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Evaluation and management of angioedema of the head and neck

Bas, Murata; Hoffmann, Thomas K.a; Kojda, Georgb

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2006 - Volume 14 - Issue 3 - p 170-175
doi: 10.1097/01.moo.0000193202.85837.7d
General otolaryngology

Purpose of review Sudden occurrence of subcutaneous or submucosal swelling, the so-called angioedema, is an established and potentially life-threatening condition. Several forms of angioedema show a great variety of tissue localizations and different underlying mechanisms such as genetic mutations, allergic reactions and nonallergic reactions exist. Unfortunately, angioedema is often unrecognized and/or incorrectly treated. To change this situation, a better understanding of angioedema and possible therapeutic approaches appears necessary.

Recent findings Recent investigations have shed new light on the pathomechanism of nonallergic drug-induced angioedema and new therapeutic options targeting the kallikrein–kinin system have become available for patients in clinical trials. Furthermore, extensive clinical evaluations of commonly used inhibitors of the renin–angiotensin system have provided reliable data on the incidence of angioedema induced by these drugs. Accordingly, several thousand patients worldwide experience severe fatal attacks although timely medical care would have saved their lives.

Summary Current data suggest that the nonapetide bradykinin plays a crucial role in the pathogenesis of most forms of nonallergic angioedema, while histamine acts as the main biogenic mediator in allergic angioedema. Thus, correct diagnosis is crucial for effective treatment. Standard antiallergic drugs such as glucocorticoids and antihistamines are most probably ineffective in nonallergic angioedema forms.

aClinic of Otolaryngology, Heinrich-Heine-University, Düsseldorf, Germany

bInstitute of Pharmacology and Clinical Pharmacology, University-Hospital, Düsseldorf, Germany

Correspondence to Georg Kojda PharmD, PhD, Institut für Pharmakologie und Klinische Pharmakologie, Universitaetsklinik, Moorenstrasse, 5, 40225 Düsseldorf, Germany. Tel: +49 211 811 2518; fax: +49 211 811 4781; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.