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Published in: European Journal of Pediatrics 9/2012

Open Access 01-09-2012 | Original Article

Hereditary angioedema (HAE) in children and adolescents—a consensus on therapeutic strategies

Authors: V. Wahn, W. Aberer, W. Eberl, M. Faßhauer, T. Kühne, K. Kurnik, M. Magerl, D. Meyer-Olson, I. Martinez-Saguer, P. Späth, P. Staubach-Renz, W. Kreuz

Published in: European Journal of Pediatrics | Issue 9/2012

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Abstract

Hereditary angioedema due to C1 inhibitor (C1 esterase inhibitor) deficiency (types I and II HAE-C1-INH) is a rare disease that usually presents during childhood or adolescence with intermittent episodes of potentially life-threatening angioedema. Diagnosis as early as possible is important to avoid ineffective therapies and to properly treat swelling attacks. At a consensus meeting in June 2011, pediatricians and dermatologists from Germany, Austria, and Switzerland reviewed the currently available literature, including published international consensus recommendations for HAE therapy across all age groups. Published recommendations cannot be unconditionally adopted for pediatric patients in German-speaking countries given the current approval status of HAE drugs. This article provides an overview and discusses drugs available for HAE therapy, their approval status, and study results obtained in adult and pediatric patients. Recommendations for developing appropriate treatment strategies in the management of HAE in pediatric patients in German-speaking countries are provided.Conclusion Currently, plasma-derived C1 inhibitor concentrate is considered the best available option for the treatment of acute HAE-C1-INH attacks in pediatric patients in German-speaking countries, as well as for short-term and long-term prophylaxis.
Literature
1.
go back to reference Bork K, Hardt J (2009) Hereditary angioedema: increased number of attacks after frequent treatments with C1 inhibitor concentrate. Am J Med 122:780–783PubMedCrossRef Bork K, Hardt J (2009) Hereditary angioedema: increased number of attacks after frequent treatments with C1 inhibitor concentrate. Am J Med 122:780–783PubMedCrossRef
2.
go back to reference Bork K, Hardt J, Schicketanz KH, Ressel N (2003) Clinical studies of sudden upper airway obstruction in patients with hereditary angioedema due to C1 esterase inhibitor deficiency. Arch Intern Med 163:1229–1235PubMedCrossRef Bork K, Hardt J, Schicketanz KH, Ressel N (2003) Clinical studies of sudden upper airway obstruction in patients with hereditary angioedema due to C1 esterase inhibitor deficiency. Arch Intern Med 163:1229–1235PubMedCrossRef
3.
go back to reference Bork K, Hardt J, Staubach-Renz P, Witzke G (2011) Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:58–64PubMedCrossRef Bork K, Hardt J, Staubach-Renz P, Witzke G (2011) Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:58–64PubMedCrossRef
4.
go back to reference Bork K, Siedlecki K, Bosch S et al (2000) Asphyxiation by laryngeal edema in patients with hereditary angioedema. Mayo Clin Proc 75:349–354PubMedCrossRef Bork K, Siedlecki K, Bosch S et al (2000) Asphyxiation by laryngeal edema in patients with hereditary angioedema. Mayo Clin Proc 75:349–354PubMedCrossRef
5.
go back to reference Bowen T (2011) Hereditary angioedema: beyond international consensus—circa December 2010—the Canadian Society of Allergy and Clinical Immunology Dr. David McCourtie Lecture. Allergy asthma. Clin Immunol 7:1 Bowen T (2011) Hereditary angioedema: beyond international consensus—circa December 2010—the Canadian Society of Allergy and Clinical Immunology Dr. David McCourtie Lecture. Allergy asthma. Clin Immunol 7:1
6.
go back to reference Bowen T, Cicardi M, Farkas H et al (2010) 2010 international consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol 6:24PubMedCrossRef Bowen T, Cicardi M, Farkas H et al (2010) 2010 international consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol 6:24PubMedCrossRef
7.
go back to reference Boyle RJ, Nikpour M, Tang MLK (2005) Hereditary angioedema in children: a management guideline. Pediatr Allergy Immunol 16:288–294PubMedCrossRef Boyle RJ, Nikpour M, Tang MLK (2005) Hereditary angioedema in children: a management guideline. Pediatr Allergy Immunol 16:288–294PubMedCrossRef
8.
go back to reference Cicardi M, Banerji A, Bracho F et al (2010) Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema. N Engl J Med 363:532–541PubMedCrossRef Cicardi M, Banerji A, Bracho F et al (2010) Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema. N Engl J Med 363:532–541PubMedCrossRef
9.
go back to reference Cicardi M, Bork K, Caballero T et al (2012) Evidence-based recommendations for therapeutic management of angioedema owing to hereditary C1 inhibitor deficiency: consensus report of an International Working Group. Allergy 67:147–157PubMedCrossRef Cicardi M, Bork K, Caballero T et al (2012) Evidence-based recommendations for therapeutic management of angioedema owing to hereditary C1 inhibitor deficiency: consensus report of an International Working Group. Allergy 67:147–157PubMedCrossRef
10.
go back to reference Cicardi M, Levy RJ, McNeil DL et al (2010) Ecallantide for the treatment of acute attacks in hereditary angioedema. N Engl J Med 363:523–531PubMedCrossRef Cicardi M, Levy RJ, McNeil DL et al (2010) Ecallantide for the treatment of acute attacks in hereditary angioedema. N Engl J Med 363:523–531PubMedCrossRef
12.
go back to reference Craig TJ, Bewtra AK, Bahna SL et al (2011) C1 esterase inhibitor concentrate in 1085 hereditary angioedema attacks—final results of the I.M.P.A.C.T.2 study. Allergy 66:1604–1611PubMedCrossRef Craig TJ, Bewtra AK, Bahna SL et al (2011) C1 esterase inhibitor concentrate in 1085 hereditary angioedema attacks—final results of the I.M.P.A.C.T.2 study. Allergy 66:1604–1611PubMedCrossRef
13.
go back to reference Craig TJ, Levy RJ, Wasserman RL et al (2009) Efficacy of human C1 esterase inhibitor concentrate compared with placebo in acute hereditary angioedema attack. J Allergy Clin Immunol 124:801–808PubMedCrossRef Craig TJ, Levy RJ, Wasserman RL et al (2009) Efficacy of human C1 esterase inhibitor concentrate compared with placebo in acute hereditary angioedema attack. J Allergy Clin Immunol 124:801–808PubMedCrossRef
14.
go back to reference De Serres J, Gröner A, Lindner J (2003) Safety and efficacy of pasteurized C1 inhibitor concentrate (Berinert P) in hereditary angioedema: a review. Transfus Apher Sci 29:247–254PubMedCrossRef De Serres J, Gröner A, Lindner J (2003) Safety and efficacy of pasteurized C1 inhibitor concentrate (Berinert P) in hereditary angioedema: a review. Transfus Apher Sci 29:247–254PubMedCrossRef
15.
go back to reference Farkas H, Harmat G, Gyeney L, Füst G, Varga L (1999) Danazol therapy for hereditary angio-oedema in children. Lancet 354:1031–1032PubMedCrossRef Farkas H, Harmat G, Gyeney L, Füst G, Varga L (1999) Danazol therapy for hereditary angio-oedema in children. Lancet 354:1031–1032PubMedCrossRef
16.
go back to reference Farkas H, Jakab L, Temesszentandrási G et al (2007) Hereditary angioedema: a decade of human C1-inhibitor concentrate therapy. J Allergy Clin Immunol 120:941–947PubMedCrossRef Farkas H, Jakab L, Temesszentandrási G et al (2007) Hereditary angioedema: a decade of human C1-inhibitor concentrate therapy. J Allergy Clin Immunol 120:941–947PubMedCrossRef
17.
go back to reference Frank MM, Jiang H (2008) New therapies for angioedema: disease outlook changes dramatically. J Allergy Clin Immunol 121:272–280PubMedCrossRef Frank MM, Jiang H (2008) New therapies for angioedema: disease outlook changes dramatically. J Allergy Clin Immunol 121:272–280PubMedCrossRef
18.
go back to reference Frank MM, Sergent JS, Kane MA, Alling DW (1972) Epsilon aminocaproic acid therapy of hereditary angioneurotic edema. A double-blind study. N Engl J Med 286:808–812PubMedCrossRef Frank MM, Sergent JS, Kane MA, Alling DW (1972) Epsilon aminocaproic acid therapy of hereditary angioneurotic edema. A double-blind study. N Engl J Med 286:808–812PubMedCrossRef
19.
20.
22.
go back to reference Kreuz W, Rusicke E, Martinez-Saguer I, Aygören-Pürsün E, Heller C, Klingebiel T (2012) Home therapy with intravenous human C1-inhibitor in children and adolescents with hereditary angioedema. Transfusion 52:100–107PubMedCrossRef Kreuz W, Rusicke E, Martinez-Saguer I, Aygören-Pürsün E, Heller C, Klingebiel T (2012) Home therapy with intravenous human C1-inhibitor in children and adolescents with hereditary angioedema. Transfusion 52:100–107PubMedCrossRef
23.
go back to reference Levy JH, Freiberger DJ, Roback J (2010) Hereditary angioedema: current and emerging treatment options. Anesth Analg 110:1271–1280PubMedCrossRef Levy JH, Freiberger DJ, Roback J (2010) Hereditary angioedema: current and emerging treatment options. Anesth Analg 110:1271–1280PubMedCrossRef
24.
go back to reference Levy RJ, Lumry WR, McNeil DL et al (2010) EDEMA4: a phase 3, double-blind study of subcutaneous ecallantide treatment for acute attacks of hereditary angioedema. Ann Allergy Asthma Immunol 104:523–529PubMedCrossRef Levy RJ, Lumry WR, McNeil DL et al (2010) EDEMA4: a phase 3, double-blind study of subcutaneous ecallantide treatment for acute attacks of hereditary angioedema. Ann Allergy Asthma Immunol 104:523–529PubMedCrossRef
25.
go back to reference Longhurst HJ, Farkas H, Craig TJ et al (2010) HAE international home therapy consensus document. Allergy Asthma Clin Immunol 6:22PubMedCrossRef Longhurst HJ, Farkas H, Craig TJ et al (2010) HAE international home therapy consensus document. Allergy Asthma Clin Immunol 6:22PubMedCrossRef
26.
go back to reference Martinez-Saguer I, Rusicke E, Aygören-Pürsün E, von Hentig N, Klingebiel T, Kreuz W (2010) Pharmacokinetic analysis of human plasma-derived pasteurized C1-inhibitor concentrate in adults and children with hereditary angioedema: a prospective study. Transfusion 50:354–360PubMedCrossRef Martinez-Saguer I, Rusicke E, Aygören-Pürsün E, von Hentig N, Klingebiel T, Kreuz W (2010) Pharmacokinetic analysis of human plasma-derived pasteurized C1-inhibitor concentrate in adults and children with hereditary angioedema: a prospective study. Transfusion 50:354–360PubMedCrossRef
27.
go back to reference Maurer M, Magerl M (2010) Hereditary angioedema: an update on available therapeutic options. J Dtsch Dermatol Ges 8:663–672PubMed Maurer M, Magerl M (2010) Hereditary angioedema: an update on available therapeutic options. J Dtsch Dermatol Ges 8:663–672PubMed
28.
go back to reference Maurer M, Magerl M (2011) Long-term prophylaxis of hereditary angioedema with androgen derivatives: a critical appraisal and potential alternatives. J Dtsch Dermatol Ges 9:99–107PubMed Maurer M, Magerl M (2011) Long-term prophylaxis of hereditary angioedema with androgen derivatives: a critical appraisal and potential alternatives. J Dtsch Dermatol Ges 9:99–107PubMed
29.
go back to reference Sheffer AL, Austen KF, Rosen FS (1972) Tranexamic acid therapy in hereditary angioneurotic edema. N Engl J Med 287:452–454PubMedCrossRef Sheffer AL, Austen KF, Rosen FS (1972) Tranexamic acid therapy in hereditary angioneurotic edema. N Engl J Med 287:452–454PubMedCrossRef
30.
go back to reference Sheffer AL, Campion M, Levy RJ, Li HH, Horn PT, Pullman WE (2011) Ecallantide (DX-88) for acute hereditary angioedema attacks: integrated analysis of 2 double-blind, phase 3 studies. J Allergy Clin Immunol 128:153–159PubMedCrossRef Sheffer AL, Campion M, Levy RJ, Li HH, Horn PT, Pullman WE (2011) Ecallantide (DX-88) for acute hereditary angioedema attacks: integrated analysis of 2 double-blind, phase 3 studies. J Allergy Clin Immunol 128:153–159PubMedCrossRef
31.
go back to reference Tallroth GA (2011) Long-term prophylaxis of hereditary angioedema with a pasteurized C1 inhibitor concentrate. Int Arch Allergy Immunol 154:356–359PubMedCrossRef Tallroth GA (2011) Long-term prophylaxis of hereditary angioedema with a pasteurized C1 inhibitor concentrate. Int Arch Allergy Immunol 154:356–359PubMedCrossRef
32.
go back to reference Zanichelli A, Vachini R, Badini M, Penna V, Cicardi M (2011) Standard care impact on angioedema because of hereditary C1 inhibitor deficiency: a 21-month prospective study in a cohort of 103 patients. Allergy 66:192–196PubMedCrossRef Zanichelli A, Vachini R, Badini M, Penna V, Cicardi M (2011) Standard care impact on angioedema because of hereditary C1 inhibitor deficiency: a 21-month prospective study in a cohort of 103 patients. Allergy 66:192–196PubMedCrossRef
34.
go back to reference Zuraw BL, Busse PJ, White M et al (2010) Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N Engl J Med 363:513–522PubMedCrossRef Zuraw BL, Busse PJ, White M et al (2010) Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N Engl J Med 363:513–522PubMedCrossRef
35.
go back to reference Zuraw BL, Cicardi M, Levy RJ et al (2010) Recombinant human C1-inhibitor for the treatment of acute angioedema attacks in patients with hereditary angioedema. J Allergy Clin Immunol 126:821–827PubMedCrossRef Zuraw BL, Cicardi M, Levy RJ et al (2010) Recombinant human C1-inhibitor for the treatment of acute angioedema attacks in patients with hereditary angioedema. J Allergy Clin Immunol 126:821–827PubMedCrossRef
Metadata
Title
Hereditary angioedema (HAE) in children and adolescents—a consensus on therapeutic strategies
Authors
V. Wahn
W. Aberer
W. Eberl
M. Faßhauer
T. Kühne
K. Kurnik
M. Magerl
D. Meyer-Olson
I. Martinez-Saguer
P. Späth
P. Staubach-Renz
W. Kreuz
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
European Journal of Pediatrics / Issue 9/2012
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-012-1726-4

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