Angioedema hereditário: Experiência com icatibant em crises graves

background:hereditary angioedema (hae) is a clinical syndrome characterized by recurrent and transient episodes of submucosal and/or subcutaneous edema. icatibant, a selective bradykinin b2 receptor antagonist is a new drug available for the treatment of hae attacks. aim: description of our department’s experience with icatibant’s use in severe hae attacks. methods: retrospective study of the patients’ files and telephone interview to the patients admitted between november/2009 and june/2011 to whom icatibant has been administered for acute treatment of severe hae attacks. results: nine patients (5 females; mean age: 30.5 years) were treated with icatibant. seven had hae type ii. five patients were admitted due to faringo -laringeal attacks, one of them with associated abdominal complaints, 2 due to exclusive abdominal attacks, and 2 due to exuberant mucocutaneous facial and/or lingual attacks. laryngoscopy was performed in 7 patients, by ent specialist, revealing upper airway edema in 3, with regression being documented by laringoscopy in a second ent evaluation 6 -24 hours later. every patient reported symptomatic relief in the first 2 hours after subcutaneous administration of 30 mg icatibant. the sole adverse effect mentioned by 88,9% of the patients (8/9), being well tolerated, was a mild pain and/or burn sensation at the injection site. the average time between hospital admission and icatibant’s subcutaneous administration was 2.44 hours, with a median of one hour. three patients had been previously treated with c1 inhibitor concentrate for past hae attacks with similar symptoms. these patients reported subjective perception of a shorter time to the beginning of action of icatibant. conclusions: the authors suggest that icatibant use in acute treatment of severe hae attacks (faringo -laringeal, abdominal and exuberant mucocutaneous facial/lingual attacks) is effective and safe, associated to minor local, well-tolerated adverse reactions.