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DOI: 10.1055/s-0030-1253694
© Georg Thieme Verlag KG Stuttgart · New York
Notfallsituation akutes Angioödem
Emergency management of acute angioedemaPublikationsverlauf
eingereicht: 4.12.2009
akzeptiert: 29.4.2010
Publikationsdatum:
11. Mai 2010 (online)
![](https://www.thieme-connect.de/media/dmw/201020/lookinside/thumbnails/10.1055-s-0030-1253694-1.jpg)
Zusammenfassung
Das Angioödem ist eine ödematöse Schwellung tieferer Hautschichten. Akute Angioödeme bedeuten vor allem dann einen klinischen Notfall, wenn die obere Atem-Schluckstraße betroffen und die Atmung der Patienten beeinträchtigt ist. Für eine rasche und wirksame Therapie ist es notwendig, allergische von nicht-allergischen Angioödemen zu unterscheiden. Von den fünf Unterformen nicht-allergischer Angioödeme sind drei durch Bradykinin vermittelt: Das durch Blocker des Renin-Angiotensin-Aldosteron-Systems (RAAS) induzierte Angioödem (RAE), das hereditäre Angioödem (HAE) sowie das erworbene Angioödem (AAE). Antihistaminika, Kortikoide und Adrenalin können bei allergischen Angioödemen eingesetzt werden, zeigen bei akuten Attacken nicht-allergischer Angioödeme jedoch keine Wirkung. Hier stellen der Bradykinin-B2-Rezeptor-Antagonist Icatibant (HAE, ggf. RAE) oder C1-INH-Konzentrat (bei HAE, ggf. AAE) Therapieoptionen dar, die akute Angioödeme rasch zum Rückgang bringen. Die folgende Arbeit möchte eine Übersicht zur Diagnostik und Therapie für die Notfallsituation „akutes Angioödem”, insbesondere mit Schwellung im Kopf-Hals-Bereich, geben.
Abstract
Angioedema is an oedematous swelling of the mucosa or submucosa of the skin. Acute angioedema represents a clinical emergency when the pharynx or larynx are involved and breathing of the patient is impaired. For rapid and effective treatment it is necessary to differentiate between allergic and non-allergic angioedema. Three of the five subforms of non-allergic angioedema are mediated by bradykinin: renin-angiotensin-aldosterone system (RAAS)-blocker-induced angioedema (RAE), hereditary angioedema (HAE) and acquired angioedema (AAE). Antihistamines, corticosteroids and adrenalin can be used to treat allergic angioedema but are ineffective in acute attacks of non-allergic angioedema. In these events the bradykinin-B2-receptor antagonist icatibant (in HAE, or RAE) or C1-INH concentrate (in HAE, or AAE) are therapeutic options for rapid alleviation of acute angioedema. The following article gives an overview of the diagnostics and treatment in the emergency situation of „acute angioedema”, especially if swelling of the head-and-neck region is present.
Schlüsselwörter
akutes Angioödem - hereditäres Angioödem - Bradykinin - Icatibant - C1-INH - ACE-Hemmer
Keywords
acute angioedema - hereditary angioedema - bradykinin - icatibant - C1-INH - ACE inhibitor
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Dr. Murat Bas
Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum
rechts der Isar der Technischen Universität München
Ismaninger Straße 22
81675 München
Telefon: 089/4140-2370
Fax: 089/4140-4853
eMail: basmurat@web.de