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      Canadian hereditary angioedema guideline

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      Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology
      BioMed Central
      Hereditary angioedema, Guideline, Recommendations, Acute attacks, Short-term prophylaxis, Long-term prophylaxis, Self-administration, Individualized therapy, Quality of life, Comprehensive care, GRADE

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          Abstract

          Hereditary angioedema (HAE) is a disease which is associated with random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased Health Related Quality of Life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada is neither optimal nor uniform across the country. It lags behind other countries where there are more organized models for HAE management, and where additional therapeutic options are licensed and available for use. The objective of this guideline is to provide graded recommendations for the management of patients in Canada with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. It is anticipated that by providing this guideline to caregivers, policy makers, patients and their advocates, that there will be an improved understanding of the current recommendations regarding management of HAE and the factors that need to be considered when choosing therapies and treatment plans for individual patients. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency physicians, gastroenterologists, dentists and otolaryngologists, who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.

          Electronic supplementary material

          The online version of this article (doi:10.1186/1710-1492-10-50) contains supplementary material, which is available to authorized users.

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          Most cited references86

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          Clinical practice. Hereditary angioedema.

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            Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema.

            Hereditary angioedema is characterized by recurrent attacks of angioedema of the skin, larynx, and gastrointestinal tract. Bradykinin is the key mediator of symptoms. Icatibant is a selective bradykinin B2 receptor antagonist. In two double-blind, randomized, multicenter trials, we evaluated the effect of icatibant in patients with hereditary angioedema presenting with cutaneous or abdominal attacks. In the For Angioedema Subcutaneous Treatment (FAST) 1 trial, patients received either icatibant or placebo; in FAST-2, patients received either icatibant or oral tranexamic acid, at a dose of 3 g daily for 2 days. Icatibant was given once, subcutaneously, at a dose of 30 mg. The primary end point was the median time to clinically significant relief of symptoms. A total of 56 and 74 patients underwent randomization in the FAST-1 and FAST-2 trials, respectively. The primary end point was reached in 2.5 hours with icatibant versus 4.6 hours with placebo in the FAST-1 trial (P=0.14) and in 2.0 hours with icatibant versus 12.0 hours with tranexamic acid in the FAST-2 trial (P<0.001). In the FAST-1 study, 3 recipients of icatibant and 13 recipients of placebo needed treatment with rescue medication. The median time to first improvement of symptoms, as assessed by patients and by investigators, was significantly shorter with icatibant in both trials. No icatibant-related serious adverse events were reported. In patients with hereditary angioedema having acute attacks, we found a significant benefit of icatibant as compared with tranexamic acid in one trial and a nonsignificant benefit of icatibant as compared with placebo in the other trial with regard to the primary end point. The early use of rescue medication may have obscured the benefit of icatibant in the placebo trial. (Funded by Jerini; ClinicalTrials.gov numbers, NCT00097695 and NCT00500656.)
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              Hereditary and acquired angioedema: Problems and progress: Proceedings of the third C1 esterase inhibitor deficiency workshop and beyond

              Hereditary angioedema (HAE), a rare but life-threatening condition, manifests as acute attacks of facial, laryngeal, genital, or peripheral swelling or abdominal pain secondary to intra-abdominal edema. Resulting from mutations affecting C1 esterase inhibitor (C1-INH), inhibitor of the first complement system component, attacks are not histamine-mediated and do not respond to antihistamines or corticosteroids. Low awareness and resemblance to other disorders often delay diagnosis; despite availability of C1-INH replacement in some countries, no approved, safe acute attack therapy exists in the United States. The biennial C1 Esterase Inhibitor Deficiency Workshops resulted from a European initiative for better knowledge and treatment of HAE and related diseases. This supplement contains work presented at the third workshop and expanded content toward a definitive picture of angioedema in the absence of allergy. Most notably, it includes cumulative genetic investigations; multinational laboratory diagnosis recommendations; current pathogenesis hypotheses; suggested prophylaxis and acute attack treatment, including home treatment; future treatment options; and analysis of patient subpopulations, including pediatric patients and patients whose angioedema worsened during pregnancy or hormone administration. Causes and management of acquired angioedema and a new type of angioedema with normal C1-INH are also discussed. Collaborative patient and physician efforts, crucial in rare diseases, are emphasized. This supplement seeks to raise awareness and aid diagnosis of HAE, optimize treatment for all patients, and provide a platform for further research in this rare, partially understood disorder.
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                Author and article information

                Contributors
                betschels@smh.ca
                rjbadiou@hotmail.com
                binkleyk@smh.ca
                hebert.j@videotron.ca
                a.kanani@ubc.ca
                keithp@mcmaster.ca
                glacuesta@gmail.com
                wyang@yangmedicine.com
                Aygoeren-Puersuen@em.uni-frankfurt.de
                bernstja@ucmail.uc.edu
                konrad.bork@unimedizin-mainz.de
                Mteresa.caballero@idipaz.es
                Marco.Cicardi@unimi.it
                tcraig@hmc.psu.edu
                farkas.henriette@med.semmelweis-univ.hu
                Hilary.Longhurst@bartshealth.nhs.uk
                bzuraw@ucsd.edu
                h.boysen@haei.org
                rb.mazi@queensu.ca
                thomasjbowen@gmail.com
                Karen.Dallas@saskatoonhealthregion.ca
                jdean@cw.bc.ca
                kelly.lang.robertson@effectivepractice.org
                benoitlaramee@hotmail.com
                es_leithmd@hotmail.com
                drmace@bellnet.ca
                christine.mccusker@mcgill.ca
                moote@uwo.ca
                mcpoon@ucalgary.ca
                britchie@ualberta.ca
                dstark@mail.ubc.ca
                gsussman@rogers.com
                waserman@mcmaster.ca
                Journal
                Allergy Asthma Clin Immunol
                Allergy Asthma Clin Immunol
                Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology
                BioMed Central (London )
                1710-1484
                1710-1492
                24 October 2014
                24 October 2014
                2014
                : 10
                : 1
                : 50
                Affiliations
                [ ]University of Toronto, Toronto, Ontario Canada
                [ ]HAE Canada, Notre Dame des Lourdes, Manitoba, Canada
                [ ]Department of Medicine, Laval University, Quebec City, Quebec Canada
                [ ]Department of Medicine, University of British Columbia, Vancouver, British Columbia Canada
                [ ]Department of Medicine, McMaster University, Hamilton, Ontario Canada
                [ ]Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
                [ ]University of Ottawa Medical School, Ottawa, Ontario Canada
                [ ]Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
                [ ]Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio USA
                [ ]Department of Dermatology, University Hospital of the Johannes Gutenberg-University of Mainz, Mainz, Germany
                [ ]Hospital La Paz Health Research Institute, Madrid, Spain
                [ ]Department of Internal Medicine, UniversitadegliStudi di Milano, Ospedale L. Sacco, Milan, Italy
                [ ]Departments of Medicine and Pediatrics, Penn State University, Hershey, Pennsylvania USA
                [ ]3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
                [ ]Department of Immunology, Barts and the London NHS Trust, London, England, UK
                [ ]University of California, San Diego, San Diego, California USA
                [ ]HAE International, Skanderborg, Denmark
                [ ]Department of Medicine, Queen’s University, Kingston, Ontario Canada
                [ ]Departments of Medicine and Paediatrics, University of Calgary, Calgary, Alberta Canada
                [ ]Saskatoon Health Region, Saskatoon, Saskatchewan Canada
                [ ]BC Children’s Hospital, Vancouver, British Columbia Canada
                [ ]Centre hospitalier de l’université de Montréal, Montréal, Quebec Canada
                [ ]Department of Medicine, University of Toronto, Oakville, Ontario Canada
                [ ]Department of Immunology, McGill University Health Centre, Montreal, Quebec Canada
                [ ]Department of Medicine, Western University, London, Ontario Canada
                [ ]Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, Alberta Canada
                [ ]Departments of Medicine and Medical Oncology, University of Alberta, Edmonton, Alberta Canada
                Article
                521
                10.1186/1710-1492-10-50
                4210625
                25352908
                8c27f0ff-5d9c-4168-927f-9be28186dda4
                © Betschel et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 August 2014
                : 10 September 2014
                Categories
                Position Article and Guidelines
                Custom metadata
                © The Author(s) 2014

                Immunology
                hereditary angioedema,guideline,recommendations,acute attacks,short-term prophylaxis,long-term prophylaxis,self-administration,individualized therapy,quality of life,comprehensive care,grade

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