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Issue |
Original Article |
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Management of Dental-Oral Procedures
in Patients With Hereditary Angioedema due to C1
Inhibitor Deficiency |
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J Jurado-Palomo,1 JM
Muñoz-Caro,2 MC López-Serrano,1 N
Prior,1 R Cabañas,1 M Pedrosa,1
M Burgueño,2 T Caballero1,3 |
1Department of Allergology,
Hospital La Paz Health Research Institute (IdiPAZ),
Madrid, Spain
2Department of Oral and Maxillofacial
Surgery, Hospital La Paz Health Research Institute (IdiPAZ),
Madrid, Spain
3Biomedical Research Network on Rare Diseases
U754 (CIBERER) |
J Investig Allergol Clin Immunol
2013; Vol. 23(1): 1-6 |
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Abstract |
Background:
Hereditary
angioedema due to C1
inhibitor deficiency
(HAE-C1-INH) has
considerable
implications for
dental health care
providers, since
dental procedures
may trigger severe
and even
life-threatening
episodes. The aim of
the present study
was to analyze the
efficacy and safety
of premedication
with attenuated
androgens (AAs),
plasma-derived human
C1 esterase
inhibitor
concentrate
(pdhC1INH), or both
to prevent the
development of upper
airway angioedema
after dental-oral
procedures in
patients with
HAE-C1-INH.
Material and
Methods: All
dental-oral
procedures performed
on patients with
HAE-C1-INH who were
followed up at La
Paz University
Hospital, Madrid,
Spain were reviewed.
Demographic data,
maintenance
treatment,
preprocedure
prophylaxis, disease
severity, and
occurrence of upper
airway angioedema
were recorded.
Results:
Twenty-four patients
(14 male/10 female;
mean age, 42.6
years) underwent 66
procedures. Most
procedures were
performed on
patients with severe
HAE-C1-INH (20
procedures) or
moderate HAE-C1-INH
(26 procedures).
Only 9 procedures
were performed
without short-term
prophylaxis. Mild
upper airway
angioedema developed
after 3 procedures
performed without
short-term
prophylaxis in
patients with
minimal or
asymptomatic
HAE-C1-INH. A
statistically
significant
association was
found between
development of mild
postprocedure upper
airway angioedema
and lack of
maintenance
treatment with AA,
lack of increased
dose of preprocedure
AA, and failure to
administer
preprocedure
pdhC1INH (P=.002,
Fisher exact test).
Conclusions:
Increased doses of
prophylactic AA,
administration of
pdhC1INH, or both
were good options
for ambulatory
management of
dental-oral
procedures in
patients with
HAE-C1-INH.
Prophylaxis with
pdC1INH or increased
doses of AA is
advisable before
dental-oral
procedures, even in
patients with low
disease severity.
Key words:
Hereditary
angioedema. C1
esterase inhibitor.
Acute
pharyngeal-laryngeal
attack. Dental-oral
procedures. Dental
surgery.
Plasma-derived human
C1 inhibitor
concentrate.
Bradykinin.
Attenuated androgen. |
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