National Reference Center for Angioedema (CREAK), Grenoble University Hospital (CHUGA), Grenoble, France.
Grenoble Alpes University (UGA), France.
Medicine (Baltimore). 2022 Aug 5;101(31):e29513. doi: 10.1097/MD.0000000000029513.
Angioedema (AE) is a reason for emergency care when it is severe. Care is difficult when the diagnostic is not known before the attack: mast cell (MC) or bradykinin (BK) mediated. One is very common but often benign, the other rare but potentially fatal. The French national reference center of angioedema (CREAK) provides emergency physicians with a hotline and a guideline to help them manage their patients. This study aimed to describe the clinical features of AE episodes prompting a call on the CREAK hotline and classify patients depending on the suspected cause of the AE. This is a retrospective study between March and August 2019. Each physician calling on the CREAK hotline was asked to fill a clinical description form for the AE emergency. Known patients of CREAK was excluded. Eighty four patients were included. Forty one (48.8%) in the angiotensin converting enzyme inhibitors induced acquired angioedema (ACEi-AAE), 39 (46.4%) in the mast cell induced angioedema, and 4 (4.8%) in the Bradykinin mediated angioedema. The mast cell induced angioedema patients have more history of hives (29.3%) than ACEi-AAE (2.4%, P = .0004). ACEi-AAE mainly affected the tongue (58.5% vs 25.6%, P = .003) and larynx (29.3% vs 13%, P = .001). In 65.5% of cases, the etiological diagnosis was not mentioned by the appellant, but made by the hotline. In 31% of cases, the hotline suggested the administration of a specific treatment not previously provided by the caller. All the doctors who called the hotline appreciate this tele-expertise especially in case of ACEi-AAE presumptions. In addition to providing rapid AE expertise, this service also allows to educate physicians in the management of AE irrespective of its origin.
血管性水肿（AE）在严重时是急诊的原因。在发病前不知道诊断时（是肥大细胞[MC]或缓激肽[BK]介导的），治疗会很困难。一种非常常见但通常良性，另一种则罕见但可能致命。法国血管性水肿国家参考中心（CREAK）为急诊医生提供热线和指南，以帮助他们管理患者。本研究旨在描述促使 CREAK 热线求助的 AE 发作的临床特征，并根据 AE 的疑似病因对患者进行分类。这是一项 2019 年 3 月至 8 月间的回顾性研究。每位向 CREAK 热线求助的医生都被要求填写一份 AE 急诊的临床描述表。已知 CREAK 的患者被排除在外。共纳入 84 名患者。41 名（48.8%）为血管紧张素转换酶抑制剂诱导的获得性血管性水肿（ACEi-AAE），39 名（46.4%）为肥大细胞诱导的血管性水肿，4 名（4.8%）为缓激肽介导的血管性水肿。肥大细胞诱导的血管性水肿患者比 ACEi-AAE 患者（2.4%，P =.0004）更常出现荨麻疹病史（29.3%）。ACEi-AAE 主要影响舌头（58.5% vs 25.6%，P =.003）和喉咙（29.3% vs 13%，P =.001）。在 65.5%的病例中，上诉人未提及病因诊断，但由热线提出。在 31%的病例中，热线建议使用以前未提供给呼叫者的特定治疗方法。所有拨打热线的医生都特别赞赏这种远程专业知识，尤其是在 ACEi-AAE 假定的情况下。除了提供快速的 AE 专业知识外，该服务还可以教育医生管理 AE，无论其来源如何。
