Clinical aspect of Bradykinin-induced angioedema

 Q: Bradykinin-induced angioedema is usually associated with life-threatening bronchospasm? 

A) True 

B) False

Answer: B

The objective of this question is to highlight the clinical difference between mast-cell mediated and bradykinin-induced angioedema. In contrast to mast-cell mediated angioedema, bradykinin-induced angioedema is not associated with urticaria, bronchospasm, or any other signs of allergic reaction. Also, it is very hard to establish the cause or time frame. It has a prolonged course, developing over a day or so. Epinephrine is usually not required. 

The classic example of bradykinin-induced angioedema is an angiotensin-converting enzyme (ACE) inhibitor-induced angioedema, which is mostly confined to lips, tongue, and upper airway. The treatment is Fresh-Frozen Plasma (FFP) instead of epinephrine. ACE-I-induced angioedema may occur even after use for many years.

#allergy-immunology

References:

1. Obtułowicz K. Bradykinin-mediated angioedema. Pol Arch Med Wewn. 2016;126(1-2):76-85. doi: 10.20452/pamw.3273. PMID: 26842379.

2. Kostis WJ, Shetty M, Chowdhury YS, Kostis JB. ACE Inhibitor-Induced Angioedema: a Review. Curr Hypertens Rep. 2018 Jun 8;20(7):55. doi: 10.1007/s11906-018-0859-x. PMID: 29884969.