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About Hereditary Angioedema

Hereditary angioedema (HAE) is a rare autosomal dominant disorder characterized by recurrent episodes of non-pitting, asymmetric swelling affecting the skin, mucous membranes, and potentially life-threatening laryngeal edema. The condition results from deficiency or dysfunction of C1 esterase inhibitor, leading to uncontrolled activation of the complement and contact systems.

Pathophysiology

HAE is caused by mutations in the SERPING1 gene encoding C1 esterase inhibitor, with Type I showing reduced levels and Type II showing dysfunctional protein. Deficient C1 inhibitor activity leads to excessive bradykinin production through uncontrolled kallikrein activation, resulting in increased vascular permeability and the characteristic angioedema without urticaria.

Clinical Reasoning

Diagnosis should be suspected in patients with recurrent angioedema without urticaria, especially with family history, abdominal pain episodes, or laryngeal involvement. Laboratory confirmation requires measuring C1 inhibitor levels and function, along with C4 levels which are typically low during attacks and between episodes in most patients.

References

  1. Bernstein JA. Hereditary Angioedema. StatPearls [Internet]. NCBI Bookshelf. 2024. https://www.ncbi.nlm.nih.gov/books/NBK482420/
  2. Busse PJ, Christiansen SC, et al. US HAEA Medical Advisory Board 2020 Guidelines for HAE. J Allergy Clin Immunol Pract. 2021;9(1):132–150. PMC7790141. https://pmc.ncbi.nlm.nih.gov/articles/PMC7790141/
  3. Zuraw BL, et al. HAE pathophysiology and treatment. StatPearls. NCBI Bookshelf. 2024. Covers: C1-INH Type I/II, bradykinin, icatibant, C1-INH concentrate, lanadelumab, berotralstat. https://www.ncbi.nlm.nih.gov/books/NBK482420/

Related Topics

AngioedemaHereditary AngioedemaAnaphylaxis