[Gender aspects in angioedema]

Abstract

Background: Angioedema can be triggered by mediators bradykinin or histamine. Gender-specific differences and potential biomarkers for follow-up/therapy monitoring are mostly unknown.

Objectives: To what extent are gender-related defects, prodromes, trigger factors, clinical parameters such as number of attacks, frequency, localization, laboratory values, hormones and response to therapy different for the variant types of angioedema.

Materials and methods: A literature search was performed in PubMed with the keywords "angioedema" and "sex" or "gender" as well as targeted screening of reviews, guidelines and registration studies with angioedema-relevant drugs.

Results: In histamine-mediated angioedema, there are few gender-specific differences. In bradykinin-mediated hereditary angioedema, especially with factor XII mutation, but also in angiotensin-converting enzyme inhibitor-induced angioedema, women are more frequent, more affected and hormonal influences are documented. The localization of bradykinin-mediated hereditary angioedema (HAE) is also gender specific. The proportion of women in clinical trials for HAE therapies is about two-thirds.

Conclusion: Principally, differentiating between estrogen-dependent, estrogen-sensitive and estrogen-insensitive angioedema seems reasonable. The characterization of these subgroups may lead to a better understanding of the pathomechanism of the hormone effects on angioedema. This could lead to the development of urgently needed biomarkers for faster and more targeted diagnosis and prediction of attacks, to significantly improve the health and quality of life of angioedema patients by means of individualized gender-specific therapy.

Keywords: Bradykinin; Hereditary angioedema; Histamine; Hormones; Quality of life.