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Angioedema: « From localized swelling attacks to potentially fatal asphyxia »

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Angioedemas are characterized by an accumulation of fluid in the mucous membranes and skin resulting in swelling of the face, limbs or genitals.They may carry a risk of asphyxiation when the throat is affected.

ANGIOEDEMA OF ALLERGIC ORIGIN

In the vast majority of cases, it is an angioedema of allergic origin, about 20% of the population are affected at some point in their life. Often associated with an urticaria, it can be caused by  food,  insect bite or drug. The treatment of this histamine angioedema is based on corticosteroids and antihistamine drugs. In the most severe cases (quincke’s oedema), adrenaline is essential to avoid anaphylactic shock (spread of allergy throughout the body).

THE HEREDITARY ANGIOEDEMA

Angioedema may have another cause, often unknown : it is the hereditary bradykinic angioedema. This rarer form occurs most often during childhood or adolescence, edema develops gradually and recidivally in a few hours and persists for an average of 2 to 5 days and disappears without sequelae. The frequency and severity of seizures vary according to the patients and for the same patient according to the periods of life. Certain events such as dental procedures,  infections, stress, pregnancy … are the triggering factors of the crisis. The swelling may affect the abdomen, causing severe pain, nausea and vomiting as well as diarrhea. Laryngeal edema is life-threatening with a 25% risk of death in the absence of appropriate treatment.

Even more rarely, bradykinetic angioedema exists in an acquired non-hereditary form, usually occurring in adults over 50 years of age and subsequent to another disease (autoimmune or cancerous) or to certain drugs such as antihypertensive drugs of the family of angiotensin converting enzyme inhibitors or antidiabetic agents..

The treatment of bradykin angioedema attacks is based on the use of drugs that are not yet available in Morocco (subcutaneous injections of icatibant or intravenous C1Inh concentrate). Tranexamic acid or danazol are basic treatments for the disease.

The Moroccan Association of Angioedema Patients (AMMAO), chaired by Mr. Imad Elaouni, was created in February 2018 by civil society people and members of the medical and paramedical profession with the aim providing information and awareness to the population about these pathologies as well as the unification of the efforts and the assistance to lend to the people suffering from them. Professor Laurence Bouillet, Professor of Internal Medicine and coordinator of the national reference center on angioedema in France, is the honorary president. AMMAO is also a member of the global network of angioedema -HAEI.

Dr Moussayer Khadija,  medical doctor in internal medecine, chairwoman of the alliance of rare diseases in Morocco, vice-president of the Moroccan Association of Angioedema Patients (AMMAO)

 اختصاصية في الطب الباطني و أمراض  الشيخوخة  ,  رئيسة الجمعية المغربية لأمراض المناعة الذاتية و والجهازية , رئيسة ائتلاف الأمراض النادرة المغرب

BIBLIOGRAPHY
– Isabelle Boccon-Gibod , Laurence Bouillet, MD , Clement Olivier, Clinical Characteristics of Hereditary Angioedema (HAE) Type III Patients Compared with Those with HAE Type I/II , JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY 26/01/13, Doi : 10.1016/j.jaci.2012.12.791
– Laurence Bouillet, Diagnostic des angioedèmes héréditaires, La Presse Médicale, Volume 44, Issue 1, 2015, Pages 52-56, ISSN 0755-4982, https://doi.org/10.1016/j.lpm.2014.06.027.
– Khadija Moussayer, Les angioedèmes en débat à Casablanca le 19 janvier 2019, Mescursus 29 Décembre 2018. https://medcursus.com/442/les-angioedemes-en-debat-casablanca-le-19-janvier-2019
– Khadija Moussayer, On estime que 2.000 personnes sont touchées par les angioedèmes bradykiniques au Maroc, Le Matin ma, 4 janvier 2024 https://lematin.ma/express/2022/maroc-compte-2000-cas-angioedeme-bradykinique/384170.html

 

 

 

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