In patients with acute hereditary angioedema is treatment with C1 esterase inhibitor better than fresh frozen plasma?
Date First Published:
July 12, 2010
Last Updated:
July 13, 2010
Report by:
Katherine Palmer, Medical Student (Manchester Royal Infirmary)
Search checked by:
Katherine Palmer, Manchester Royal Infirmary
Three-Part Question:
In [patients with acute hereditary angioedema] is [C1 esterase inhibitor] better than [fresh frozen plasma] at [reducing mortality]?
Clinical Scenario:
A 50 year old female teacher with known hereditary angioedema presents to the Emergency Department 2 hours after a routine dental extraction with a rash and periorbital oedema.
Search Strategy:
MEDLINE 1950 to 2010 June Week 5 and Embase 1980 to 2010 Week 27 using the OVID interface on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010
Search Details:
MEDLINE and Embase - (exp Hereditary Angioedema Type III/ OR exp Angioedema/ OR exp "Hereditary Angioedema Types I and II"/ OR hereditary angioedema.mp. OR angioedema.mp.) AND (exp Plasma/ OR fresh frozen plasma.mp. OR ffp.mp.) AND (exp Complement C1 Inactivator Proteins/ OR exp Complement C1 Inhibitor Protein/ OR exp Complement C1/ OR c1 esterase inhibitor.mp. OR c1 inhibitor.mp.)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Fresh Frozen Plasma) and (C1 inhibitor)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Fresh Frozen Plasma) and (C1 inhibitor)
Outcome:
MEDLINE - 69 papers, 0 relevant
Embase - 129 papers, 0 relevant
CINAHL - 5 papers, 0 relevant
Embase - 129 papers, 0 relevant
CINAHL - 5 papers, 0 relevant
Author Commentary:
In the UK C1 inhibitor is licensed for use in acute hereditary angioedema attacks and despite a lack of clinical trials it is recommended for use over fresh frozen plasma. Fresh frozen plasma carries a small risk of blood bourn disease transmission but C1 inhibitor can cause anaphylaxis in some people.
Bottom Line:
Despite little evidence C1 inhibitor seems to be the treatment of choice for acute hereditary angioedema attacks rather than fresh frozen plasma but more trials need to be carried out.