Pedrosa Maria, Prieto-García Alicia, Sala-Cunill Anna
Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
Ann Med. 2014 Dec;46(8):607-18. doi: 10.3109/07853890.2014.949300.
Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.
血管性水肿是指深层皮肤、上呼吸道或胃肠道黏膜的局限性、暂时性肿胀。它主要由两种不同的血管活性肽，即组胺或缓激肽引起。每种情况下的病理生理学以及治疗方法都有所不同；然而，所产生的体征和症状可能相似且难以区分。血管性水肿可发生于任何部位。当受累区域涉及上呼吸道时，两种类型的血管性水肿均可导致即将发生的上气道梗阻并引发危及生命的紧急情况。急诊医生必须对这一过程的病理生理学有基本的了解。急诊科对血管性水肿的评估应旨在区分组胺介导和缓激肽介导的血管性水肿，以便为患者提供适当的治疗。然而，在急诊科环境中无法获得诊断方法，既无法证实是哪种机制，也无法确定病因。因此，血管性水肿的管理应根据具体病例中发作和患者的特定特征，依靠临床数据。问诊应致力于识别可能的病因或触发因素，记录完整信息以便后续在门诊进行诊断性研究。必须迅速识别并治疗潜在的危及生命的上气道梗阻或过敏反应。本综述重点关注急诊科组胺介导和缓激肽介导的血管性水肿的潜在机制及管理，并提供当前可用治疗方法的最新信息。
