RESUMO
Patients with urticaria and angioedema often have triggers that cause an outbreak or a swelling episode or worsen their chronic condition. Exploring these factors with each patient may result in better understanding and control of their disease. Patients should be advised to avoid known triggers, if feasible, or prepare to prevent or control an exacerbation with appropriate pretreatment if avoidance is not possible. In this review, we describe and discuss a variety of factors for which there is evidence that they cause or exacerbate chronic spontaneous urticaria and angioedema. These potentially exacerbating factors include drugs, food additives, and naturally occurring pseudoallergens, mental stress, and trauma.
Assuntos
Angioedema , Urticária Crônica , Urticária , Angioedema/epidemiologia , Doença Crônica , Humanos , Prevalência , Urticária/epidemiologiaAssuntos
Alergia e Imunologia/organização & administração , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/terapia , Cooperação Internacional , Guias de Prática Clínica como Assunto , Angioedemas Hereditários/classificação , Angioedemas Hereditários/prevenção & controle , Antagonistas de Receptor B2 da Bradicinina/administração & dosagem , Antagonistas de Receptor B2 da Bradicinina/farmacologia , Criança , Pré-Escolar , Proteína Inibidora do Complemento C1/administração & dosagem , Danazol/administração & dosagem , Danazol/efeitos adversos , Diagnóstico Diferencial , Medicina Baseada em Evidências , Feminino , Humanos , Calicreínas/antagonistas & inibidores , Masculino , Planejamento de Assistência ao Paciente , Peptídeos/administração & dosagem , Peptídeos/farmacologia , Gravidez , Proteínas Recombinantes , Apoio SocialRESUMO
OBJECTIVES: To evaluate the use of Cinryze (nanofiltered C1-esterase inhibitor [C1 INH-nf]) for the acute management and prevention of hereditary angioedema attacks in the subgroup of children and adolescents who participated in 2 placebo-controlled and 2 open-label extension studies. STUDY DESIGN: In the acute-attack treatment studies, the efficacy of 1000 U of C1 INH-nf (with an additional 1000 U given 1 hour later if needed) was assessed based on the time to the start of symptomatic relief and the proportion of patients experiencing relief within 4 hours of therapy. In the prophylaxis studies, C1 INH-nf 1000 U was given twice weekly, and efficacy was based on the frequency of attacks. RESULTS: Across 4 studies, 46 children received a total of 2237 C1 INH-nf infusions. The median time to the start of unequivocal relief in the acute-attack treatment study (n = 12) was 30 minutes with C1 INH-nf, compared with 2 hours for placebo. In the open-label extension (n = 22), clinical relief began within 4 hours of therapy in 89% of attacks. In the prophylaxis study (n = 4), the number of attacks was reduced by approximately 2-fold with C1 INH-nf compared with placebo. In the prophylaxis open-label extension (n = 23), the median monthly attack rate decreased from 3.0 before treatment to 0.39 with C1 INH-nf use. CONCLUSION: In children, C1 INH-nf was well tolerated, provided relief from symptoms of hereditary angioedema attacks, and reduced the rate of attacks.