Department of Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
J Allergy Clin Immunol. 2024 Jan;153(1):42-54. doi: 10.1016/j.jaci.2023.09.039. Epub 2023 Oct 28.
Hereditary angioedema (HAE) due to C1-inhibitor deficiency or dysfunction is a rare genetic disorder that causes recurrent episodes of swelling in various parts of the body. Treatment goals of HAE aim to "normalize" life for all patients; however, lack of diagnostic facilities and limited access to effective treatment options in developing nations cause delays in diagnosis and place a significant burden on patients. In this review, we aim to highlight the burden of disease caused by C1-inhibitor HAE across the Asia-Pacific region, considering its epidemiology, morbidity and mortality, and socioeconomic and psychological impact. We also review the availability of guideline-recommended diagnostic facilities and treatments, and how patients are currently managed. Data were collected from published literature and HAE experts in the region, who provided information regarding diagnosis and management in their countries. Current practice was reviewed against international guidelines, as well as local guidelines/consensus used in Australia, Japan, and China. Suggestions are provided for improving the time to diagnosis in the region, increasing access to guideline-recommended treatments, and providing support to reduce the burden on patients and caregivers. There is an urgent need to improve HAE services and provide access to life-saving treatment in developing countries, and efforts should be made to increase awareness of guideline recommendations in high-income economies that do not currently provide long-term prophylactic treatments.
遗传性血管性水肿(HAE)是一种由 C1 抑制剂缺乏或功能障碍引起的罕见遗传性疾病,会导致身体各部位反复发作肿胀。HAE 的治疗目标是“使所有患者的生活正常化”;然而,发展中国家缺乏诊断设施和有限的有效治疗选择导致诊断延迟,并给患者带来沉重负担。在这篇综述中,我们旨在强调亚太地区 C1 抑制剂 HAE 引起的疾病负担,考虑其流行病学、发病率和死亡率,以及社会经济和心理影响。我们还回顾了指南推荐的诊断设施和治疗方法的可用性,以及目前患者的管理情况。数据来自已发表的文献和该地区的 HAE 专家,他们提供了有关其所在国家/地区诊断和管理的信息。根据国际指南以及澳大利亚、日本和中国使用的当地指南/共识,对当前的实践进行了审查。针对该地区如何改善诊断时间、增加获得指南推荐治疗的机会以及提供支持以减轻患者和护理人员的负担,提出了一些建议。迫切需要改善发展中国家的 HAE 服务并提供救生治疗,还应努力提高在那些目前不提供长期预防治疗的高收入经济体中对指南建议的认识。