Zampeli V, Magerl M
Klinik für Dermatologie, Venerologie und Allergologie, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Hautarzt. 2019 Feb;70(2):107-115. doi: 10.1007/s00105-018-4345-9.
Angioedema is a spontaneous, edematous swelling of the deep layers of the skin or mucous membrane. Angioedema in the respiratory tract is potentially life-threatening. The classification of angioedema into mast-cell-mediated (e. g. urticaria) or bradykinin-mediated (e. g. hereditary angioedema) is important for correct and rational treatment. Generally, two therapeutic strategies are available for angioedema treatment. On-demand treatment of angioedema symptoms that already have emerged aims to stop the further development of the attack and, thus, limits the severity and duration of the attack. This strategy is well established in the treatment of patients with hereditary angioedema, whereas in chronic spontaneous urticaria on-demand therapy plays no role in the guideline recommendations. In contrast, the therapeutic strategy of prophylaxis aims to prevent the occurrence of spontaneous and induced attacks as far as possible. Prophylaxis is the sole therapy strategy for chronic urticaria and is applied at all stages of the treatment algorithm. In the case of hereditary angioedema, on-demand therapy can be complemented by prophylaxis after careful and individual indication. In hereditary angioedema, prophylaxis is currently gaining in importance due to improved treatment options. Patients who use a prophylactic regime are much less likely to be forced to wait for the unpredictable occurrence of an attack and then to react with an on-demand treatment. Prophylactic treatment takes place at times determined by the patient himself, in contrast to treatment on an as-needed basis. The loss of unpredictability is a decisive moment in improving the quality of life.
血管性水肿是皮肤或黏膜深层的自发性水肿肿胀。呼吸道的血管性水肿有潜在生命危险。将血管性水肿分为肥大细胞介导型(如荨麻疹)或缓激肽介导型(如遗传性血管性水肿)对于正确合理的治疗很重要。一般来说,血管性水肿治疗有两种策略。对已出现的血管性水肿症状进行按需治疗旨在阻止发作的进一步发展,从而限制发作的严重程度和持续时间。这种策略在遗传性血管性水肿患者的治疗中已得到充分确立,而在慢性自发性荨麻疹中,按需治疗在指南推荐中不起作用。相比之下,预防治疗策略旨在尽可能预防自发性和诱发性发作的发生。预防是慢性荨麻疹的唯一治疗策略,并且应用于治疗方案的所有阶段。在遗传性血管性水肿中,经过仔细的个体化评估后,按需治疗可辅以预防治疗。在遗传性血管性水肿中,由于治疗选择的改善,预防目前变得越来越重要。与按需治疗相比,采用预防方案的患者不太可能被迫等待不可预测的发作发生然后进行按需治疗。预防性治疗在患者自己确定的时间进行,这是提高生活质量的一个决定性时刻。