Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
5-Year Experience at a Single Center: Retrospective Analysis of 38 Patients with Hereditary Angioedema: A Descriptive Study
Tek Merkez 5 Yıllık Deneyimimiz: 38 Herediter Anjiyoödem Hastasının Retrospektif Analizi: Tanımlayıcı Bir Araştırma
Gökhan AYTEKİNa, Eray YILDIZb, Fatih ÇÖLKESENb, Nazire Belgin AKILLIc, Şevket ARSLANb, Ahmet Zafer ÇALIŞKANERb
aClinic of Allergy and Clinical Immunology, University of Health Sciences Konya State Hospital, Konya, TURKEY
bDivision of Allergy and Clinical Immunology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, TURKEY
cClinic of Emergency Department, University of Health Sciences Konya State Hospital, Konya, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(3):258-65
doi: 10.5336/medsci.2021-81334
Article Language: EN
Full Text
ABSTRACT
 Objective: Hereditary angioedema (HAE) is a rare autosomal dominant disorder characterized by recurrent angioedema attacks, without itching or urticaria. With this study, we aimed to increase the awareness of HAE by presenting the characteristics of these patients who applied to the emergency department and allergy immunology clinic. Material and Methods: A total of 38 patients, 25 (65.8%) female and 13 (34.2%) male, were included. Results: The mean age was 40.90±12.66, mean age at the onset of symptoms was 13.5 (1-56), mean age at HAE diagnosis was 24.61±13.78, and the diagnostic delay was 8.84±8.97 years. Of all cases, 18 (47.4%) were followed-up with Type I HEA and 20 (52.6%) were followed up with Type II HAE. A family history of HAE was present in 89.5% and a family history of death due to HAE was present in 31.6% of the patients. Mean age at diagnosis differed significantly between those with or without a family history of death due to HAE (18.0±7.24 vs. 27.65±15.08 years; p=0.043). The episodes were triggered by stress in 20 (52.6%) patients. The symptoms at first presentation included swelling in extremities in 18 (47.4%) patients. Conclusion: Although HAE is a rare disorder associated with variable clinical presentations complicating the diagnostic process, it may also be associated with mortality. Periodic reporting of clinical experience from centers dealing with HAE patients bears significance not only for increasing awareness among medical professionals and preventing diagnostic delays but also for improving the life quality of patients as well as for decreasing the morbidity and mortality.

Keywords: Hereditary angioedema; C1 esterase inhibitor; laryngeal diseases
ÖZET
 Amaç: Herediter anjiyoödem (HAÖ), ürtiker ve kaşıntının eşlik etmediği, tekrarlayan anjiyoödem atakları ile karakterize, otozomal dominant geçişli nadir bir bozukluktur. Biz, bu çalışma ile HAÖ farkındalığını artırmak için acil servise ve alerji immünoloji kliniğine başvuran HAÖ hastalarının genel özelliklerini sunmayı amaçladık. Gereç ve Yöntemler: Toplam 38 [kadın: 25 (%65,8), erkek: 13 (%34,2)] hastanın verileri incelendi. Bulgular: Hastaların yaş ortalaması 40,90±12,66 yıl, ilk şikâyetlerin başlama yaşı 13,5 (1-56), HAÖ tanı yaşları 24,61±13,78 yaş ve tanıda gecikme 8,84±8,97 yıl idi. On sekiz (%47,4) hasta Tip I HAÖ, 20 (%52,6) hasta Tip II HAÖ olarak takip edilmekteydi. Hastaların %89,5'inin akrabalarında HAÖ tanısı, %31,6'sında ise HAÖ ilişkili akraba ölümü hikâyesi mevcuttu. Ailesinde HAÖ sebebiyle mortalite öyküsü olanlarda tanı yaşı 18,0±7,24; mortalite öyküsü olmayanlarda ise 27,65±15,08 olmak üzere anlamlı fark vardı (p=0,043). Yirmi (%52,6) hastada stres atakları tetiklerken; 18 (%47,4) hastada hastaların başlangıç şikâyeti ekstremitelerde şişlik şeklindeydi. Sonuç: HAÖ, farklı klinik prezantasyonları sebebiyle tanınması zor, nadir ama ölümcül olabilen bir hastalıktır. Hem hekimlerin bu konuda farkındalığının artırılması hem hastalara gecikmeden tanı konulması ve hastaların tedavilerinin gecikmeden başlanması açısından, HAÖ ile ilgilenen merkezlerin belli aralıklar klinik tecrübelerini paylaşması, hastaların yaşam kalitesinin artırılması ve hastalığa bağlı mortalite ve morbiditenin azaltılması açısından oldukça önemlidir.

Anahtar Kelimeler: Herediter anjiyoödem; C1 esteraz inhibitörü; larinks hastalıkları
REFERENCES:
  1. Longhurst HJ, Bork K. Hereditary angioedema: causes, manifestations and treatment. Br J Hosp Med (Lond). 2006;67(12): 654-7. [Crossref]  [PubMed] 
  2. Roche O, Blanch A, Caballero T, Sastre N, Callejo D, López-Trascasa M. Hereditary angioedema due to C1 inhibitor deficiency: patient registry and approach to the prevalence in Spain. Ann Allergy Asthma Immunol. 2005;94(4):498-503. [Crossref]  [PubMed] 
  3. Bowen T, Cicardi M, Farkas H, Bork K, Longhurst HJ, Zuraw B, et al. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol. 2010;6(1):24. [Crossref]  [PubMed]  [PMC] 
  4. 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):1575-96. [Crossref]  [PubMed] 
  5. Andersen MF, Longhurst HJ, Rasmussen ER, Bygum A. How not to be misled by disorders mimicking angioedema: a review of pseu doangioedema. Int Arch Allergy Immunol. 2016;169(3):163-70. [Crossref]  [PubMed] 
  6. Frank MM, Gelfand JA, Atkinson JP. Hereditary angioedema: the clinical syndrome and its management. Ann Intern Med. 1976;84(5): 580-93. [Crossref]  [PubMed] 
  7. Longhurst HJ, Bork K. Hereditary angioedema: an update on causes, manifestations and treatment. Br J Hosp Med (Lond). 2019; 80(7):391-8. [Crossref]  [PubMed] 
  8. Zanichelli A, Magerl M, Longhurst HJ, Aberer W, Caballero T, Bouillet L, et al; IOS Study Group. Improvement in diagnostic delays over time in patients with hereditary angioedema: findings from the Icatibant Outcome Survey. Clin Transl Allergy. 2018;8:42. [Crossref]  [PubMed]  [PMC] 
  9. Gómez-Traseira C, Pérez-Fernández E, López-Serrano MC, García-Ara MC, Pedrosa M, López-Trascasa M, et al. Clinical pattern and acute and long-term management of hereditary angioedema due to C1-esterase inhibitor deficiency. J Investig Allergol Clin Immunol. 2015;25(5):358-64. [PubMed] 
  10. 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):692-7. [Crossref]  [PubMed] 
  11. Bork K, Meng G, Staubach P, Hardt J. Hereditary angioedema: new findings concerning symptoms, affected organs, and course. Am J Med. 2006;119(3):267-74. [Crossref]  [PubMed] 
  12. Caballero T, Baeza ML, Caba-as R, Campos A, Cimbollek S, Gómez-Traseira C, et al; Spanish Study Group on Bradykinin-Induced Angioedema; Grupo Espa-ol de Estudio del Angioedema mediado por Bradicinina. Consensus statement on the diagnosis, management, and treatment of angioedema mediated by bradykinin. Part I. Classification, epidemiology, pathophysiology, genetics, clinical symptoms, and diagnosis. J Investig Allergol Clin Immunol. 2011;21(5):333-47; quiz follow 347. Erratum in: J Investig Allergol Clin Immunol. 2012;22(2):3 p following 153. [PubMed] 
  13. Kesim B, Uyguner ZO, Gelincik A,Mete Gökmen N, Sin AZ, Karakaya G, et al. The Turkish Hereditary Angioedema Pilot Study (TURHAPS): the first Turkish series of hereditary angioedema. Int Arch Allergy Immunol. 2011 156(4):443-50. Erratum in: Int ArchAllergy Immunol. 2011;156(4):450. [Crossref]  [PubMed] 
  14. Agostoni A, Aygören-Pürsün E, Binkley KE, Blanch A, Bork K, Bouillet L, et al. Hereditary and acquired angioedema: problems and progress: proceedings of the third C1 esterase inhibitor deficiency workshop and beyond. J Allergy Clin Immunol. 2004;114(3 Suppl):S51-131. [Crossref]  [PubMed]  [PMC] 
  15. Ricketti AJ, Cleri DJ, Ramos-Bonner LS, Vernaleo JR. Hereditary angioedema presenting in late middle age after angiotensin-converting enzyme inhibitor treatment. Ann Allergy Asthma Immunol. 2007;98(4):397-401. [Crossref]  [PubMed] 
  16. Zotter Z, Veszeli N, Kőhalmi KV, Varga L, Imreh É, Kovács G, et al. Bacteriuria increases the risk of edematous attacks in hereditary angioedema with C1-inhibitor deficiency. Allergy. 2016;71(12):1791-3. [Crossref]  [PubMed] 
  17. Bork K, Hardt J, Staubach-Renz P, Witzke G. Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(1):58-64. [Crossref]  [PubMed] 
  18. Bouillet L, Longhurst H, Boccon-Gibod I, Bork K, Bucher C, Bygum A, et al. Disease expression in women with hereditary angioedema. Am J Obstet Gynecol. 2008;199(5):484.e1-4. [Crossref]  [PubMed] 
  19. Chinniah N, Katelaris CH. Hereditary angioedema and pregnancy. Aust N Z J Obstet Gynaecol. 2009;49(1):2-5. [Crossref]  [PubMed] 
  20. Caballero T, Farkas H, Bouillet L, Bowen T, Gompel A, Fagerberg C, et al; C-1-INH Deficiency Working Group. International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency. J Allergy Clin Immunol. 2012;129(2):308-20. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com