedemas are recurrent, concomitant or not with wheals. They appear skin-coloured, sometimes slightly rosy, non-inflammatory, and more painful than itchy. They are transient, ephemeral, migrant, last most of the time a few hours (< 24 or 48h) and disappear without after-effects. They are considered "deep urticaria" and wheals "superficial urticaria". When AE or wheals last more than 6 weeks (with or without free intermission), it is called chronic urticaria. Angioedema can be elicited or worsened by physical factors (cold urticaria, exercise, heat, solar, vibratory, aquagenic, delayed pressure urticaria…) and /or drugs (as aspirin, nonsteroid anti-inflammatory drugs, morphine, antibiotics…). The treatment of histaminergic angioedemas of chronic urticaria is based on modern second generation antihistamines (anti H1). In allergic acute urticaria only, additional treatment for anaphylaxis can be used if needed (grade 2 to 4). In chronic urticaria, steroids should be avoided : they can make symptoms worse and long-lasting because of corticosteroid dependence.
血管性水肿（AE）是荨麻疹（U）的临床表现，当荨麻疹位于皮下组织时就会出现。它是一种以突发性、局限性皮下和/或黏膜下肿胀为特征的综合征。最新的荨麻疹分类区分了急性和慢性荨麻疹。慢性荨麻疹分为自发性（CSU）或诱导性（CIU）。慢性荨麻疹中的血管性水肿很少是过敏性的，但大多数情况下是由活化肥大细胞释放非特异性组胺引起的（非IgE介导反应）。血管性水肿反复发作，可伴有或不伴有风团。它们呈肤色，有时略带红润，无炎症，疼痛比瘙痒更明显。它们是短暂的、临时的、游走性的，大多数情况下持续数小时（<24或48小时），消退后无后遗症。它们被认为是“深部荨麻疹”，而风团是“浅表性荨麻疹”。当AE或风团持续超过6周（无论有无间歇期）时，称为慢性荨麻疹。血管性水肿可由物理因素（寒冷性荨麻疹、运动、热、日光、振动、水源性、迟发性压力性荨麻疹等）和/或药物（如阿司匹林、非甾体类抗炎药、吗啡、抗生素等）诱发或加重。慢性荨麻疹组胺能性血管性水肿的治疗基于现代第二代抗组胺药（抗H1）。仅在过敏性急性荨麻疹中，如有必要可使用额外的过敏反应治疗（2至4级）。在慢性荨麻疹中，应避免使用类固醇：由于皮质类固醇依赖，它们会使症状加重且持续时间延长。
