Subject(s)
Angioedemas, Hereditary , COVID-19 , Complement C1 Inhibitor Protein , Humans , SARS-CoV-2 , Treatment OutcomeABSTRACT
Hereditary angioedema (HAE) with C1 inhibitor deficiency is a genetic disorder that clinically manifests with attacks of angioedema in the subcutaneous and submucosal tissues, mainly in the extremities, abdomen, and upper airway. During attacks, vascular permeability is increased due to increased bradykinin (BK). This means that special therapies are needed for attacks that do not respond to traditional antiallergic therapies involving antihistamines, corticosteroids, and epinephrine. The recurring attacks may disable patients and lead to frequent visits to emergency rooms where misdiagnoses are common. HAE attacks may be fatal when upper-airway edema occurs, if proper treatment with a C1 inhibitor concentrate or BK receptor antagonist is not administered or an emergency tracheostomy is not performed. We propose a mnemonic method for the warning signs of HAE for the use as a diagnostic tool, i.e., the so-called "ABC" of the warning signs of HAE. The letters represent the following: A = Angioedema, B = Bradykinin, C = C1 inhibitor, D = Distress factors, E = Epinephrine nonresponsive, F = Family history, and G = Glottis/Gastrointestinal edema. To avoid fatalities, medical staff and patients, including family members, must be aware of HAE. An alphabetical mnemonic method has been developed and we hope it may benefit patients.
Subject(s)
Angioedemas, Hereditary/diagnosis , Angioedemas, Hereditary/drug therapy , Bradykinin Receptor Antagonists/therapeutic use , Bradykinin/analogs & derivatives , Complement C1 Inactivator Proteins/deficiency , Angioedemas, Hereditary/pathology , Bradykinin/metabolism , Bradykinin/therapeutic use , Capillary Permeability/genetics , Capillary Permeability/physiology , Complement C1 Inactivator Proteins/genetics , Complement C1 Inhibitor Protein , Genetic Predisposition to Disease/genetics , Humans , Receptors, Bradykinin/metabolismABSTRACT
Immunoglobulins are heterodimeric proteins composed of 2 heavy chains and 2 light chains. Human immunoglobulin G (IgG) is a plasma derivative and contains more than 95% of IgG. The composition of IgG subclasses is similar to that of normal human plasma. Immunoglobulin therapy was first introduced more than 50 years ago, and its use has been described in numerous diseases. In Colombia, the importance of this immunomodulatory resource prompted the need for clinical practice guidelines to be available for its use. For this reason, a multidisciplinary group of experts was brought together and distributed in working groups, by specialties, in order to develop an initial manuscript. Systematic literature searches were undertaken; identified evidences were evaluated and classified to support a preliminary draft that was discussed, analyzed and amended. Recommendations were issued on the use of intravenous immunoglobulin in pathologies that include primary and secondary immunodeficiencies, autoimmune diseas es, neurological disorders, infections, transplants and miscellaneous conditions; grades were assigned to each one of them according to the GRADE system. The final result translated into recommendations that are put forth with the purpose to inform, guide and support on optimal use of this immunomodulatory resource.
Las inmunoglobulinas son proteínas heterodiméricas compuestas de 2 cadenas pesadas y 2 cadenas ligeras. La inmunoglobulina G humana es un derivado del plasma y contiene más de 95 % de IgG. La composición de las subclases de IgG es similar a la del plasma humano normal. El tratamiento con inmunoglobulina comenzó hace más de 50 años y su uso se ha descrito en numerosas enfermedades. En Colombia, la importancia de este recurso inmunomodulador condujo a la necesidad de contar con una guía de práctica clínica para su uso, para lo cual se reunió un grupo multidisciplinario de expertos, quienes se distribuyeron en mesas de trabajo, por especialidad, para redactar un texto base. Se llevaron a cabo búsquedas bibliográficas sistemáticas; las evidencias identificadas se valoraron y clasificaron para sustentar un texto preliminar que fue discutido, analizado y corregido. Se emitieron recomendaciones de uso de la inmunoglobulina intravenosa en patologías que abarcan inmunodeficiencias primarias y secundarias, enfermedades autoinmunes, alteraciones neurológicas, infecciones, trasplantes y enfermedades misceláneas; se asignaron calificaciones según el sistema GRADE para cada una. El resultado final se tradujo en las recomendaciones que se presentan con la finalidad de informar, orientar y apoyar en el uso óptimo de dicho recurso inmunomodulador.
Subject(s)
Immunoglobulins/therapeutic use , Immunologic Deficiency Syndromes/drug therapy , Immunomodulation , Infections/drug therapy , Nervous System Diseases/drug therapy , Colombia , Humans , Practice Guidelines as TopicABSTRACT
El síndrome de Wiskott-Aldrich es una compleja enfermedad de origen genético que compromete la función del sistema inmune y la coagulación; la mortalidad es elevada en la primera década de la vida a menos que se dé una corrección definitiva al defecto de base. Debido a que las alteraciones se presentan exclusivamente en células derivadas de la médula ósea, el tratamiento ideal es el trasplante de este órgano. Sin embargo, no siempre se puede conseguir un donante apto para este procedimiento, y deben surgir otras opciones de manejo que incrementen la sobrevida y prevengan el desarrollo de las secuelas más frecuentes. El tratamiento combinado con esplenectomía, antibióticos profilácticos y gamaglobulina humana venosa permite lograr estos objetivos, además de disminuir los costos de atención y mejorar notablemente la calidad de vida del paciente y su familia.
