SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

November 2, 2007

Future therapies for acute attacks of hereditary angioedema

Summary
This is a review of three articles which discuss new and far more effective, therapies for acute exacerbations of hereditary angioedema. The Sheffer article is an editorial which gives a brief, and extremely helpful summary of these therapies with emphasis on administration of purified C1 inhibitor concentrate. Because these new agents, hopefully, will soon be available for clinical use in the United States, it is incumbent upon us to become familiar with their administration and the differences between these agents. Dr. Sheffer has assisted us in doing this in his editorial.

Briefly, there are three basic approaches:

  1. The administration of the C1 inhibitor which is presently being evaluated in purified human form and a recombinant antibody preparation.
  2. The administration of a kallikrein inhibitor.
  3. The administration of a bradykinin 2 receptor antagonist.

The preparations of purified inhibitors are all administered intravenously. The kallikrein inhibitor and bradykinin 2 receptor antagonist are being studied in subcutaneous forms.

Editor's Comments
A review to date of these preparations indicates that they will be far more effective than any present therapy including standard treatments such as epinephrine, antihistamines, epsilon aminocaproic acid, and the administration of fresh frozen plasma.

Reference
1. Bork K, et al. Treatment of Acute Edema Attacks in Hereditary Angioedema with a Bradykinin Receptor-2 Antagonist (icatibant). J Allergy Clin Immunol 2007; 119:1497-1503.
2. Sheffer AL. Hereditary angioedema: optimal therapy. J Allergy Clin Immunol 2007; 120:756-757.
3. Farkas H. Hereditary angioedema: a decade of human C-1 inhibitor concentrate therapy. J Allerg Clin Immunol 2007; 120:941-947.

 

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