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Review
. 2022 Nov 30;14(11):e32075.
doi: 10.7759/cureus.32075. eCollection 2022 Nov.

A Comprehensive Review of Bradykinin-Induced Angioedema Versus Histamine-Induced Angioedema in the Emergency Department

Maleesha Jayasinghe  1 , Dilushini Caldera  2 , Omesh Prathiraja  3 , Rahul Jena  4 , James Anwar Coffie-Pierre  2 , James Agyei  5 , Minollie Suzanne Silva  3 , Abdul Mueez Alam Kayani  6 , Ozair S Siddiqui  7
Affiliations
Review

A Comprehensive Review of Bradykinin-Induced Angioedema Versus Histamine-Induced Angioedema in the Emergency Department

Maleesha Jayasinghe et al. Cureus. .

Abstract

Angioedema (AE) is a condition that is frequently encountered in the emergency department (ED). It is a rare condition with localized, asymmetrical swelling of the skin and/or mucosa that is frequently nonpruritic and primarily affects locations with loose connective tissue. Physicians must have a thorough understanding of this condition since it can cause fatal airway compromise, which might be the presenting symptom. Histamine-mediated AE is the most common type of AE seen in EDs. However, ED physicians must be on the lookout for the less common bradykinin-mediated types of AE as these do not respond to the same therapy as histamine-mediated AE. Hospitals may lack specialized drugs or protocols, and many ED staff may be unable to identify or treat bradykinin-mediated AE. It is crucial to understand the pathophysiology of the various kinds of AE in order to optimize treatment. The goal of this review paper is to provide an overview of the pathophysiology, clinical manifestations, and treatment options for bradykinin and histamine-induced AE in the ED.

Keywords: ace inhibitors; angioedema; bradykinin; bradykinin-induced angioedema; bradykinin-mediated angioedema; emergency; emergency department; histamine; histamine-induced angioedema.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The pathophysiology of bradykinin-mediated angioedema
ACE: Angiotensin-converting enzyme. Image credit: Dr. Dilushini Caldera, one of the authors of the current study.
Figure 2
Figure 2. Classification of histamine-mediated angioedema
Image credit: Dr. Rahul Jena, one of the authors of the current study.
Figure 3
Figure 3. Mechanism of histamine-mediated angioedema
Image credit: Dr. Maleesha Jayasinghe, one of the authors of the current study.
Figure 4
Figure 4. Management of bradykinin and histamine-mediated angioedema
C1-INH: C1 esterase inhibitor; pdC1-INH: Plasma-derived C1-inhibitor; FFP: Fresh frozen plasma. Image credit: Dr. Maleesha Jayasinghe, one of the authors of the current study.
See this image and copyright information in PMC

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