ABSTRACT
Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.
Subject(s)
Humans , Female , Middle Aged , Aged , Ischemic Stroke/complications , Angioedema/chemically induced , Angioedema/therapy , Plasma , Histamine , Airway ManagementABSTRACT
The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.
Subject(s)
Angioedema , Ischemic Stroke , Female , Humans , Aged , Ischemic Stroke/complications , Angioedema/chemically induced , Angioedema/therapy , Airway Management , Histamine , PlasmaABSTRACT
Mass vaccination campaigns are essential to control the ongoing novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The Covishield vaccine consists of the replication-deficient simian adenovirus vector ChAdOx1, which contains the full-length structural spike protein of SARS-CoV-2. Occasionally, it can lead to cutaneous reactions that contribute to fear of vaccination, hesitancy, and incomplete vaccination schedules. We report a case of facial angioedema following the first dose of Covishield in a 63-year-old woman with no previous history of allergies or hypersensitivity to drugs or vaccines. No rebound of angioedema was recorded after the second homologous and third heterologous doses.
Subject(s)
Angioedema , COVID-19 , ChAdOx1 nCoV-19 , Adenoviridae , Angioedema/chemically induced , Antibodies, Viral , COVID-19/prevention & control , ChAdOx1 nCoV-19/adverse effects , Female , Follow-Up Studies , Humans , Middle Aged , SARS-CoV-2 , Vaccination/adverse effectsABSTRACT
We present the case of a patient with small bowel angioedema induced by iodinated contrast media during computed tomography. It is important to know this entity and to differentiate it from other intestinal diseases in order to avoid inappropriate treatment.
Subject(s)
Angioedema , Intestinal Diseases , Angioedema/chemically induced , Angioedema/diagnostic imaging , Contrast Media/adverse effects , Humans , Intestinal Diseases/chemically induced , Intestine, Small , Tomography, X-Ray ComputedSubject(s)
Angioedema/chemically induced , Contrast Media/adverse effects , Duodenal Diseases/chemically induced , Iodine Compounds/adverse effects , Adolescent , Contrast Media/administration & dosage , Duodenal Diseases/diagnostic imaging , Female , Humans , Injections, Intravenous , Iodine Compounds/administration & dosage , Tomography, X-Ray Computed/methodsABSTRACT
This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
Subject(s)
Anaphylaxis/diagnosis , Anaphylaxis/etiology , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Adult , Allergy and Immunology , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Bradykinin/adverse effects , Brazil , Child , Drug Hypersensitivity/physiopathology , Humans , IgA Deficiency/complications , Immunoglobulin E/immunology , In Vitro Techniques , Mastocytosis/complications , Preoperative Care , Risk Factors , Skin Tests/methods , Societies, Medical , Symptom Assessment , Terminology as Topic , Vasodilator Agents/adverse effectsABSTRACT
Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
Resumo Este segundo documento, escrito por especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória, tem por objetivo revisar os mecanismos fisiopatológicos, agentes desencadeantes (em adultos e crianças), assim como a abordagem diagnóstica durante e após o episódio. Por se tratar de uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados, e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.
Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as TopicABSTRACT
Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.
Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as TopicABSTRACT
Abstract Background and objectives: Angioedema is a potentially fatal condition that may occur at any time in the perioperative period. It may result from histamine release, hypersensitivity reaction to drugs, or be triggered by bradykinin, in non-allergic reactions of hereditary or acquired etiology. The aim of this report is to report a case of angioedema in the early postoperative period in a patient on antihypertensive medication involving angiotensin-converting enzyme inhibitors. Case report: A 67-year-old male, Afro-descendant, hypertensive, and taken enalapril maleate underwent orthopedic shoulder surgery under general anesthesia combined with brachial plexus block. The procedure lasted 3 hours uneventfully. After discharge from the post-anesthesia care unit, the patient presented with angioedema and severe airway impairment. Tracheal intubation was attempted but it was impossible due to edema affecting the lips, tongue, and oropharyngeal region Emergency cricothyroidotomy was performed. The onset of angioedema had no causal relationship with the administration of any medication; there were no cutaneous manifestations and also not response to therapy for hypersensitivity reaction to drugs, such as antihistamines, corticoid, and adrenaline. It was considered to be mediated by bradykinin, as the patient had already had two similar episodes and was on regular medication (enalapril). The evolution was satisfactory. Conclusion: Angioedema is a potentially fatal condition when it affects the airway, and should be recognized by anesthesiologists and physicians working in the emergency departments.
Resumo Justificativa e objetivos: O angioedema é uma condição potencialmente fatal que pode surgir em qualquer momento no perioperatório. Pode decorrer da liberação de histamina, em uma reação de hipersensibilidade a drogas ou ser desencadeado pela bradicinina, em reações não alérgicas, de etiologia hereditária ou adquirida. O objetivo desse relato é descrever um caso de angioedema, no pós-operatório imediato, em um paciente em uso de medicação anti-hipertensiva da classe dos inibidores da enzima conversora da angiotensina. Relato de caso: Paciente de 67 anos, masculino, negro, hipertenso e em uso do maleato de enalapril, foi submetido a cirurgia ortopédica de ombro sob anestesia geral associada a bloqueio do plexo braquial. O procedimento durou 3 horas, sem intercorrências. Após a alta da sala de recuperação pós-anestésica, apresentou angioedema com grave comprometimento das vias aéreas. Tentou-se fazer intubação traqueal, mas foi impossível devido ao edema que acometia os lábios, a língua e região orofaringeana. Fez-se a cricotireoidostomia de emergência. O aparecimento do angioedema não apresentou relação causal com a administração de qualquer medicação, não houve manifestações cutâneas e também não respondeu à terapêutica para reação de hipersensibilidade a drogas, como anti-histamínicos, corticoide e adrenalina. Foi considerado como mediado pela bradicinina, pois o paciente já havia apresentado dois episódios semelhantes e estava em uso regular de medicação (enalapril). A evolução foi satisfatória. Conclusão: O angioedema é uma condição potencialmente fatal quando atinge as vias aéreas e deve ser de conhecimento do anestesiologista e dos médicos que trabalham nos setores de emergência.
Subject(s)
Humans , Male , Aged , Postoperative Complications/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angioedema/chemically inducedABSTRACT
BACKGROUND AND OBJECTIVES: Angioedema is a potentially fatal condition that may occur at any time in the perioperative period. It may result from histamine release, hypersensitivity reaction to drugs, or be triggered by bradykinin, in non-allergic reactions of hereditary or acquired etiology. The aim of this report is to report a case of angioedema in the early postoperative period in a patient on antihypertensive medication involving angiotensin-converting enzyme inhibitors. CASE REPORT: A 67-year-old male, Afro-descendant, hypertensive, and taken enalapril maleate underwent orthopedic shoulder surgery under general anesthesia combined with brachial plexus block. The procedure lasted 3hours uneventfully. After discharge from the post-anesthesia care unit, the patient presented with angioedema and severe airway impairment. Tracheal intubation was attempted but it was impossible due to edema affecting the lips, tongue, and oropharyngeal region Emergency cricothyroidotomy was performed. The onset of angioedema had no causal relationship with the administration of any medication; there were no cutaneous manifestations and also not response to therapy for hypersensitivity reaction to drugs, such as antihistamines, corticoid, and adrenaline. It was considered to be mediated by bradykinin, as the patient had already had two similar episodes and was on regular medication (enalapril). The evolution was satisfactory. CONCLUSION: Angioedema is a potentially fatal condition when it affects the airway, and should be recognized by anesthesiologists and physicians working in the emergency departments.
Subject(s)
Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Postoperative Complications/chemically induced , Aged , Humans , MaleSubject(s)
Angioedema/chemically induced , Anti-Allergic Agents/adverse effects , Drug Eruptions/etiology , Omalizumab/adverse effects , Urticaria/chemically induced , Angioedema/pathology , Chronic Disease , Drug Eruptions/pathology , Humans , Male , Middle Aged , Severity of Illness Index , Time Factors , Urticaria/pathologySubject(s)
Humans , Male , Middle Aged , Urticaria/chemically induced , Drug Eruptions/etiology , Anti-Allergic Agents/adverse effects , Omalizumab/adverse effects , Angioedema/chemically induced , Time Factors , Urticaria/pathology , Severity of Illness Index , Chronic Disease , Drug Eruptions/pathology , Angioedema/pathologyABSTRACT
El angioedema inducido por inhibidores de la enzima convertidora de angiotensina es una entidad poco frecuente caracterizada por edema en piel y mucosas, debido al aumento de la permeabilidad vascular provocada por la inhibición de la enzima convertidora y el subsiguiente aumento de la bradiquinina. De manera frecuente cursa con compromiso facial y de mucosas, siendo infrecuente el compromiso intestinal o de vía aérea. El angioedema intestinal puede presentarse asociado a angioedema facial o aislado, siendo este último excepcional. Cursa con episodios recurrentes de dolor, distensión abdominal y diarrea acuosa con recuperación completa en dos o tres días. Si bien es una entidad poco frecuente, el hecho de que esté asociada a fármacos utilizados con frecuencia nos hace incluirla en el diagnóstico diferencial del dolor abdominal recurrente. Presentamos un caso de angioedema intestinal aislado, asociado al uso de enalapril.
Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.
Subject(s)
Humans , Female , Aged , Enalapril/adverse effects , Intestinal Diseases/chemically induced , Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Hypertension/drug therapy , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imaging , Angioedema/diagnostic imagingABSTRACT
Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.
Subject(s)
Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Enalapril/adverse effects , Intestinal Diseases/chemically induced , Aged , Angioedema/diagnostic imaging , Female , Humans , Hypertension/drug therapy , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imagingSubject(s)
Aminobutyrates/adverse effects , Angioedema/chemically induced , Angiotensin Receptor Antagonists/adverse effects , Heart Failure/drug therapy , Ileus/etiology , Tetrazoles/adverse effects , Aged , Angioedema/complications , Biphenyl Compounds , Conservative Treatment , Drug Combinations , Humans , Ileus/diagnostic imaging , Ileus/therapy , Intestine, Small/blood supply , Intestine, Small/diagnostic imaging , Intestine, Small/drug effects , Male , Tomography, X-Ray Computed , ValsartanABSTRACT
Angioedema of the small bowel (ASB) is an extremely rare side effect of the angiotensin-converting enzyme inhibitors (ACEI). We present a case of ACEI-induced ASB mimicking postoperative complication. The diagnosis of ACEI-induced ASB should be considered in patients using these drugs and presenting sudden gastrointestinal symptoms and thickening of small bowel not attributable to other diseases.
Subject(s)
Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Diagnosis, Differential , Intestinal Diseases/chemically induced , Intestine, Small , Aged, 80 and over , Angioedema/diagnostic imaging , Female , Humans , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.
Subject(s)
Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Captopril/adverse effects , Mouth Diseases/chemically induced , Pemphigus/chemically induced , Adult , Angioedema/pathology , Female , Fluorescent Antibody Technique, Direct , Humans , Immunoglobulin G/blood , Mouth Diseases/pathology , Mouth Mucosa/drug effects , Mouth Mucosa/pathology , Pemphigus/pathologyABSTRACT
AbstractWe describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.
Subject(s)
Adult , Female , Humans , Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Captopril/adverse effects , Mouth Diseases/chemically induced , Pemphigus/chemically induced , Angioedema/pathology , Fluorescent Antibody Technique, Direct , Immunoglobulin G/blood , Mouth Diseases/pathology , Mouth Mucosa/drug effects , Mouth Mucosa/pathology , Pemphigus/pathologyABSTRACT
BACKGROUND: A subset of patients with chronic spontaneous urticaria (CSU) experience disease exacerbations after receiving non-steroidal anti-inflammatory drugs (NSAIDs). This condition has been designated as Aspirin-Exacerbated Cutaneous Disease (AECD). OBJECTIVES: The purpose of this study was twofold: (i) Investigate the demographic and clinical features of patients affected by AECD; (ii) To compare patients with AECD and NSAID-tolerant CSU patients for those characteristics. METHODS: Patients with AECD and a group of unselected CSU patients tolerant to NSAIDs were studied. Demographic and clinical data were obtained by direct questioning and physical examination. Laboratory investigations and allergen skin prick tests were performed only in selected patients, as guided by the medical history. RESULTS: Of 423 CSU patients admitted in the clinics, 52 (12.2%) had AECD. Compared with NSAID-tolerant CSU patients, AECD patients had significantly longer disease duration (57.7 ± 118.4 vs. 24.4 ± 36.6 months, P < 0.05), higher prevalence of angio-oedema (72.7 vs. 30.9%, P < 0.05) and atopy (83.8% vs. 58.4%, P < 0.05) and more frequent involvement of the face and upper respiratory tract (54.5% vs. 29.6%, P < 0.05). CONCLUSIONS: AECD is a distinct phenotype that should be considered for inclusion as a separate subtype of chronic spontaneous urticaria.