TY - JOUR
T1 - What's New in the Treatment of Urticaria and Angioedema
AU - Khan, David A.
AU - Kocatürk, Emek
AU - Bauer, Andrea
AU - Aygören-Pürsün, Emel
N1 - Funding Information:
Conflict of interest: D. A. Khan declares that he has no relevant conflicts of interest. E. Kocat?rk has received honoraria for scientific advice or consultancy from Novartis, Sanofi, and Menarini. A. Bauer is or recently was a speaker and/or advisor for, and/or has received research funding from Novartis, Leo Pharma, Sanofi/Regeneron, and Shire/Takeda. E. Ayg?ren-P?rs?n reports grants and/or personal fees and/or consulting activities for Adverum, BioCryst, CSL Behring, Kalvista, Pharming, Pharvaris, and Shire/Takeda.
Publisher Copyright:
© 2021 American Academy of Allergy, Asthma & Immunology
PY - 2021/6
Y1 - 2021/6
N2 - Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. Angioedema without wheals may have several different pathophysiologic mechanisms. Optimal management of mast cell–mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. Drug-induced angioedema due to angiotensin-converting enzyme inhibitors is a common cause of angioedema in the emergency department. Although bradykinin is thought to be a primary mediator for this type of angioedema, studies of targeted therapies have been generally disappointing. In contrast, several targeted therapies have been proven successful using acute and preventive approaches for management of hereditary angioedema. Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.
AB - Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. Angioedema without wheals may have several different pathophysiologic mechanisms. Optimal management of mast cell–mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. Drug-induced angioedema due to angiotensin-converting enzyme inhibitors is a common cause of angioedema in the emergency department. Although bradykinin is thought to be a primary mediator for this type of angioedema, studies of targeted therapies have been generally disappointing. In contrast, several targeted therapies have been proven successful using acute and preventive approaches for management of hereditary angioedema. Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.
KW - ACE-I angioedema
KW - Alternative therapies
KW - Angioedema
KW - Chronic urticaria
KW - Hereditary angioedema
KW - Management
KW - Mast cell–mediated angioedema
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U2 - 10.1016/j.jaip.2021.03.012
DO - 10.1016/j.jaip.2021.03.012
M3 - Article
C2 - 34112473
AN - SCOPUS:85106867728
SN - 2213-2198
VL - 9
SP - 2170
EP - 2184
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 6
ER -