Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug;61(1):84-97.
doi: 10.1007/s12016-021-08854-5. Epub 2021 May 18.

Mitigating Disparity in Health-care Resources Between Countries for Management of Hereditary Angioedema

Ankur Kumar Jindal  1 , Avner Reshef  2 , Hilary Longhurst  3   4   5 ; GEHM workgroup (Global Equity in HAE Management)
Collaborators, Affiliations
Review

Mitigating Disparity in Health-care Resources Between Countries for Management of Hereditary Angioedema

Ankur Kumar Jindal et al. Clin Rev Allergy Immunol. 2021 Aug.

Erratum in

Abstract

Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent episodes of skin and mucosal edema. The main treatment goal is to enable a "normal life" for all patients. However, due to high costs, there are limited options for the management of HAE in most developing and low-income countries. As a result, most of the recommended first-line treatments are not available. In this review, we attempt to highlight the disparities in health-care resources for the management of patients with HAE amongst different countries. Data was collected from HAE experts in countries who provide tabulated information regarding management and availability of HAE treatments in their countries. We reviewed the two most recent international HAE guidelines. Using India, the world's second most populous country, as a paradigm for HAE management in lower-income countries, we reviewed the evidence for second-line and non-recommended practices reported by HAE experts. Results suggest significant inequities in provision of HAE services and treatments. HAE patients in low-income countries do not have access to life-saving acute drugs or recently developed highly effective prophylactic medications. Most low-income countries do not have specialized HAE services or diagnostic facilities, resulting in consequent long delays in diagnosis. Suggestions for optimizing the use of limited resources as a basis for future discussion and reaching a global consensus are provided. There is an urgent need to improve HAE services, diagnostics and treatments currently available to lower-income countries. We recommend that all HAE stakeholders support the need for global equity and access to these essential measures.

Keywords: Angioedema; Clinical guidelines; Disparity; Inequity; Medications; Treatment.

PubMed Disclaimer

Conflict of interest statement

AR-received research grants and served as a consultant or speaker for the following: BioCryst, CSL-Behring, Pharming, Shire-Takeda, Teva, Allergopharm

Figures

Fig. 1
Fig. 1
a: GDP per capita (2018). b Compliance with acute treatment guideline. c Compliance with international treatment guideline. d Acute and overall international treatment guideline compliance
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Agostoni A, Cicardi M. Hereditary and acquired C1-inhibitor deficiency: biological and clinical characteristics in 235 patients. Medicine (Baltimore) 1992;71(4):206–215. doi: 10.1097/00005792-199207000-00003. - DOI - PubMed
    1. Bork K, Hardt J, Witzke G. Fatal laryngeal attacks and mortality in hereditary angioedema due to C1-INH deficiency. J Allergy Clin Immunol. 2012;130(3):692–697. doi: 10.1016/j.jaci.2012.05.055. - DOI - PubMed
    1. Kim SJ, Brooks JC, Sheikh J, Kaplan MS, Goldberg BJ. Angioedema deaths in the United States, 1979–2010. Ann Allergy Asthma Immunol. 2014;113(6):630–634. doi: 10.1016/j.anai.2014.09.003. - DOI - PubMed
    1. Maurer M, Magerl M, Ansotegui I, Aygören-Pürsün E, Betschel S, Bork K, et al. The international WAO/EAACI guideline for the management of hereditary angioedema-the 2017 revision and update. Allergy. 2018;73(8):1575–1596. doi: 10.1111/all.13384. - DOI - PubMed
    1. Betschel S, Badiou J, Binkley K, Borici-Mazi R, Hébert J, Kanani A, et al. The International/Canadian Hereditary Angioedema Guideline. Allergy Asthma Clin Immunol. 2019;15:72. doi: 10.1186/s13223-019-0376-8. - DOI - PMC - PubMed

LinkOut - more resources