Objective
Tooth extractions may trigger clinical symptoms of hereditary angioedema due to C1
inhibitor deficiency (HAE-C1-INH). The aim of this study was to determine how many
tooth extractions were followed by symptoms of HAE-C1-INH in patients with and without
preoperative short-term prophylaxis with C1 inhibitor concentrate.
Study design
Tooth extractions and clinical symptoms of HAE-C1-INH were determined from clinical
record files of 171 patients with HAE-C1-INH.
Results
Facial swelling or potentially life-threatening laryngeal edema, or both, occurred
in 124/577 tooth extractions (21.5%) without prophylaxis. Similar symptoms occurred
in a fewer proportion of patients undergoing extractions (16/128; 12.5%) after short-term
prophylaxis with C1 inhibitor concentrate. The graded dose-response relationship was
significant at P < .05.
Conclusions
Short-term prophylaxis with C1 inhibitor concentrate significantly reduces the risk
of HAE-C1-INH symptoms after tooth extraction. In some patients, however, facial swellings
and laryngeal edema symptoms may occur despite prophylaxis.
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References
- Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema.J Am Dent Assoc. 2003; 134: 1088-1094
- Altered C1 inhibitor genes in type I hereditary angioedema.N Engl J Med. 1987; 317: 1-6
- Hereditary angioedema: a current state-of-the-art review, III: mechanisms of hereditary angioedema.Ann Allergy Asthma Immunol. 2008; 100: S7-S12
- Pasteurized C1 inhibitor concentrate in hereditary angioedema: pharmacology, safety, efficacy and future directions.Expert Review Clin Immunol. 2008; 4: 13-20
- Efficacy of human C1 esterase inhibitor concentrate compared with placebo in acute hereditary angioedema attacks.J Allergy Clin Immunol. 2009; 124: 801-808
- Treatment of acute edema attacks in hereditary angioedema with a bradykinin receptor-2 antagonist (icatibant).J Allergy Clin Immunol. 2007; 119: 1497-1503
- Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema.N Engl J Med. 2010; 363: 532-541
- Ecallantide for the treatment of acute attacks in hereditary angioedema.N Engl J Med. 2010; 363: 523-531
- The efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial and dental procedures.J Oral Maxillofac Surg. 1999; 57: 404-408
- Oral manifestations and dental management of patients with hereditary angioedema.J Oral Pathol Med. 1991; 20: 139-142
- Tranexamic acid: preoperative prophylactic therapy for patients with hereditary angioneurotic edema.J Allergy Clin Immunol. 1977; 60: 38-40
- Emergency management of upper airway angio-oedema after routine dental extraction in a patient with C1 esterase deficiency.Br J Oral Maxillofac Surg. 2008; 46: 394-396
- Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 168-172
- Familial angioneurotic oedema: two fatal cases after dental extractions.BMJ. 1960; 2: 1787
- Type I hereditary angio-oedema.J Intern Med. 1997; 241: 39-46
- Hereditary angioedema: case report and review of management.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83: 462-464
- Acute airway obstruction following tooth extraction in hereditary angioedema.J Oral Maxillofac Surg. 1985; 43: 52-54
- Hereditary angioedema: the use of fresh frozen plasma for prophylaxis in patients undergoing oral surgery.J Allergy Clin Immunol. 1975; 55: 386-393
- Hereditary angioneurotic edema: report of case.J Oral Surg. 1979; 37: 888-890
- Hereditary angioneurotic edema: clinical management and case report.J Am Dent Assoc. 1982; 104: 641-643
- Hereditary angioedema: report of case.Spec Care Dentist. 1989; 9: 23-26
- Preoperative prophylaxis for C1 esterase–inhibitor deficiency in patients undergoing oral surgery: a report of three cases.Quintessence Int. 1997; 28: 169-171
- Use of recombinant plasma kallikrein inhibitor in hereditary angioedema: a case report and review of the management of the disorder.J Oral Maxillofac Surg. 2004; 62: 1553-1556
- Prophylactic use of epsilon aminocaproic acid for oral surgery in a patient with hereditary angioneurotic edema.J Allergy Clin Immunol. 1974; 53: 298-302
- Intravenous tranexamic acid in the management of hereditary angio-oedema.Br J Oral Maxillofac Surg. 1987; 25: 500-506
- Hereditary angioedema controlled with danazol.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1979; 48: 418-420
- Potentially fatal hereditary angioedema: a review and case report.J Can Dent Assoc. 1990; 56: 1096-1099
- Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor.Farm Hosp. 2003; 27 ([in Spanish]): 346-352
- C1-Esterase inhibitor concentrate prevents upper airway obstruction in hereditary angio-oedema.Med J Aust. 1994; 160: 383-384
- Hereditary angioedema: uncomplicated maxillofacial surgery using short-term C1 inhibitor replacement therapy.Int Arch Allergy Immunol. 1993; 101: 107-112
- [The use of a C1-inhibior concentrate for short-term preoperative prophylaxis in two patients with hereditary angioedema].Anaesthesist. 1996; 45 ([in German]): 626-630
- Management of oral surgery in patients with hereditary or acquired angioedemas: review and case report.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 540-543
- Pharmacokinetic analysis of human plasma-derived pasteurized C1-inhibitor concentrate in adults and children with hereditary angioedema: a prospective study.Transfusion. 2009; 50: 354-360
- The pathophysiology of hereditary angioedema.Clin Immunol. 2005; 114: 3-9
Article info
Publication history
Published online: May 23, 2011
Accepted:
February 19,
2011
Received in revised form:
February 16,
2011
Received:
October 5,
2010
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
