Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Clin Rev Allergy Immunol. 2021 Aug;61(1):40-49. doi: 10.1007/s12016-021-08841-w. Epub 2021 Feb 3.
Angioedema (AE), transient localized swelling due to extravasated fluid, is commonly classified as mast cell mediator-induced, bradykinin-mediated or of unknown cause. AE often occurs more than once, and it is these recurrent forms of AE that are challenging for patients and physicians, and they are the ones we focus on and refer to as AE in this review. Since effective treatment depends on the causative mediator, reliable and early diagnosis is essential. Although their clinical presentations bear similarities, many forms of angioedema exhibit specific patterns of clinical appearance or disease history that may aid in diagnosis. Here, we describe the most common differences and similarities in the mechanisms and clinical features of bradykinin-mediated and mast cell mediator-induced types of angioedema. We first provide an overview of the diseases that manifest with mast cell mediator-induced versus bradykinin-mediated angioedema as well as their respective underlying pathogenesis. We then compare these diseases for key clinical features, including angioedema location, course and duration of swelling, attack frequency, prevalence and relevance of prodromal signs and symptoms, triggers of angioedema attacks, and other signs and symptoms including wheals, age of onset, and duration. Our review and comparison of the clinical profiles of different types of angioedema incorporate our own clinical experience as well as published information. Our aim is to highlight that mast cell mediator-induced and bradykinin-mediated angioedema types share common features but are different in many aspects. Knowledge of the differences in underlying pathomechanisms and clinical profiles between different types of angioedema can help with the diagnostic approach in affected patients and facilitate targeted and effective treatment.
血管性水肿（AE）是一种由于液体外渗导致的短暂局部肿胀，通常分为肥大细胞介质诱导型、缓激肽介导型或原因不明型。AE 常反复发作，正是这些复发性 AE 给患者和医生带来了挑战，我们在本综述中关注并提到的正是这些复发性 AE。由于有效的治疗取决于致病介质，因此可靠和早期的诊断至关重要。尽管它们的临床表现相似，但许多形式的血管性水肿表现出特定的临床特征或疾病史，这可能有助于诊断。在这里，我们描述了缓激肽介导型和肥大细胞介质诱导型血管性水肿在机制和临床特征方面最常见的异同。我们首先概述了表现为肥大细胞介质诱导型和缓激肽介导型血管性水肿的疾病及其各自的潜在发病机制。然后，我们比较了这些疾病的关键临床特征，包括血管性水肿的位置、肿胀的病程和持续时间、发作频率、发病的普遍性和相关的前驱症状、血管性水肿发作的诱因以及其他症状和体征，包括风团、发病年龄和持续时间。我们对不同类型血管性水肿的临床特征的综述和比较结合了我们自己的临床经验和已发表的信息。我们的目的是强调肥大细胞介质诱导型和缓激肽介导型血管性水肿类型具有共同特征，但在许多方面存在差异。了解不同类型血管性水肿在潜在发病机制和临床特征方面的差异有助于对受累患者进行诊断方法，并促进有针对性和有效的治疗。
